Literal question
INTERVIEWER VISITS
INTERVIEWER VISIT 1
DATE ______________
INTERVIEWER'S NAME _______________
RESULT** ______________
NEXT VISIT:
DATE ______
TIME _____
INTERVIEWER VISIT 2
DATE ______________
INTERVIEWER'S NAME _______________
RESULT** ______________
NEXT VISIT:
DATE ______
TIME _____
INTERVIEWER VISIT 3
DATE ______________
INTERVIEWER'S NAME _______________
RESULT** ______________
FINAL VISIT
DAY ____
MONTH ____
YEAR 200__
INT. CODE ___
FINAL RESULT ____