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Questionnaire Ref<br />

Question No<br />

Q1O<br />

QIOi<br />

Qll<br />

Qll(i)<br />

Q12<br />

Q12(i)<br />

Q13<br />

Coding Sheet<br />

Reference<br />

Q1O<br />

QIOi<br />

Qll<br />

Qlli<br />

Q12<br />

Q12i<br />

Q13<br />

No of<br />

Boxes/<br />

Characters<br />

2<br />

2<br />

2<br />

2<br />

2<br />

2<br />

2<br />

Coding Instructions/Remarks<br />

Values -3-02<br />

(Applies only if coded 1 at<br />

Check A/B)<br />

Any children have longstanding<br />

illness?<br />

Yes (any child ) ...........Ol<br />

No (none of them) ........02<br />

Values -3-10<br />

Enter number of children<br />

affected<br />

Values -3-02<br />

Children have to ..cut-down<br />

on things due to illness?<br />

Yes (any child) ..........01<br />

No (none of them) ........02<br />

Values -3-10<br />

Enter number of children<br />

affected<br />

Values -3-02<br />

Any children talk to doctor<br />

Yes (any child) ..........01<br />

No (none of them) ........02<br />

Values -3-10<br />

Enter number of children for<br />

whom contact was made<br />

Values -3-02<br />

Any children outpatients at<br />

hospital ?<br />

Yes (any child) ..........01<br />

No (none of them) ........02<br />

lJ4<br />

f“

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