Literal question
INTERVIEWER VISITS
FIRST VISIT
DATE_______
INTERVIEWER'S NAME________
RESULT CODE*________
SECOND VISIT
DATE_______
INTERVIEWER'S NAME________
RESULT CODE*________
THIRD VISIT
DATE_______
INTERVIEWER'S NAME________
RESULT CODE*________
FINAL VISIT
DAY __ __
MONTH __ __
YEAR __ __ __ __
INT. NO. __ __ __
RESULT CODE* __
NEXT VISIT:
DATE____
TIME ____
TOTAL NUMBER OF VISITS __
SUPERVISOR'S NAME____________
SUPERVISOR NUMBER __ __ __