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2003

Survey form view entire document: text image

CIM.286

How many additional Hepatitis A shots has {Child's name} received?

FR: ENTER 96 IF "ALL" IS REPORTED.

HEPAMNO

(01-04) 1-4 Shots (CIM.440)
(96)All (CIM.440)
(97) Refused (CIM.440)
(99) Don't know (CIM.440)

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2002

Survey form view entire document: text image

CIM.286

How many additional Hepatitis A shots has {Child's name} received?

FR: ENTER 96 IF "ALL" IS REPORTED.

HEPAMNO

(01-04) 1-4 Shots (CIM.440)
(96)All (CIM.440)
(97) Refused (CIM.440)
(99) Don't know (CIM.440)

top

2001

Survey form view entire document: text image

CIM.286

How many additional Hepatitis A shots has {Child's name} received?

FR: ENTER 96 IF "ALL" IS REPORTED.

HEPAMNO

(01-04) 1-4 Shots (CIM.440)
(96)All (CIM.440)
(97) Refused (CIM.440)
(99) Don't know (CIM.440)

Survey Text