Survey Text

2003
2002
2001
top
2003
Survey form view entire document:  text  image

CIM.431

[If AGE le 6]
Has {Child's name} received any OTHER immunizations that I have NOT asked you about?

[else]
Has {Child's name} received any OTHER immunizations that I have NOT asked you about? I am only interested in shots given after {his/her} 6th birthday.
OTHRAY
(1) Yes
(2) No (CIM.440)
(7) Refused (CIM.440)
(9) Don't know (CIM.440)

top
2002
Survey form view entire document:  text  image

CIM.431

[If AGE le 6]
Has {Child's name} received any OTHER immunizations that I have NOT asked you about?

[else]
Has {Child's name} received any OTHER immunizations that I have NOT asked you about? I am only interested in shots given after {his/her} 6th birthday.
OTHRAY
(1) Yes
(2) No (CIM.440)
(7) Refused (CIM.440)
(9) Don't know (CIM.440)

top
2001
Survey form view entire document:  text  image

CIM.431

[If AGE le 6]
Has {Child's name} received any OTHER immunizations that I have NOT asked you about?

[else]
Has {Child's name} received any OTHER immunizations that I have NOT asked you about? I am only interested in shots given after {his/her} 6th birthday.
OTHRAY
(1) Yes
(2) No (CIM.440)
(7) Refused (CIM.440)
(9) Don't know (CIM.440)