Literal question
INTERVIEWER VISITS
FIRST VISIT (REPEAT FOR SECOND AND THIRD VISITS)
DATE___
INTERVIEWER'S NAME__
RESULT*__
NEXT VISIT__
FINAL VISIT
DAY__
MONTH__
YEAR____
INT. NUMBER__
RESULT*
*RESULT CODES:
1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTLY COMPLETED
6 INCAPACITATED
7 OTHER ___(SPECIFY)