Home Care, Hospice and Palliative Care Alliance of New ...
( ) Chest pain ( ) Pain over heart ( ) Difficulty breathing ( ) Persistent cough ( ) Coughing phlegm ( ) Coughing blood ( ) Rapid heartbeat ( ) Heart problems ( ) Lung problems ( ) Varicose veins ( ) High blood pressure. I understand and agree that health and accident insurance policies are an arrangement between an insurance carrier and myself. ................
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