2-WEEKS DOCTOR VISITS PAGE
Earlier, you told me that -- had seen or talked to a doctor during the past 2 weeks.
2a. On what (other) dates during that 2-week period did -- visit or talk to a doctor?
7777  Last week
8888  Week before
b. Were there any other doctor visits for him during that period?
 N (Ask 3-6 for each visit)
3. Where did he see the doctor on the (date), at a clinic, hospital, doctor's office, or some other place?
If Hospital: Was it the out-patient clinic, or the emergency room?
If Clinic: Was it a hospital out-patient clinic, a company clinic, or some other kind of clinic?
1  Doctor's office (group practice or doctor's clinic)
2  Telephone
3  Hospital Outpatient Clinic
4  Home
5  Hospital Emergency Room
6  Company or Industry Clinic
7  Other -- Specify ____
4. Is the doctor a general practitioner or a specialist?
 Specialist -- What kind of specialist is he? ____
5. During this visit (call) did -- actually see (talk to) the doctor?
2  N
6a. Why did he visit (call) a doctor on (date)? Write in reason. ________
Mark appropriate box(es)
3  General checkup (6b)
2  Pre or Postnatal care (P1)
4  Eye exam. (glasses) (P1)
5  Immunization (P1)
6  Other ____ (P1)
b. Was this for any specific condition?
 N (P1)
Mark box or ask:
c. For what condition did -- visit (call) the doctor on (date)? ____
If the condition in question 6 is first reported on the DV page, a Condition page is required. If there is no Condition page, enter condition in item C and fill a page for it after completing columns for all required doctor visits.