Survey Text

2003
2002
2001
2000
1999
1998
1997
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2003
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CIM.127

FR: TRANSCRIBE FROM SHOT RECORD OR ASK:

Looking at the shot record, please tell me how many times {Child's name} has received an ACTHib shot?
OTH5
(1-6) 1-6 times
(7) Refused (CIMCCI4)
(9) Don't know (CIMCCI4)

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2002
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CIM.127

FR: TRANSCRIBE FROM SHOT RECORD OR ASK:

Looking at the shot record, please tell me how many times {Child's name} has received an ACTHib shot?
OTH5
(1-6) 1-6 times
(7) Refused (CIMCCI4)
(9) Don't know (CIMCCI4)

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2001
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CIM.127

FR: TRANSCRIBE FROM SHOT RECORD OR ASK:

Looking at the shot record, please tell me how many times {Child's name} has received an ACTHib shot?
OTH5
(1-6) 1-6 times
(7) Refused (CIMCCI4)
(9) Don't know (CIMCCI4)

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2000
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CIM.127

FR: TRANSCRIBE FROM SHOT RECORD OR ASK:

Looking at the shot record, please tell me how many times {Child's name} has received an ACTHib shot?
OTH5
(1-6) 1-6 times
(7) Refused (CIMCCI4)
(9) Don't know (CIMCCI4)

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1999
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CIM.127

FR: TRANSCRIBE FROM SHOT RECORD OR ASK:

Looking at the shot record, please tell me how many times {Child's name} has received an ACTHib shot?
OTH5
(1-6) 1-6 times
(7) Refused (CIMCCI4)
(9) Don't know (CIMCCI4)

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1998
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CIM.127

FR: TRANSCRIBE FROM SHOT RECORD OR ASK:

Looking at the shot record, please tell me how many times {Child's name} has received an ACTHib shot?
OTH5
(1-6) 1-6 times
(7) Refused (CIMCCI4)
(9) Don't know (CIMCCI4)

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1997
Survey form view entire document:  text  image

CIM.127

FR: TRANSCRIBE FROM SHOT RECORD OR ASK:

Looking at the shot record, please tell me how many times {Child's name} has received an ACTHib shot?
OTH5
(1-6) 1-6 times
(7) Refused (CIMCCI4)
(9) Don't know (CIMCCI4)