km 654e-20180516091635 form.pdfduring the past 30 days, did you use chewing tobacco, snuff, or dip?...

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Page 1: KM 654e-20180516091635 form.pdfDuring the past 30 days, did you use chewing tobacco, snuff, or dip? During the past 30 days, have you had at least 1 drink of alcohol? Have you ever

Page 2: KM 654e-20180516091635 form.pdfDuring the past 30 days, did you use chewing tobacco, snuff, or dip? During the past 30 days, have you had at least 1 drink of alcohol? Have you ever

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