Answer the questions as completely and accurately as possible. If the information requested is not available from the patient's medical chart or records, please type "N/A" or indicate/select "Unknown". The "Additional Comments" section can be used to enter information concerning the patient's previous health status or to address any information not asked in the questionnaire that may be relevant to the patient or investigation. The more information and details provided, the more accurately cases can be classified and reported to the CDC.

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