S. No. | QUESTION. | ANSWER. |
1. | Do you take any alcoholic beverage? | [1] Yes [2] No |
2. | If yes, please specify: |
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3. | Do you take alcohol: | [1] Yes [2] No |
4. | If yes, which type of alcohol/s do you take? |
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5. | If yes, how many standard drinks do you take in one drinking session? |
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6. | If yes, For how long have you take alcohol? |
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7. | Do you smoke cigarettes? | [1] Yes [2] No |
8. | If yes, how many cigarettes do you take in one day? |
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9. | If yes, how long have you taken cigarette? |
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10. | Do you take any other type of drug? | [1] Yes [2] No |
11. | If yes, please specify: |
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