Survey Text

1978
top
1978
Survey form view entire document:  text  image

3a. Since the first of (month) 1978 has -- received a mumps shot?

1 [] Y
2 [] N (4)
3 [] DK (4)

c. Where did -- receive the mumps shot - at a clinic, hospital, school, doctor's office, or some other place? If clinic: was it a hospital outpatient clinic, a company clinic, a public health clinic or some other kind of clinic? 1. Doctor's office (group practice or doctor's clinic). 2. Hospital outpatient clinic or emergency room. 3. Public health clinic. 4. School. 8. Other-specify

[] 1
[] 2
[] 3
[] 4
[] 8 (specify) ________