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Have you used Tabasco or nicotine products within the past 12 months?
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Do you require assistance performing activities of daily living such as dressing, bathing, cooking, cleaning, or shopping due to health conditions or injury?
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Are you currently hospitalized, under hospice care, or do you reside in an assisted living or nursing facility?
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Other than routine care, in the past 3 months, have you or found out you will need surgery by a medical professional?
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Do you require the use of oxygen?
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4'11"
5'0"
5'1"
5'2"
5'3"
5'4"
5'5"
5'6"
5'7"
5'8"
5'9"
5'10"
5'11"
6'0"
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6'2"
6'3"
6'4"
6'5"
6'6"
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