Literal question
NEXT VISIT:
DATE_____
TIME______
FINAL VISIT
DAY___
MONTH_____
YEAR 2000
TEAM_____
INTERVIEWER______
SUPERVISOR______
RESULT______
TOTAL VISITS_____
TOTAL IN HOUSEHOLD______
TOTAL ELIGIBLE WOMEN______
LINE NO. OF RESPONDENT FROM HOUSEHOLD SCHEDULE_______
WOMAN/CHILD/ADOLESCENT REFERRED FOR SEVERE ANEMIA
ADDRESS CHECKED (BY NAME:______)
REINTERVIEW:
YES 1
NO 2