Literal question
INTERVIEW 1
DATE ____
INTERVIEWER'S NAME ____
RESULT*____
NEXT VISIT:
DATE ___
TIME____
INTERVIEW 2
DATE ____
INTERVIEWER'S NAME ____
RESULT*____
NEXT VISIT:
DATE ___
TIME____
INTERVIEW 2 DATE ____
INTERVIEWER'S NAME ____
RESULT*____
FINAL VISIT
DAY___
MONTH ___
YEAR 2008
INT. NUMBER ____
RESULT____