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- Are you enrolled in NEXUS? If so, please contact the NEXUS Director for a different application.
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Format: (000) 000-0000.
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- What is your biological sex?*
- Have you ever been diagnosed with cancer?*
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- Do you have a primary care provider?*
- What is your current military status?*
- Which branch of service were you most recently affiliated with?*
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- 16. Which of the following military occupations were you a part of?*
- Which of the following locations have you deployed to?*
- History of cigarette use?*
- If you have used cigarettes, if you add up all of the years when you regularly smoked cigarettes, have you smoked for 20 years of more of your life?*
- At any time in your life, did you regularly smoke one or more packs of cigarettes per day?*
- Are you up to date on your recommended mammogram?*
- Are you up to date on your recommended cervical cancer screening?*
- Are you up to date on your recommended colorectal cancer screening?*
- Are you up to date on your recommended lung cancer screening?*
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- Date*
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- Should be Empty: