Literal question
INTERVIEWER VISITS
FIRST VISIT:
DATE
INTERVIEWER'S NAME
RESULT
NEXT VISIT:
DATE
TIME
SECOND VISIT:
DATE
INTERVIEWER'S NAME
RESULT
NEXT VISIT:
DATE
TIME
THIRD VISIT:
DATE
INTERVIEWER'S NAME
RESULT
FINAL VISIT:
DAY
MONTH
YEAR
NAME
RESULT
TOTAL NUMBER OF VISITS
*RESULT CODES:
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER (SPECIFY) _____________