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If there is an owner other than the annuitant be sure to give Beneficiary information for the owner as well as the Annuitant. What was the reason for your last visit 4. What was the diagnosis or treatment resulting from that last visit 5. Please list all current medications and medical assistive devices or equipment e.g. CPAP oxygen 6. In the past 12 months has the proposed insured used tobacco/nicotine in any form such as cigarettes pipes cigars snuff or chewing tobacco OR smoking cessation...
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