12.07.2015 Views

Final Report (PDF, 2132K) - Measure DHS

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MINISTRY OF HEALTH, ONDO STATE, NIGERIADEMOGRAPHIC AND HEALTH SURVEYSHOUSEHOLD SCHEDULEIDENTIFICATIONPLACE NAMECLUSTER NUMBER ....................................HOUSEHOLD NUMBER (in cluster} . . . . . . . . . . . . . . . . . . . . .IIINTERVIEWERVISITSI 2 3FINAL VISITDATE . . . . . . . . . . . . . . .monthyearINTERVIEWER'S NAME..RESULT (-) . . . . . . . . .NEXT VISIT:datetimeTotal numberof visits(.) RESULT CODES:I COMPLETED2 NO COMPETENTRESPONDENT AT HOME3 DEFERRED4 REFUSED5 DWELLING VACANT6 NO DWELLING ATADRESS7 ADDRESS NOTFOUND/INEXISTENT8 OTHER:IIIIlIIIFIELD EDITORdste: . . . . / . . . . / . . . .SUPERVISORdste: . . . . / . . . . / . . . .El99

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