Literal question
INTERVIEWER VISIT 1
DATE _________
INTERVIEWER'S NAME __________
RESULT* __________
NEXT VISIT:
DATE _______
TIME ________
INTERVIEWER VISIT 2
DATE _________
INTERVIEWER'S NAME __________
RESULT* __________
NEXT VISIT:
DATE _______
TIME ________
INTERVIEWER VISIT 3
DATE _________
INTERVIEWER'S NAME __________
RESULT* __________
FINAL VISIT
DAY __
MONTH __
YEAR __
NAME ___
RESULT __