1 - ESDS
1 - ESDS 1 - ESDS
Questionnaire Ref Question No Coding Sheet No of Reference Boxes/ Coding InStructiOLls/Remarks Characters Q6(A) Q6A 2 Values -3-12 How many separate staya as inpatient ? Enter number Q7 Q7 2 Values -3-02 QIA Q7B Q8 Q8A I Wear Glasses or Contact Lenses? Yes .................. ......Ol No .........................02 Q7A 2 Values -3-03 I I Check I do you wear? Q7B Q8 Q8A 2 2 Glasses Only ..............01 Contact lenses only .......02 Sometimes glasses[sometimes contact lenses ............O3 Values -3-OZ Ever had a pair of glasses or contact lenses? Yes .......................01 No ........................02 Values -3-02 Sight tested? Yes ......................01 No .......................02 values -3-0~ Free or paid for? Free ......................01 Paid for .................02 DK ........................-1 A A,? r
QUastaonnaara Raf Q9 Q9A Q9 B Questaon No CHECK A CHECK B CHECK C Coding she-t R-f ●rmncm I ●NS CON’XIWUE WITH 1 UTB sECTION 0~ IF CODED 2 AZ EITEER I GO TO NEXT= Q9 Q9A Q9 B CNK/A CKKIB CHK/C No of Boxms/ Characters 2 2 2 2 2 : 1? cODED 1 ZION I Coding Iastructaons/Remarks values -3-02 St>ll got soma of your natural teath or lost them all> StLll has somo natural teeth .... .. .01 Has lost all natural teeth . . . .... . . . .02 Valu, s -3-04 In general, do you go to the dent~st for a regular check-up~ Rqul.sr chack-up. ........ .01 occas~onal check-up ..... .02 Only when havang trouble. 03 Never goes to the dant Lst. .04 ~ues -- 02 Yea. .............. ...... ...01 No ..... ........ ..... . .02 OK. .. . ........ .. ... .. -1 ~m -- 2 M- thar* any chlldran under 16 Ln the hou~ohold? rem ..... ....... ... .. ..01 No ................. ......02 -e s -3-02 Is this informant the Derson raspons~ble for any chLldran? Yam ...... .......... . ..01 No .... .. .. . .. . . . ..02 Values -3-16 En’car numLI*r of children ? CSECK A AND CSECK 0. 133
- Page 131 and 132: Quast>onnaLre R-f Q5(0) Q5(0) Q5(0)
- Page 133 and 134: ,.. --- Quastuannmra Raf Cod>ng Sha
- Page 135 and 136: QumstaonnaLra Rmf QuastLon No Q6(A)
- Page 137 and 138: Q6(A) (ii) Q6(A) (11) Q6(A) (U) Q6(
- Page 139: — Quastxonnaarm Ref Cod~ng sheet
- Page 143 and 144: Questaonnur, R9f Questaon No Qlc Q2
- Page 145 and 146: Q.astuxmaxre Ref Questaon No Q4(A)
- Page 147 and 148: . . . + . Quastzonna~r= R-f Codang
- Page 149 and 150: Q6 Q6 Q7[A) Q7A Q7(B) Q7B cHECK C C
- Page 151 and 152: Quastuanna.ra R-f Q13 Q14 Q15 Quast
- Page 153 and 154: Quastzonnaara R-f Questmn No Q18 Q1
- Page 155 and 156: Qu*stmnnaLr* R-f Cod~iig Shoat No o
- Page 157 and 158: Q19(B) Q19B Q19(B) (i.) Q19(C) Q19C
- Page 159 and 160: — Qu8stx0nrIUr9 Raf Quwstaon No Q
- Page 161: Quest ~onnalrm Rmf — QumstLOn No
- Page 164 and 165: Questiomaire Ref Coding Sheet Quest
- Page 166 and 167: Questionnaire Ref 1 Coding sheet No
- Page 169: — Qu=stlonnalra R-f Qumstaon No P
- Page 172 and 173: Questionnaire Ref Question No Q3B P
- Page 175: Quastaonnalre Re f —. Quest~on No
- Page 178 and 179: Questionnaire Re f Question No Q2(A
- Page 180 and 181: Q.estaonnaire Ref Question No Q4(C)
- Page 184 and 185: Questionnaire Ref Question No Q1O Q
- Page 186 and 187: CHILD HEALTH TSE FOLLOWING QUESTION
- Page 188 and 189: Questionnaire Ref Question No QIO(A
- Page 190 and 191: Quest ionnaire Re f Question No Q12
- Page 193 and 194: Quast>onnalr. Ref —. Quastlon No
- Page 195 and 196: Questlonna~r9 R-f Q1(A) Qumstaon No
- Page 197 and 198: Q2(C) Q3 Q3 Q3A Q3B Q3C -i Cadang S
- Page 199 and 200: Questaonnaxrm Ref Qu-st>on No Q4A Q
- Page 201 and 202: Qu8staonnaxrm Raf Qumstmn No Q8A Q8
- Page 203 and 204: cHSCK F CHECK G Q13 Q13A Q13A CHX F
- Page 205 and 206: Questxonnalra Raf Q14C Quest.on No
- Page 207 and 208: Quastlonnaare R-f Qu6st~on No Q17 Q
- Page 209: — Questuannaxre Ref Coding Shaat
- Page 213 and 214: Q.est.m.n~.r= Rmf Quastaon No Q3 Q4
- Page 215 and 216: Quastionnaara Ref Questzon No Q1O R
- Page 217 and 218: Questaonnalrm Raf Coding Shoot No o
- Page 219 and 220: Q29 Q30 Q31 Q32 Q33 Q34 Ref ●r*nc
- Page 221 and 222: Quastaonnaara Raf I Codang Shmat I
- Page 223 and 224: Q43 Q43 Q43 Q43 Q44 Q44 Q43 (1) Q43
- Page 225 and 226: Qu9sta0nnaar* Raf Qu*staon No Q46 Q
- Page 227 and 228: Q51 Q51 Q51 Q52 Q53 Q51 (2) Q51 (3)
- Page 229: Q56 Q56 Q57 Q58 Q58 Q58 Q58 Codang
QUastaonnaara Raf<br />
Q9<br />
Q9A<br />
Q9 B<br />
Questaon No<br />
CHECK A<br />
CHECK B<br />
CHECK C<br />
Coding she-t<br />
R-f ●rmncm<br />
I<br />
●NS CON’XIWUE WITH 1 UTB sECTION 0~<br />
IF CODED 2 AZ EITEER<br />
I<br />
GO TO NEXT=<br />
Q9<br />
Q9A<br />
Q9 B<br />
CNK/A<br />
CKKIB<br />
CHK/C<br />
No of<br />
Boxms/<br />
Characters<br />
2<br />
2<br />
2<br />
2<br />
2<br />
: 1? cODED 1<br />
ZION<br />
I<br />
Coding Iastructaons/Remarks<br />
values -3-02<br />
St>ll got soma of your<br />
natural teath or lost them<br />
all><br />
StLll has somo natural<br />
teeth .... .. .01<br />
Has lost all natural<br />
teeth . . . .... . . . .02<br />
Valu, s -3-04<br />
In general, do you go to the<br />
dent~st for a regular<br />
check-up~<br />
Rqul.sr chack-up. ........ .01<br />
occas~onal check-up ..... .02<br />
Only when havang trouble. 03<br />
Never goes to the dant Lst. .04<br />
~ues -- 02<br />
Yea. .............. ...... ...01<br />
No ..... ........ ..... . .02<br />
OK. .. . ........ .. ... .. -1<br />
~m --<br />
2<br />
M- thar* any chlldran<br />
under 16 Ln the hou~ohold?<br />
rem ..... ....... ... .. ..01<br />
No ................. ......02<br />
-e s -3-02<br />
Is this informant the Derson<br />
raspons~ble for any<br />
chLldran?<br />
Yam ...... .......... . ..01<br />
No .... .. .. . .. . . . ..02<br />
Values -3-16<br />
En’car numLI*r of children<br />
? CSECK A AND CSECK 0.<br />
133
Change language