Literal question
INTERVIEWER VISITS
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 _____
INT. NUMBER ______
RESULT _____