Literal question
830. Where is this?
Is there another place?
RECORD ALL PLACES MENTIONED.
IF THE PLACE IS A HOSPITAL, HEALTH CENTER OR CLINIC, RECORD THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
NAME OF PLACE _____
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
PLANNING FAMILY CENTER C
TESTING CENTER D
STRAT. AVANCÉE/EQU. MOBLI E
HEALTH CARE WORKER F
OTHER PUBLIC (SPECIFY) _____G
PRIVATE MEDICAL SECTOR
HOSPITAL/CLINIC/OFFICE H
PHARMACY I
PRIVATE DOCTOR J
HEALTH CARE WORKER K
OTHER PRIVATE (SPECIFY) _____L
OTHER (SPECIFY) _____X