What is your date of birth?
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Have you taken any of the following medications in the past? If so, when was the last time you took it? - Rituxan®, MabThera, Truxima® (rituximab)
- Campath®, MabCampath®, Lemtrada® (alemtuzumab)
- Visilizumab
- Tysabri® (natalizumab)