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Get MI DCH-1315 2017

1 glass of wine, or 1 shot. 7. In the last 30 days have you smoked or used tobacco? Yes No If YES, Do you want to quit smoking or using tobacco? Yes 8. I am working on quitting or cutting back right now No How often is stress a problem for you in handling everyday things such as your health, money, work, or relationships with family and friends? Almost every day DCH-1315 (12/17) Sometimes Rarely Page 2 of 5 Never Health Risk Assessment First Name, Middle Name, Last Name, and Suf.

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