|
In the last 3 days have you taken any type of medication or drugs (pills, needles) except birth control pills or vitamins?
|
3
|
|
Taken Accutane in the past 12 months or Proscar, Danazol, or methotrexate ever?
|
1
|
|
Surgery in last 12 months
|
1
|
|
Ever had epilepsy, coma, stroke, repeated seizures, fainting
|
2
|
|
Ever had heart or blood pressure problems or heart surgery
|
12
|
|
Ever had kidney, lung, or blood condition
|
7
|
|
Been pregnant in the last 6 months or breast-fed in the last 3 months
|
1
|
|
Ever had yellow jaundice (other than at birth), hepatitis or liver disease
|
2
|
|
Received blood plasma, clotting factors or immune globulin in past 12 months
|
1
|
|
Had an AIDS test elsewhere (other than for donating blood)
|
1
|
