Case File
efta-efta00314176DOJ Data Set 9OtherPRIORITY PRIVATE CARE
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta00314176
Pages
1
Persons
0
Integrity
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PRIORITY PRIVATE CARE
SOCIAL HISTORY
Tobacco Use (cigarettes)
Other Tobacco Used
K Pipe
K Cigar
Do you drink alcohol?
K Snuff
K Chew
Number of drinks per week:
Is your alcohol use a concern for you or others?
K Yes
K No
Caffeine intake (cup
ner day incliidinn raft'," tea and soda
(please state if none)
170 East 77th Street, New York, NY 1007
EFTA00314176
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