RECORD OBSERVATION.
RECORD OBSERVATION.
RECORD OBSERVATION.
PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE.
IF UNABLE TO DETERMINE IF HOSPITAL, HEALTH CENTER, OR CLINIC IS PUBLIC OR PRIVATE MEDICAL, WRITE THE NAME OF THE PLACE.
RECORD OBSERVATION.
RECORD OBSERVATION.
RECORD OBSERVATION.
RECORD OBSERVATION.
RECORD OBSERVATION.
RECORD OBSERVATION.
RECORD OBSERVATION.