Not Assigned Child Access to Health Care and Utilization

National Health Interview Survey 2007-2009

3-CAU

NHIS 2007 Child Core Questionnaire

OMB: 0920-0214

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Page 1 of 14

2007 NHIS Questionnaire - Sample Child

Child Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: CAU.020_00.000 Instrument Variable Name: CUSUALPL QuestionnaireFileName: Sample Child

QuestionText: The next questions are about health care.

Is there a place that [fill1: alias] USUALLY goes when [fill2: he/she] is sick or you need advice

about [fill3: his/her] health?

1 Yes

2 There is NO place

3 There is MORE THAN ONE place

7 Refused

9 Don't know

UniverseText: Sample Children <18

SkipInstructions: <1,3> [go to CPLKIND]

<2,D,R> [go to CHCPLKND]

Question ID: CAU.030_00.000 Instrument Variable Name: CPLKIND QuestionnaireFileName: Sample Child

QuestionText: [fill1: What kind of place is it / What kind of place does [fill2: alias] go to most often] - a clinic, doctor's office, emergency

room, or some other place?

1 Clinic or health center

2 Doctor's office or HMO

3 Hospital emergency room

4 Hospital outpatient department

5 Some other place

6 Doesn't go to one place most often

7 Refused

9 Don't know

UniverseText: Sample children <18 with one or more usual places to go when sick or need health advice

SkipInstructions: <1-5> [go to CHCPLROU]

<6,D,R> [go to CHCPLKND]

Question ID: CAU.035_00.000 Instrument Variable Name: CHCPLROU QuestionnaireFileName: Sample Child

QuestionText: Is that [fill1: CPLKIND/CAU.030] the same place [fill2: alias] USUALLY goes when [fill3: he/she] needs routine or

preventive care, such as a physical examination or (well baby/child) check-up?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children <18 with one or more usual places to go when sick or need health advice who reported that place as

a clinic or health center, doctor's office or HMO, hospital emergency room, hospital outpatient department, or some

other place

SkipInstructions: <1> [go to CHCCHGYR]

<2,D,R> [go to CHCPLKND]

Page 2 of 14

2007 NHIS Questionnaire - Sample Child

Child Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: CAU.037_00.000 Instrument Variable Name: CHCPLKND QuestionnaireFileName: Sample Child

QuestionText: What kind of place does [fill1: alias] USUALLY go to when [fill2: he/she] needs routine or preventive care, such as a

physical examination or (well baby/child) check-up?

0 Doesn't get preventive care anywhere

1 Clinic or health center

2 Doctor's office of HMO

3 Hospital emergency room

4 Hospital outpatient department

5 Some other place

6 Doesn't go to one place most often

7 Refused

9 Don't know

UniverseText: Sample Children <18 who do not have a usual source of sick care; who Ref/NA/DK if have a usual source of sick

care; who have a usual source of sick care but does not go to one place most often; who have a usual source of sick

care but Ref/NA/DK what kind of place; who have a usual source of sick care, but it is not same place as usual source

of routine/preventive care; who have a usual source of sick care but Ref/NA/DK if it is same place as usual source of

routine/preventive care.

SkipInstructions: <0-6,D,R> [ if CUSUALPL=2,D,R goto CHCDLYR_1; else goto CHCCHGYR]

Question ID: CAU.040_00.000 Instrument Variable Name: CHCCHGYR QuestionnaireFileName: Sample Child

QuestionText: At any time IN THE PAST 12 MONTHS did you CHANGE the place(s) to which [fill: alias] USUALLY goes for health

care?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children <18 with one or more place to go when sick/need advice [or who reported same place as usual

source of routine/preventive care]

SkipInstructions: <1> [go to CHCCHGHI]

<2,D,R> to CHCDLYR1_1]

Question ID: CAU.050_00.000 Instrument Variable Name: CHCCHGHI QuestionnaireFileName: Sample Child

QuestionText: Was this change for a reason related to health insurance?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All sample children <18 that have changed their usual place of health care in the past 12 months

SkipInstructions: <1,2,D,R> [goto CHCDLYR1_1]

Page 3 of 14

2007 NHIS Questionnaire - Sample Child

Child Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: CAU.080_01.000 Instrument Variable Name: CHCDLYR1_1 QuestionnaireFileName: Sample Child

QuestionText: * Read if necessary.

There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] for any of the

following reasons IN THE PAST 12 MONTHS...

You couldn't get through on the telephone. [fill: alias]

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All sample children <18

SkipInstructions: <1,2,D,R> [goto CHCDLYR1_2]

Question ID: CAU.080_02.000 Instrument Variable Name: CHCDLYR1_2 QuestionnaireFileName: Sample Child

QuestionText: * Read if necessary.

There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] for any of the

following reasons IN THE PAST 12 MONTHS...

You couldn't get an appointment for [fill: alias] soon enough.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All sample children <18

SkipInstructions: <1,2,D,R> [goto CHCDLYR1_3]

Question ID: CAU.080_03.000 Instrument Variable Name: CHCDLYR1_3 QuestionnaireFileName: Sample Child

QuestionText: * Read if necessary.

There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] for any of the

following reasons IN THE PAST 12 MONTHS...

Once you get there, [fill: alias] has to wait too long to see the doctor.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All sample children <18

SkipInstructions: <1,2,D,R> [goto CHCDLYR1_4]

Page 4 of 14

2007 NHIS Questionnaire - Sample Child

Child Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: CAU.080_04.000 Instrument Variable Name: CHCDLYR1_4 QuestionnaireFileName: Sample Child

QuestionText: * Read if necessary.

There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] for any of the

following reasons IN THE PAST 12 MONTHS...

The (clinic/doctor's office) wasn't open when you could get there.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All sample children <18

SkipInstructions: <1,2,D,R> [goto CHCDLYR1_5]

Question ID: CAU.080_05.000 Instrument Variable Name: CHCDLYR1_5 QuestionnaireFileName: Sample Child

QuestionText: * Read if necessary.

There are many reasons people delay getting medical care. Have you delayed getting care for [fill: alias] for any of the

following reasons IN THE PAST 12 MONTHS...

You didn’t have transportation.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All sample children <18

SkipInstructions: <1,2,D,R> [if AGE GE <2> goto CHCAFYR1_1; else goto CHCAFYR]

Question ID: CAU.130_00.000 Instrument Variable Name: CHCAFYR QuestionnaireFileName: Sample Child

QuestionText: DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it

because you couldn't afford it...

Prescription medicines?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children <2

SkipInstructions: <1, 2, D, R> [if AGE <1 goto CHCSYR1_2; else goto CDENLONG]

Page 5 of 14

2007 NHIS Questionnaire - Sample Child

Child Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: CAU.135_01.000 Instrument Variable Name: CHCAFYR1_1 QuestionnaireFileName: Sample Child

QuestionText: DURING THE PAST 12 MONTHS, was there any time when {S.C. name} NEEDED any of the following, but didn't get

it because you couldn't afford it? ... Prescription medicines?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children GE 2

SkipInstructions: <1, 2, D, R> [goto CHCAFYR1_2]

Question ID: CAU.135_02.000 Instrument Variable Name: CHCAFYR1_2 QuestionnaireFileName: Sample Child

QuestionText: * Read if necessary.

DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it

because you couldn't afford it...

Mental health care or counseling?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children GE 2

SkipInstructions: <1, 2, D, R> [goto CHCAFYR1_3]

Question ID: CAU.135_03.000 Instrument Variable Name: CHCAFYR1_3 QuestionnaireFileName: Sample Child

QuestionText: * Read if necessary.

DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it

because you couldn't afford it...

Dental care (including check-ups)?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children GE 2

SkipInstructions: <1, 2, D, R> [goto CHCAFYR1_4]

Page 6 of 14

2007 NHIS Questionnaire - Sample Child

Child Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: CAU.135_04.000 Instrument Variable Name: CHCAFYR1_4 QuestionnaireFileName: Sample Child

QuestionText: * Read if necessary.

DURING THE PAST 12 MONTHS, was there any time when [fill: alias] NEEDED any of the following, but didn't get it

because you couldn't afford it...

Eyeglasses?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children GE 2

SkipInstructions: <1, 2, D, R> [goto CDENLONG]

Question ID: CAU.160_00.000 Instrument Variable Name: CDENLONG QuestionnaireFileName: Sample Child

QuestionText: (book) C4

About how long has it been since [fill: alias] last saw a dentist? Include all types of dentists, such as orthodontists, oral

surgeons, and all other dental specialists, as well as dental hygienists.

0 Never

1 6 months or less

2 More than 6 months, but not more than 1 year ago

3 More than 1 year, but not more than 2 years ago

4 More than 2 years, but not more than 5 years ago

5 More than 5 years ago

7 Refused

9 Don't know

UniverseText: Sample children GE 1

SkipInstructions: <0-5, D , R> [if AGE GE <2> goto CHCSYR_1; else go to CHCSYR1_2]

Question ID: CAU.170_01.000 Instrument Variable Name: CHCSYR1_2 QuestionnaireFileName: Sample Child

QuestionText: DURING THE PAST 12 MONTHS, that is since {12-month ref. date}, has anyone in the family seen or talked to any of

the following health care providers about {S.C. name}'s health? ... An optometrist, ophthalmologist, or eye doctor

(someone who prescribes eyeglasses)?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children <2

SkipInstructions: <1, 2, D, R> [goto CHCSYR1_3]

Page 7 of 14

2007 NHIS Questionnaire - Sample Child

Child Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: CAU.170_02.000 Instrument Variable Name: CHCSYR1_3 QuestionnaireFileName: Sample Child

QuestionText: * Read if necessary.

DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], has anyone in the family seen or talked to

any of the following health care providers about [fill2: alias]'s health?

A foot doctor?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children <2

SkipInstructions: <1,2, D, R> [goto CHCSYR1_5]

Question ID: CAU.170_03.000 Instrument Variable Name: CHCSYR1_5 QuestionnaireFileName: Sample Child

QuestionText: * Read if necessary.

DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], has anyone in the family seen or talked to

any of the following health care providers about [fill2: alias]'s health?

A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children <2

SkipInstructions: <1,2, D, R> [goto CHCSYR1_6]

Question ID: CAU.170_04.000 Instrument Variable Name: CHCSYR1_6 QuestionnaireFileName: Sample Child

QuestionText: * Read if necessary.

DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], has anyone in the family seen or talked to

any of the following health care providers about [fill2: alias]'s health?

A nurse practitioner, physician assistant or midwife?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children <2

SkipInstructions: <1, 2, D, R> [goto CHCSYR8]

Page 8 of 14

2007 NHIS Questionnaire - Sample Child

Child Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: CAU.175_01.000 Instrument Variable Name: CHCSYR_1 QuestionnaireFileName: Sample Child

QuestionText: DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], have you seen or talked to any of the

following health care providers about [fill2: alias]'s health?

A mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children GE 2

SkipInstructions: <1, 2, D, R> [goto CHCSYR_2]

Question ID: CAU.175_02.000 Instrument Variable Name: CHCSYR_2 QuestionnaireFileName: Sample Child

QuestionText: * Read if necessary.

DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], have you seen or talked to any of the

following health care providers about [fill2: alias]'s health?

An optometrist, ophthalmologist, or eye doctor (someone who prescribes eyeglasses)?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children GE 2

SkipInstructions: <1, 2, D, R> [goto CHCSYR_3]

Question ID: CAU.175_03.000 Instrument Variable Name: CHCSYR_3 QuestionnaireFileName: Sample Child

QuestionText: * Read if necessary.

DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], have you seen or talked to any of the

following health care providers about [fill2: alias]'s health?

A foot doctor?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children GE 2

SkipInstructions: <1, 2, D, R> [goto CHCSYR_4]

Page 9 of 14

2007 NHIS Questionnaire - Sample Child

Child Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: CAU.175_04.000 Instrument Variable Name: CHCSYR_4 QuestionnaireFileName: Sample Child

QuestionText: * Read if necessary.

DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], have you seen or talked to any of the

following health care providers about [fill2: alias]'s health?

A chiropractor?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children GE 2

SkipInstructions: <1, 2, D, R> [goto CHCSYR_5]

Question ID: CAU.175_05.000 Instrument Variable Name: CHCSYR_5 QuestionnaireFileName: Sample Child

QuestionText: * Read if necessary.

DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], have you seen or talked to any of the

following health care providers about [fill2: alias]'s health?

A physical therapist, speech therapist, respiratory therapist, audiologist, or occupational therapist?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children GE 2

SkipInstructions: <1, 2, D, R> [goto CHCSYR_6]

Question ID: CAU.175_06.000 Instrument Variable Name: CHCSYR_6 QuestionnaireFileName: Sample Child

QuestionText: * Read if necessary.

DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], have you seen or talked to any of the

following health care providers about [fill2: alias]'s health?

A nurse practitioner, physician assistant or midwife?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children GE 2

SkipInstructions: <1, 2, D, R> [if SEX eq <2> and AGE GE 15 goto CHCSYR7; else goto CHCSYR8]

Page 10 of 14

2007 NHIS Questionnaire - Sample Child

Child Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: CAU.230_00.000 Instrument Variable Name: CHCSYR7 QuestionnaireFileName: Sample Child

QuestionText: DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], have you seen or talked to a doctor who

specializes in women's health (an obstetrician/gynecologist) about [fill2: alias]'s health?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children GE 15 who are female

SkipInstructions: <1, 2, R, D> [goto CHCSYR8_1]

Question ID: CAU.240_01.000 Instrument Variable Name: CHCSYR8_1 QuestionnaireFileName: Sample Child

QuestionText: DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], have you seen or talked to the following

about [fill2: alias]'s health?

A medical doctor who specializes in a particular medical disease or problem (fill3:other than obstetrician/ gynecologist,

psychiatrist or ophthalmologist? /fill4: other than psychiatrist or ophthalmologist)?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All sample children <18

SkipInstructions: <1, 2, D, R> [goto CHCSYR8_2]

Question ID: CAU.240_02.000 Instrument Variable Name: CHCSYR8_2 QuestionnaireFileName: Sample Child

QuestionText: * Read if necessary.

DURING THE PAST 12 MONTHS, that is since [fill1: 12 month reference date], have you seen or talked to the following

about [fill2: alias]'s health?

A general doctor who treats a variety of illnesses (a doctor in general practice, pediatrics, family medicine, or internal

medicine)?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: All sample children <18

SkipInstructions: <1> [goto CHCSYR10]

<2, D, R> [goto CHPEXYR]

Page 11 of 14

2007 NHIS Questionnaire - Sample Child

Child Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: CAU.260_00.000 Instrument Variable Name: CHCSYR10 QuestionnaireFileName: Sample Child

QuestionText: Does that doctor treat children and adults (a doctor in general practice or family medicine)?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children <18 who have seen or talked to a general doctor during the past 12 months

SkipInstructions: <1, 2, D, R> [goto CHCSYREM]

Question ID: CAU.265_00.000 Instrument Variable Name: CHCSYREM QuestionnaireFileName: Sample Child

QuestionText: Did you see or talk to this general doctor because of an emotional or behavioral problem that [fill1: alias] may have?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children <18 who have seen a general doctor in the past 12 months

SkipInstructions: <1, 2, D, R> [goto CHPEXYR]

Question ID: CAU.270_00.000 Instrument Variable Name: CHPEXYR QuestionnaireFileName: Sample Child

QuestionText: DURING THE PAST 12 MONTHS, did [fill1: alias] receive a well-child check-up, that is a general check-up, when [fill2:

he/she] was not sick or injured?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children <18

SkipInstructions: <1, 2, D, R> [goto CHERNOYR]

Page 12 of 14

2007 NHIS Questionnaire - Sample Child

Child Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: CAU.280_00.000 Instrument Variable Name: CHERNOYR QuestionnaireFileName: Sample Child

QuestionText: (book) C5

DURING THE PAST 12 MONTHS, HOW MANY TIMES has [fill1: alias] gone to a HOSPITAL EMERGENCY ROOM

about [fill2: his/her] health? (This includes emergency room visits that resulted in a hospital admission.)

00 None

01 1

02 2-3

03 4-5

04 6-7

05 8-9

06 10-12

07 13-15

08 16 or more

97 Refused

99 Don't know

UniverseText: Sample children <18

SkipInstructions: <0-8, D, R> [goto CHCHYR]

Question ID: CAU.290_00.000 Instrument Variable Name: CHCHYR QuestionnaireFileName: Sample Child

QuestionText: DURING THE PAST 12 MONTHS, did [fill1: alias] receive care AT HOME from a nurse or other health care professional?

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children <18

SkipInstructions: <1> [goto CHCHMOYR]

<2, D, R> [goto CHCNOYR]

Question ID: CAU.300_00.000 Instrument Variable Name: CHCHMOYR QuestionnaireFileName: Sample Child

QuestionText: DURING THE PAST 12 MONTHS, how many months did [fill: alias] receive care AT HOME from a health care

professional?

01-12 1-12 months

97 Refused

99 Don't know

UniverseText: Sample children <18 that have received home care from health professional during the past 12 months

SkipInstructions: <01-12, D, R> [goto CHCHNOYR]

Page 13 of 14

2007 NHIS Questionnaire - Sample Child

Child Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: CAU.310_00.000 Instrument Variable Name: CHCHNOYR QuestionnaireFileName: Sample Child

QuestionText: (book) C6

What was the total number of home visits received for [fill1: alias] during [fill2: that month/those months]?

01 1

02 2-3

03 4-5

04 6-7

05 8-9

06 10-12

07 13-15

08 16 or more

97 Refused

99 Don't know

UniverseText: Sample children <18 that have received home care from health professional during the past 12 months

SkipInstructions: <1-8, D, R> [goto CHCNOYR]

Question ID: CAU.320_00.000 Instrument Variable Name: CHCNOYR QuestionnaireFileName: Sample Child

QuestionText: (book) C5

DURING THE PAST 12 MONTHS, HOW MANY TIMES has [fill1: alias] seen a doctor or other health care professional

about [fill2: his/her] health at A DOCTOR’S OFFICE, A CLINIC, OR SOME OTHER PLACE? Do not include times

[fill1: alias] was hospitalized overnight, visits to hospital emergency rooms, home visits, dental visits or telephone calls.

00 None

01 1

02 2-3

03 4-5

04 6-7

05 8-9

06 10-12

07 13-15

08 16 or more

97 Refused

99 Don't know

UniverseText: Sample children <18

SkipInstructions: <1-8, D, R> [goto CSRGYR]

Page 14 of 14

2007 NHIS Questionnaire - Sample Child

Child Access to Health Care & Utilization

Document Version Date: 12-Jul-06

Question ID: CAU.330_00.000 Instrument Variable Name: CSRGYR QuestionnaireFileName: Sample Child

QuestionText: DURING THE PAST 12 MONTHS has [fill1: alias] had SURGERY or other surgical procedures either as an inpatient or

outpatient?

* Read if necessary.

This includes both major surgery and minor procedures such as setting bones or removing growths.

1 Yes

2 No

7 Refused

9 Don't know

UniverseText: Sample children <18

SkipInstructions: <1> [goto CSRGNOYR]

<2, D, R> [goto CMDLONG]

Question ID: CAU.340_00.000 Instrument Variable Name: CSRGNOYR QuestionnaireFileName: Sample Child

QuestionText: Including any times you may have already told me about, HOW MANY DIFFERENT TIMES has [fill1: alias] had surgery

DURING THE PAST 12 MONTHS?

* Enter '95' for 95 or more times.

01-94 1-94 times

95 95+ times

97 Refused

99 Don't know

UniverseText: All sample children <18 that have undergone surgery during the past 12 months

SkipInstructions: <1-10, D, R> [goto CMDLONG]

<11-95> [goto ERR_CMDLONG]

Question ID: CAU.345_00.000 Instrument Variable Name: CMDLONG QuestionnaireFileName: Sample Child

QuestionText: (book) C4

About how long has it been since anyone in the family last saw or talked to a doctor or other health care professional about

[fill1: alias]'s health? Include doctors seen while [fill2: he/she] was a patient in a hospital.

0 Never

1 6 months or less

2 More than 6 months, but not more than 1 year ago

3 More than 1 year, but not more than 2 years ago

4 More than 2 years, but not more than 5 years ago

5 More than 5 years ago

7 Refused

9 Don't know

UniverseText: Sample children <18

SkipInstructions: <0-5, D, R> [if AGE 4-14 goto CMHCOPY; else goto CSHFLUYR]

File Typeapplication/msword
AuthorHoward Riddick
Last Modified ByHoward Riddick
File Modified2006-09-29
File Created2006-09-29

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