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Ance: b a I Male a Day Zip Year I I I I IIII 3 10 MI Street Address: City 7 Where do you live: a I Private home b I Private apartment c I Rented room d I Board and care / assisted living / group home e I Homeless (with or without shelter) f I Long-term care facility (nursing home) g I Hospice h I Other: Last b Does your home have: a I Stairs, no railing b I Stairs, railing c I Ramps d I Elevato.

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