1013) Who has done any of these things to physically hurt you while you were pregnant?
Anyone else?
RECORD ALL MENTIONED.
CURRENT HUSBAND/PARTNER A
MOTHER B
FATHER C
STEP-MOTHER D
STEP-FATHER/MOTHER'S PARTNER E
SISTER F
BROTHER G
DAUGHTER H
SON I
EX-HUSBAND/EX-PARTNER J
FRIEND/CURRENT SEXUAL PARTNER K
EX-FRIEND/EX-SEXUAL PARTNER K
MOTHER-IN-LAW (HUSBAND'S MOTHER) M
FATHER-IN-LAW (HUSBAND'S FATHER) N
OTHER FEMALE IN-LAWS O
OTHER MALE IN-LAWS P
FEMALE FRIEND/ACQUAINTANCE Q
MALE FRIEND/ACQUAINTANCE R
TEACHER S
EMPLOYER T
STRANGER U
POLICE/SOLDIER V
OTHER (SPECIFY) _____ X
THANK THE RESPONDENT FOR HER COOPERATION AND REASSURE HER ABOUT THE CONFIDENTIALITY OF HER ANSWERS. FILL OUT THE QUESTIONS BELOW WITH REFERENCE TO THE DOMESTIC VIOLENCE MODULE ONLY.