1018) 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