Literal question
INTERVIEWER VISITS
FIRST VISIT: (REPEAT FOR SECOND AND THIRD VISITS)
DATE ______
INTERVIEWER'S NAME _______________
RESULT* _____
NEXT VISIT: (FOR INTERVIEWS 1 AND 2)
DATE _____
TIME _____
FINAL VISIT:
DAY _____
MONTH _____
YEAR 2007
INT. NUMBER ____
RESULT ___