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  • 32. In the case of a pregnancy with multiples, if one fetus had a chromosomal abnormality/genetic condition/medical diagnosis that would affect quality of life, would you agree to selectively reduce if advised by a doctor and/or at intended parents' request?

  • 33. BMI
  • 34. Have you ever tested positive for HIV?

  • 35. Have you previously had chicken pox or received the varicella (chicken pox) vaccine?

  • 36. Have you been vaccinated for MMR (measles, mumps, rubella)?

  • 37. Have you ever been immunized for Hepatitis B?

  • 38. Do you currently smoke cigarettes or use tobacco products? (Please note: medical screening of surrogates includes a nicotine test.)

  • 39. Were you ever a tobacco smoker? If yes, when and for how long?

  • 40. Do you have any history of smoking cigarettes or using tobacco products during any of your prior pregnancies? (NOTE: This will be verified on your medical records.)

  • 41. Do you currently use recreational drugs or drink alcohol excessively?