Survey Text

2003 1999 1995 1991
2002 1998 1994
2001 1997 1993
2000 1996 1992
top
2003
Survey form view entire document:  text  image

CIM.140

Are all the immunizations that {Child's name} ever received included on this shot record?
SHOTA1
(1) Yes (CIM.440)
(2) No
(7) Refused
(9) Don't know
Check item CIMCCI5: If age GE 7 go to CIM.210.

top
2002
Survey form view entire document:  text  image

CIM.140

Are all the immunizations that {Child's name} ever received included on this shot record?
SHOTA1
(1) Yes (CIM.440)
(2) No
(7) Refused
(9) Don't know
Check item CIMCCI5: If age GE 7 go to CIM.210.

top
2001
Survey form view entire document:  text  image

CIM.140

Are all the immunizations that {Child's name} ever received included on this shot record?
SHOTA1
(1) Yes (CIM.440)
(2) No
(7) Refused
(9) Don't know
Check item CIMCCI5: If age GE 7 go to CIM.210.

top
2000
Survey form view entire document:  text  image

CIM.140

Are all the immunizations that {Child's name} ever received included on this shot record?
SHOTA1
(1) Yes (CIM.440)
(2) No
(7) Refused
(9) Don't know
Check item CIMCCI5: If age GE 7 go to CIM.210.

top
1999
Survey form view entire document:  text  image

CIM.140

Are all the immunizations that {Child's name} ever received included on this shot record?
SHOTA1
(1) Yes (CIM.440)
(2) No
(7) Refused
(9) Don't know
Check item CIMCCI5: If age GE 7 go to CIM.210.

top
1998
Survey form view entire document:  text  image

CIM.140

Are all the immunizations that {Child's name} ever received included on this shot record?
SHOTA1
(1) Yes (CIM.440)
(2) No
(7) Refused
(9) Don't know
Check item CIMCCI5: If age GE 7 go to CIM.210.

top
1997
Survey form view entire document:  text  image

CIM.140

Are all the immunizations that {Child's name} ever received included on this shot record?
SHOTA1
(1) Yes (CIM.440)
(2) No
(7) Refused
(9) Don't know
Check item CIMCCI5: If age GE 7 go to CIM.210.

top
1996
Survey form view entire document:  text  image

3. Are all the immunizations that -- ever received included on this shot record?

1[] Yes (11)
2[] No (4)
9[] DK (4)

top
1995
Survey form view entire document:  text  image

3. Are all the immunizations that -- ever received included on this shot record?

1[] Yes (11)
2[] No (4)
9[] DK (4)

top
1994
Survey form view entire document:  text  image

3. Are all the immunizations that -- ever received included on this shot record?

[] 1 Yes (11)
[] 2 No (4)
[] 9 DK (4)

top
1993
Survey form view entire document:  text  image

2. Are all of the immunizations that -- ever received included on this shot record?

1 [] Yes (10)
2 [] No (3)
9 [] DK (3)

top
1992
Survey form view entire document:  text  image

2. Are all of the immunizations that -- ever received included on this shot record?

1 [] Yes (10)
2 [] No (3)
9 [] DK (3)

top
1991
Survey form view entire document:  text  image

2. Are all the immunizations that -- ever received included on this shot record?

1[] Yes (9)
2[] No (3)
9[] DK (3)