1 - ESDS
1 - ESDS
1 - ESDS
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
MWQ61 WIIich of ttw foibwingmethod(s)of ptwenting pmgf’mncy,ifany,<br />
did wu usuallyuu hwnadlmtdy bofomthaW<br />
NPU had no saxual mlmtbnahip, ring —_..__.-<br />
If no mcthad Wad ●t W, Ifng .. . . . . . . . . . .<br />
If you Ww pngnmt. ring ------------<br />
If using OM w mom mcth0d8, ring all fhc<br />
n~ that apply<br />
‘Amhdmvml.........................................................................<br />
6hnUVcOnd0m .................................................................<br />
.Safapmiadlhytim m8thad . ..<br />
Cq#dfaphmgm ..................................................................<br />
cOrdmc@lve sponge ............ .................. ......... ..........<br />
Pllt mlnlFM(pmgastwononly) ............... .... ........ .........<br />
P& cmmbind pin(mcbding muiti-phmicPW)<br />
PIK notaum if mid orCOmbmd .. ....... .... ...... . ..............<br />
Plasm Wlfh the bmnd - bOiW .. . . ---------<br />
luo/milik!lr8+torim davica ................... ............. ...........<br />
Fc.srn@_yaifmsu~ (qwmWdes) . . .<br />
&ii tihoul 90XUOIhtmTWIK4 kl avoid PM911WlCY<br />
1~ . .......................................... ..............................<br />
AlWi19r nwuwd<br />
Phso Writsits n- b,low ------------<br />
MWQ62 TO TNOSE WHO ARS NOT PNSGNANT ANO WHO HAVE NOT HAD<br />
ANY OPERA- THAT PRSVENTS PREOfdANCY<br />
WIWI of tha failowingmatkmd8of pmvmtlng pregnancyifmy,<br />
am yuu, and youriIwt9nd/pwlnw usually USi18gat prasmtt7<br />
If you had no saxual relationship, ring . . . . . .<br />
If m nmthod Und ●t all, Iing .— . . ..--. . ..-.. -----<br />
Nwingomarrnc+anmthc.ch,ringalltha<br />
n~ that ●pply<br />
W?4tWrawal .........................................................................<br />
Stmamfmmdom.................................................................<br />
Safo psdwMyttm mathod .......................... ......... ... .....<br />
C@tifhagm ..................................................................<br />
Colltmcspthwapange ........ .................... . ... ...................<br />
Plk mid P4N(ping-n oniy) .. ..... ...... ..... ...............<br />
PIN rnmbinedF411 (Includingmultl.plurncPtil) .. ...<br />
Pin not- if rrirdor combined............. .... ...................<br />
Pleaw wdta ma bmnd nm’m Lwlow.. . . . . . . .<br />
Iuolcdblmm.utcdm &via .................. . ................ .......<br />
Fon~oiww@Pornti@9 (8PcnMcidas)<br />
GoinEwithoutamamlimerccwsc to avoidPmgmncy<br />
Inja.dbns ............................................................................<br />
AWthW ftWLhOd<br />
Pleaaa W* its nama below ..... .... . . . . . . . . . .<br />
MlarinE ..................................................................................<br />
[01<br />
[0]<br />
PI<br />
[0]<br />
lo]<br />
[1]<br />
[0]<br />
[0]<br />
[0]<br />
[0]<br />
[0]<br />
[0]<br />
[0]<br />
[0]<br />
[0]<br />
[0)<br />
1%<br />
la%<br />
5%<br />
35%<br />
5%<br />
0%<br />
o%<br />
8?4<br />
13s<br />
3%<br />
8%<br />
0%<br />
0?4<br />
0%<br />
o%<br />
4?4<br />
- Ralum formto<br />
lntewiewr<br />
Tafal n-r of<br />
thnassnmmnd<br />
Citad<br />
I n = 106 I<br />
— G0t0Ms6<br />
— GOto WST6AB<br />
1-Gat0MvAx3<br />
12 A13
Change language