Assessment
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HRS
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Please identify your age Range?
75+
65-74
Less than 65
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What is your gender?
Male
Female
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Do you have high blood pressure (hypertension)?
Yes
No
Unsure
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Are you considered moderately or significantly overweight?
Yes
No
Unsure
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Do you consume two or more alcoholic drinks per day?
Yes
No
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Do you have sleep apnea or have you been told that you might have sleep apnea?
Yes
No
Unsure
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Have you been diagnosed with diabetes?
Yes
No
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Has any family member (sibling or parent) been diagnosed with Atrial Fibrillation?
Yes
No
Unsure
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Have you ever had a stroke?
Yes
No
Unsure
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Do you ever feel your heart beating irregularly or “flip flopping”?
Yes
No
Unsure
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Have you been diagnosed with have an overactive thyroid?
Yes
No
Unsure
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