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*______
NEXT VISIT
DATE_______
TIME_______
FINAL VISIT
DAY ______
MONTH ______
YEAR _____
INT. NO ______
RESULT CODE * ______
TOTAL NUMBER OF VISITS _______
SUPERVISOR'S NAME_______
SUPERVISOR NUMBER ________
RESULT CODES*
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY)________