EviCore

Illicit or recreational drug use (including cigarettes and alcohol) ☐ Recreational drug or alcohol use during current pregnancy ☐ 10 or more cigarettes a day ☐ Other nicotine exposure (e-cigs, vaping, chewing, patch) ☐ Maternal history of IV drug abuse ☐ Current use of Suboxone, Subutex or Methadone ................
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