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2003

Survey form view entire document: text image

CIM.285

Has {Child's name} ever received an additional Hepatitis A shot NOT included on the shot record?

HEPAMOR

(1) Yes
(2) No (CIM.440)
(7) Refused (CIM.440)
(9) Don't know (CIM.440)

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2002

Survey form view entire document: text image

CIM.285

Has {Child's name} ever received an additional Hepatitis A shot NOT included on the shot record?

HEPAMOR

(1) Yes
(2) No (CIM.440)
(7) Refused (CIM.440)
(9) Don't know (CIM.440)

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2001

Survey form view entire document: text image

CIM.285

Has {Child's name} ever received an additional Hepatitis A shot NOT included on the shot record?

HEPAMOR

(1) Yes
(2) No (CIM.440)
(7) Refused (CIM.440)
(9) Don't know (CIM.440)

Survey Text