Literal question
INTERVIEWER VISITS
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
INTERVIEWER'S NAME: ______
DATE: ______
RESULT* _____
*RESULT CODES
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 OTHER (SPECIFY) ______
NEXT VISIT:
DATE _____
TIME ______
FINAL VISIT:
DAY ____
MONTH ___
YEAR ____
NAME ____
RESULT ____