Literal question
INTERVIEWER VISITS
FIRST VISIT
INTERVIEWER'S NAME
DATE
RESULT***
SUPERVISOR
SECOND VISIT
INTERVIEWER'S NAME
DATE
RESULT***
SUPERVISOR
THIRD VISIT
INTERVIEWER'S NAME
DATE
RESULT***
FINAL VISIT
DAY___
MONTH___
YEAR___
INTERNATIONAL CODE___
RESULT__
TOTAL NUMBER OF VISITS____
***RESULT CODES:
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 OTHER (SPECIFY)________