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2003

Survey form view entire document: text image

CIM.284

Did {Child's name} receive an influenza shot in the PAST 12 MONTHS?

INFMNO

(1) Yes
(2) No
(7) Refused
(9) Don't know

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2002

Survey form view entire document: text image

CIM.284

Did {Child's name} receive an influenza shot in the PAST 12 MONTHS?

INFMNO

(1) Yes
(2) No
(7) Refused
(9) Don't know

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2001

Survey form view entire document: text image

CIM.284

Did {Child's name} receive an influenza shot in the PAST 12 MONTHS?

INFMNO

(1) Yes
(2) No
(7) Refused
(9) Don't know

Survey Text