Literal question
642) Where is that?
Any other place?
PROBE TO DETERMINE EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF THE HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE, RECORD THE NAME OF THE SOURCE.
NAME OF PLACE: ___
PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER/INTEGRATED HEALTH CENTER/DISPENSARY/
MOTHER AND CHILD CARE CENTER B
HEALTH WORKER C
OTHER PUBLIC (SPECIFY): ___ D
PRIVATE MEDICAL SECTOR
PRIVATE RELIGIOUS HOSPITAL E
PRIVATE SECULAR HOSPITAL F
HEALTH CENTER/RELIGIOUS DISPENSARY/MISSION G
MEDICAL OFFICE H
PHARMACY I
OTHER PRIVATE MEDICAL (SPECIFY): ___ J
OTHER SOURCE
SHOP K
KIOSK/CASH REGISTER L
TRAVELING SALESMAN M
BAR/NIGHTCLUB N
PARTNER HAD CONDOM O
FRIENDS/RELATIVES P
OTHER (SPECIFY): ___ X
*****
642) Where is that?
Any other place?
PROBE TO DETERMINE EACH TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE(S).
IF UNABLE TO DETERMINE IF THE HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE, RECORD THE NAME OF THE SOURCE.
NAME OF PLACE: ___
PUBLIC SECTOR
HOSPITAL A
HEALTH CENTER/INTEGRATED HEALTH CENTER/DISPENSARY/
MOTHER AND CHILD CARE CENTER B
HEALTH WORKER C
OTHER PUBLIC (SPECIFY): ___ D
PRIVATE MEDICAL SECTOR
PRIVATE RELIGIOUS HOSPITAL E
PRIVATE SECULAR HOSPITAL F
HEALTH CENTER/RELIGIOUS DISPENSARY/MISSION G
MEDICAL OFFICE H
PHARMACY I
OTHER PRIVATE MEDICAL (SPECIFY): ___ J
OTHER SOURCE
SHOP K
KIOSK/CASH REGISTER L
TRAVELING SALESMAN M
BAR/NIGHTCLUB N
PARTNER HAD CONDOM O
FRIENDS/RELATIVES P
OTHER (SPECIFY): ___ X
