2-Weeks Doctor Visit Page
Earlier, you told me that -- had seen or talked to a doctor during the past 2 weeks.
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 outpatient clinic or the emergency room?
If Clinic: Was it a hospital outpatient 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) ____
 Specialist -- What kind of specialist is he? ____
1  Diag. or treatment (6c)
3  General checkup (6b)
2  Pre or Postnatal care
4  Eye exam. (glasses) } (Next DV)
5  Immunization
6  Other ____
b. Was this for any specific condition?
 N (Next DV)
Mark box or ask:
c. For what condition did -- visit (call) the doctor on (date)
A condition page is required for the condition in question 6. 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.