Update Clinical Details

  • Contact Details

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  • End of Column 1

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  • End of Column 2

  • Height and Weight

  • Height and Weight

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  • Height
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  • Weight
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  • Smoking

  • Smoking

  • Smoking

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  • Alcohol

  • 1 drink = 1/2 pint of beer or 1 glass of wine or 1 single spirits. 1 unit of alcohol = 10cc of alcohol. So, a small glass (125cc) of 12% wine is 12.5 * 0.12 = 1.5 units.
  • Other information

  • If yes, please provide the following information: