"" 1 Your First Name Your Last Name History of Drug Use During Pregnancy Prescription medicationsYesNo Describeif yes0 / Alcohol useYesNo Describeif yes0 / MethamphetaminesYesNo Describeif yes0 / CocaineYesNo Describeif yes0 / MarijuanaYesNo Describeif yes0 / CigarettesYesNo Describeif yes0 / Othermore details0 / NEXT Previous Next