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1. Have you ever had or now have:2? Have you ever had or now have:YesNoPlease Check each item no blanksOftenSeldom1? Chronic or frequent colds1. Shortness of breath with normal activity2. Sinusitis2.

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Individuals or organizations that meet specific criteria set by regulatory authorities are required to file the intake form-ait.

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The purpose of the intake form-ait is to ensure that all necessary information is provided for proper assessment and compliance with regulations.

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