If your client has a history of Rheumatoid Arthritis, please answer the following :
1. Date of first diagnosis ?
2. Is your client on any medication ? Yes No If yes, give details:
3. Has your client had any of the following ?
Low Blood Counts
Liver Enzyme Abnormality
4. What is your client's current functionability ?
Uses Walker, Cane, etc.
5. Has your client smoked cigarettes in the last 12 months ? Yes No
6. Does your client have any major health problems ? Yes No (example: cancer, etc.)
If yes, give details:
The underwriter will respond back to you on this case within 48 hours.