Literal question
INTERVIEW 1
DATE ___
INTERVIEWER'S NAME ___
RESULT* ___
NEXT VISIT:
DATE ___
TIME ___
INTERVIEW 2
DATE ____
INTERVIEWER'S NAME ___
RESULT* ___
NEXT VISIT:
DATE ___
TIME ___
INTERVIEW 3
DATE ___
INTERVIEWER'S NAME ___
RESULT*___
FINAL VISIT
DAY___
MONTH ___
YEAR _19__
NAME ___
RESULT ___