564) May I take your blood pressure now?
INTERVIEWER SIGNATURE_______
DATE_________
RESPONDENT ACCEPTED MEASUREMENT-RECORD THE RESULT OF THE BLOOD PRESSURE TEST
RESPONDENT REFUSED MEASUREMENT-RECORD 9994
BLOOD PRESSURE
SYSTOLIC/MAX 1__________
DIASTOLIC/MIN 2_______
REASONS FOR WHICH THE BLOOD PRESSURE WASN'T MEASURED
REFUSED '9994
TECHNICAL PROBLEMS '9995
OTHERS__________ (SPECIFY) '9996