1 - ESDS

0WQ46 If you (or yourpwtnw) umd one or mom mcUIds m ths hat 2 yoaw
ring ●ll tho ntiws thm apply
WIUIdrawal w]
SheaUdcondom [0]
Safa pem~tiythm method [0]
Ca@dmphmgm [0]
cOramCqxNospmg* [0]
PIN mm PIN(pmgastamnonty) [0]
PIN cambmadF4J(Indudlngmulil.phsmcPIII) [0]
PIN nots.uraIf minior mmbmad [0]
Plus W* U!, brandIIMM him .-—.. --—--
lUO/cu#bltim4mlna dmvla [0]
Fomns/gelwsPy#P-IIn (~mm,dd~a) [0]
Goingwdmd rnk’uallntamOuN m avosdpregnancy
[0]
Inpctmns
Anothermethod
[0]
Plaan wttta its na’m below .-. -.__—---- [01
owQ47 TO TNOSE WIO ARE NOT PREGNANT ANO HAVE NOT BEEN
STERILISEO TO PREVENT PREGNANCY
Have youhad my 00w oprationwiuci7pmvcmtayougetthg Pmgnmt
(again)?
Yes [0]
No
[10]
(n whatmonmand yew WS tlw apemtbn?
❑WQ4SMTH 0WG46TR MUIUI Year
owa4s Ws you opmthn Iesatlmn2 yearnago?
Entw Month ●nd Yam ------------ 19
Yes [0]
No [0]
11
1Ratum formto
Iramvlawmr
I
n-lo
— GOto 0W4SMlH
— Go to OW351
I n=O I
—G0t00va4a
— Got00vA2so
— Rdum farm to
Intarw-r
298