Survey Text

Chad 2004
Chad 2014
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Chad 2004
Survey form view entire document:  text 
525) Where is that?
IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
ANY OTHER PLACE?
RECORD ALL MENTIONED.

(NAME OF PLACE)_______________
PUBLIC SECTOR
HOSPITAL/MATERNITY A
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/FREE CLINIC/GARRISON C
POLYCLINIC D
HOSPITAL/HEALTH CENTER PHARMACY E
AMASOT/MASOCOT F [##TRANSLATOR NOTE: BOTH ARE ACRONYMS FOR AGENCIES THAT ADVOCATE CONDOMS]
OTHER PUBLIC G
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL H
CLINIC/OFFICE I
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING J
PRIVATE HEALTH CENTER K
COMPANY HEALTH CENTER L
CARE OFFICE/NURSE M
PHARMACY/PHARMACY DEPOT N
OTHER PRIVATE MEDICAL O
PUBLIC/PRIVATE SECTOR
VILLAGE PHARMACY/HEALTH CENTER P
OTHER
SHOP/BAR/MARKET/HOTEL Q
FIRST AID WORKER R
MOBILE VENDOR S
FRIENDS/NEIGHBORS/RELATIVES T
OTHER PLACE_______________- X

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Chad 2014
Survey form view entire document:  text 
630) Where is that?
Any other place?
PROBE TO IDENTITY THE TYPE OF SOURCE.
IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE.

(NAME OF PLACE(S))____________
PUBLIC SECTOR
HOSPITAL/MATERNITY A
MILITARY HOSPITAL/GARRISON B
HEALTH CENTER/FREE CLINIC C
POLYCLINIC D
PHARMACY OF HOSPITAL/HEALTH CENTER E
OTHER PUBLIC SECTOR (SPECIFY) F
PRIVATE MEDICAL SECTOR
PRIVATE HOSPITAL G
CLINIC/DOCTOR'S OFFICE H
CHADIAN ASSOCIATION FOR FAMILY WELL-BEING I
PRIVATE HEALTH CENTER J
BUSINESS HEALTH CENTER K
CARE OFFICE/INFIRMARY L
PHARMACY/PHARMACY DEPOT M
CHADIAN SOCIAL MARKETING ASSOCIATION N
OTHER PRIVATE MEDICAL SECTOR (SPECIFY) O
PUBLIC/PRIVATE SECTOR
PHARMACY/VILLAGE HEALTH CENTER P
OTHER
RELIGIOUS INSTITUTION Q
SHOP/BAR/MARKET R
FIRST AID WORKER S
TRAVELING VENDOR T
FRIENDS/NEIGHBORS/RELATIVES U
OTHER (SPECIFY) X