1 - ESDS

DWQ62 Plan put ●nng around tlw nunlmr, c.ppmdam. staimnntwh!ch
appllu to ymu●t pmmlt
DWQS3MET WWSI mdhmt didyou urn mosfoIlen7
W onlyu-d ono method [4]
VA umd mom than one meumd at a time [0]
SomedmasW* uwd one meftwd, samdilmesanammr P.]
PINU look at fha Ilst ●t 13WQS19forma numr of me
mcth.ai and vadwOut nutir in On box
SheWWamdom P]
Dwa64LNQ How longhad thmmemod(Cambmatmnof mathods)hmI the one you
usual~ UW, mat mtha On* you us.amostolhn?
LassUun 3 monms [01
Atkae43 months,I*s than 6 months [0]
At laast6 months,Iesa than 1 year [0]
At bad i ymr, km than 2 Yearn
At lead 2 yearn El
Dwa66 Whkh of tha followngmctlmd(s)of pravwtblg pregnancy,If any, dld
you (or yourpwbw) usuallyu= mwnndlatalybdam fim~
If ymuhad no suual mlationaht% ring .-__. _._._.
If no mathod und ●t ●ll, ring . . . . . . . . . . . .
If wu W- ptmgnant.nng .---—-— -.....-.-.
If usually ualng OIU or mom mathod~ ring all ma nwnbmm
that ●pply
~drawd
Sheathl.wndom
SafmPmmMhyihm mathod
Ca@dlmphmgm
ColtmaplW* -pony
Pill mm PIII(pmgatimn ontf)
Pill ambmcd ptll(Inchnlng mul!-phmo Pill)
Pill notsum If mmlor combmod
PIMsa wntmthe brand nanm balm _...__. _______
lUOlcaUlmmutnnrwdavla
Faamwgawspmywm-nos (sponmcdas)
GOIWvntlmti -xual lntercou~ to avoidPfD9Mlh7f
Inpahns
AnothMmethod
PlemadWnti lta nntle below --- —— ----
[1]
[0]
[0]
[01
[1]
[01
[0]
[0]
[0]
PI
[0]
[0]
[01
[1]
[0]
[0]
— GO10DWJS4LNG
— Go to D~S3MET
— Ga to 0AQS4LNG
I n-a I
—GOtuowxs
— Rdum formto
InfeMMr
— Rafum formto
lmnwlrwer
13 300