Literal question
321) CHECK 313/313A
IF MORE THAN ONE METHOD RECORDED IN 313/313A, CHECK AND ASK ABOUT METHOD HIGHEST ON THE LIST.
PILL (Where did you obtain the packet of pills you are using now (you used most recently)?)
__
INJECTION (Where did you go for your last injection?)
__
M CONDOM/ DIAPHRAGM/FOAM/ JELLY (From where did you obtain your most recent supply of (METHOD)?)
__
IF SOURCE IS HOSPITAL, HEALTH UNIT, OR CLINIC, WRITE THE NAME AND THE ADDRESS OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
(NAME AND ADDRESS OF PLACE) ______________________________________
FOR OFFICE USE:
SOURCE CODE __ __ __ __ __ __ __ __
MINISTRY OF HEALTH
URBAN HOSP'L (GENERAL/DISTRICT) 1
URBAN HEALTH UNIT 2
HEALTH OFFICE 3
RURAL HOSP'L (COMPLEMENTARY) 4
RURAL HEALTH UNIT 5
MCH CENTER 6
MOBILE UNIT 7
OTHER GOVERNMENTAL
UNIVERSITY HOSPITAL 8
TEACHING HOSPITAL 9
HEALTH INSURANCE ORG A
CURATIVE CARE ORGANIZATION B
OTHER GOVERNMENTAL C
NON-GOVERNMENTAL ORGANIZATION
EGYPT FAMILY PLANNING ASSOC D
CSI PROJECT E
OTHER NON-GOVERNMENTAL F
PRIVATE MEDICAL
PRIVATE HOSPITAL/ CLINIC G
PRIVATE DOCTOR H
PHARMACY I
OTHER PRIVATE
MOSQUE HEALTH UNIT J
CHURCH HEALTH UNIT K
OTHER NON-MEDICAL
OTHER VENDOR (SHOP, KIOSK, ETC.,) L
FRIEND/RELATIVE M
OTHER (SPECIFY) __________ X
DON'T KNOW Z