Survey Text

1994
1993
top
1994
Survey form view entire document:  text  image
Ask 2d for each person with "Has Card" box marked in 2b.
d. May I please see -- (and [other sample persons']) card(s)?
Mark (X) appropriate box in person's column. Record expiration date for each Medicaid card seen.

[] 1 Medicaid card seen
Expiration date --
Month____
Day ____
[] 2 No card seen
[] 8 Other card seen (Specify) ____

top
1993
Survey form view entire document:  text  image
Ask 2d for each person with "Has Card" box marked in 2b.
d. May I please see -- (and [other sample persons']) card(s)?
Mark (X) appropriate box in person's column. Record expiration date for each Medicaid card seen.

[] 1 Medicaid card seen
Expiration date --
Month____
Day ____
[] 2 No card seen
[] 8 Other card seen (Specify) ____