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AX_AFFF
First Name field is valid!
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Last Name field is valid!
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Eamil Address field is valid!
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Primary Phone field is valid!
Primary Phone field cannot be blank!
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State
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Exposed_to_AFFF
No
Yes
Diagnosed_Injury
Blood Cancer
Bladder Cancer
Breast Cancer
Kidney Cancer
Leukemia
Liver Cancer
Multiple Myeloma
Pancreatic cancer
Thyroid cancer
Non-Hodgkins Lymphoma
None of the above
Testicular cancer
Hyperthyroidism
Hypothyroidism
Thyroiditis
Hashimoto's disease
Grave's disease
Goiter
Thyroid nodules
Thyroid disease
Ulcerative colitis
Preeclampsia
Low birthweight
Prostate cancer
Hodgkins lymphoma
Myeloma
Have_Attorney
No
Yes
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