Literal question
INTERVIEWER VISITS
INTERVIEW 1
DATE ____
INTERVIEWER'S NAME _____
RESULT*** ____
NEXT VISIT:
DATE ____
TIME ____
INTERVIEW 2
DATE ____
INTERVIEWER'S NAME _____
RESULT*** ____
NEXT VISIT:
DATE ____
TIME ____
INTERVIEW 3
DATE ____
INTERVIEWER'S NAME _____
RESULT*** ____
FINAL VISIT
DAY ____
MONTH ____
YEAR ____
NAME ___