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Get Standard Insurance Company Medical History Statement 12970 Form

High blood pressure, heart murmur, valve, circulatory, or vascular disorders? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No E. Emphysema, asthma, bronchitis, sleep apnea, or other respiratory or lung disease? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No F. Lupus, scleroderma, vasculitis, connective tissue disease, or other immune system disorder not related to Human Immunode ciency Virus.

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