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US2021A_HINS1
Insurance through a current or former employer or union
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Questionnaire Text

Questionnaire form view entire document:  text  image
16. Is this person CURRENTLY covered by any of the following types of health insurance or health coverage plans? Mark "Yes" or "No" for EACH type of coverage in items a - h.

a) Insurance through a current or former employer or union (of this person or another family member)
[ ] Yes
[ ] No