1 - ESDS

Questaonnaxrm Ref
Qu-st>on No
Q4A
Q4A
Q4A
CHECK D
Q5
Q6
Q6
Q6
.,
Codmq Shaat I No of
Rmfmrmnc9
BYR 2
LIVHTH 2
LIVYR 2
CH3C D 2
Q5 2
Q6 2
Mont h 12
YEAR 2
I
Boxes/
Characters
Codang Instructions/Ramarks
Val ues -3-92
Enter yaar of bLrth
Values -3-U
Enter month child etarzed
l>v~ng with informant
Values -3-9?
Enter yaar child started
llvLng with informant.
Rap@at above Lnstructlons
for Q4 for ●ach subsequmt
ch~ld, Ln dascend~ng year
order. If there are more
than 8 Chlldran mvolvad
re for to supervisor
ValUOS -3-02
Mm . ...... ............ . . 01
Womm . ....... ..... .. .. 02
Values -3-02
Ever had a baby7
Y*9 . . . . . . . . . . . . . 01
Wo . . . . . . . . . . . . . . . . . 02
ValU@S -3-20
How many ch~ldran?
Entar numb-r of lLVO broths
Values -3-12
Entmr numbar of month ● ldest
child was born
Values -3-91
Enter last two digits of
Y-U eldmst child was born
14?’