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2003

Survey form view entire document: text image

CIM.260

How many additional shots for chickenpox has {Child's name} received?

FR: ENTER 96 IF "ALL" IS REPORTED

VARMNO

(01-04) 1-4 shots
(96) All
(97) Refused
(99) Don't know

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2002

Survey form view entire document: text image

CIM.260

How many additional shots for chickenpox has {Child's name} received?

FR: ENTER 96 IF "ALL" IS REPORTED

VARMNO

(01-04) 1-4 shots
(96) All
(97) Refused
(99) Don't know

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2001

Survey form view entire document: text image

CIM.260

How many additional shots for chickenpox has {Child's name} received?

FR: ENTER 96 IF "ALL" IS REPORTED

VARMNO

(01-04) 1-4 shots
(96) All
(97) Refused
(99) Don't know

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2000

Survey form view entire document: text image

CIM.260

How many additional shots for chickenpox has {Child's name} received?

FR: ENTER 96 IF "ALL" IS REPORTED

VARMNO

(01-04) 1-4 shots
(96) All
(97) Refused
(99) Don't know

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1999

Survey form view entire document: text image

CIM.260

How many additional shots for chickenpox has {Child's name} received?

FR: ENTER 96 IF "ALL" IS REPORTED

VARMNO

(01-04) 1-4 shots
(96) All
(97) Refused
(99) Don't know

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1998

Survey form view entire document: text image

CIM.260

How many additional shots for chickenpox has {Child's name} received?

FR: ENTER 96 IF "ALL" IS REPORTED

VARMNO

(01-04) 1-4 shots
(96) All
(97) Refused
(99) Don't know

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1997

Survey form view entire document: text image

CIM.260

How many additional shots for chickenpox has {Child's name} received?

FR: ENTER 96 IF "ALL" IS REPORTED

VARMNO

(01-04) 1-4 shots
(96) All
(97) Refused
(99) Don't know

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