Literal question
330. Where is this place?
IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.
NAME OF THE ESTABLISHMENT __________
PUBLIC SECTOR
NATIONAL HOSPITAL A
INTEGRATED HEALTH CENTER B
MATERNITY C
HEALTH HUT D
COMMUNITY HEALTH CARE WORKER E
OTHER PUBLIC (SPECIFY) __________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR G
PHARMACY H
WALKING SALESMAN I
STREET VENDOR J
OTHER PRIVATE (SPECIFY) __________ K
OTHER SOURCE
SHOP M
BAR/NIGHTCLUB N
KIOSK O
VENDOR P
FRIEND/ACQUAINTANCE/RELATIVE Q
HOTEL/MOTEL R
OTHER (SPECIFY) __________ X
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330. Where is this place?
IF THE SOURCE IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE SECTOR AND CIRCLE THE APPROPRIATE CODE.
NAME OF THE ESTABLISHMENT __________
PUBLIC SECTOR
NATIONAL HOSPITAL A
INTEGRATED HEALTH CENTER B
MATERNITY C
HEALTH HUT D
COMMUNITY HEALTH CARE WORKER E
OTHER PUBLIC (SPECIFY) __________ F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL/CLINIC/DOCTOR G
PHARMACY H
WALKING SALESMAN I
STREET VENDOR J
OTHER PRIVATE (SPECIFY) __________ K
OTHER SOURCE
SHOP M
BAR/NIGHTCLUB N
KIOSK O
VENDOR P
FRIEND/ACQUAINTANCE/RELATIVE Q
HOTEL/MOTEL R
OTHER (SPECIFY) __________ X
