Survey Text

1979
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1979
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b. Where did -- go for that visit - to a doctor's office, an optical store, or some other place?

1 [] Doctor's office (group practice or doctor's clinic)
2 [] Optical store
[] Other - Specify ____

c. What is the (name and) address of this (place in 5b)?

Name ____
Street ____
City ____
State ____