1 - ESDS

Q32
Q33
Q34
Q35
Q35
Q36
cw-
Q33 INHS
Q34 IWNPX
Q35 IMTH
Q35 IYR
Q36
No of
Boxm8/
Characters
2
2
2
2
2
2
tia.ng Instruction8/Ramarks
Valum -3-03
Who was sterLlised?
YOursalf ... ..............01
Hueband/patin9r ..........02
Both ........ .............03
Values --
2
CWII oparation carr~ad out
under NNS?
NNs ......... .............01
Othar ... .. ............ ...02
Did you have operation: -
As a hospital mpatiant
staying overrught or
long-r ...... .......... ...01
As a hospital outpatient. .02
At your doctor’s ●urgmcy. .03
At a clinic ..............04
Som*wh*ra ●lse ...........05
~es
--
En’car manth of own
operation.
Ent9r laat two digits of
Y*U of own operation.
Rmpaat abovm LnstructLOnm
for Qucstlons 33-35 for
humband/partnmr.
Values -3-02
Oparat>on less than two
years ago?
Yen ........ ....... .-.....01
No ....... .. ......-.......02
190