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PDF, 1536K - Measure DHS

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479 Where did you seek advice or treatment?<br />

Anywhere else?<br />

RECORD ALL MENTIONED.<br />

LAST BIRTH<br />

NAME _______________________<br />

GOVERNMENT<br />

HOSPITAL ...................................A<br />

HEALTH CENTER .......................B<br />

HEALTH STATION/CLINIC..........C<br />

HEALTH POST ............................D<br />

COMMUNITY-BASED OUTLET ..E<br />

OTHER GOV’T _____________ F<br />

(SPECIFY)<br />

NONGOVERNMENTAL (NGO)<br />

NGO HEALTH FACILITY............ G<br />

COMMUNITY-BASED OUTLET ..H<br />

OTHER NGO ______________ I<br />

(SPECIFY)<br />

PRIVATE MEDICAL<br />

PVT. HOSPITAL .......................... J<br />

PVT.DOCTOR/CLINIC.................K<br />

PHARMACY................................. L<br />

OTHER PVT.<br />

MEDICAL _______________ M<br />

(SPECIFY)<br />

OTHER SOURCE<br />

DRUG VENDOR ..........................N<br />

SHOP .......................................... O<br />

TRAD. PRACTITIONER...............P<br />

OTHER<br />

X<br />

(SPECIFY)<br />

NEXT-TO-LAST BIRTH<br />

NAME _______________________<br />

GOVERNMENT<br />

HOSPITAL...................................A<br />

HEALTH CENTER ......................B<br />

HEALTH STATION/CLINIC.........C<br />

HEALTH POST ...........................D<br />

COMMUNITY-BASED OUTLET..E<br />

OTHER GOV’T ____________ F<br />

(SPECIFY)<br />

NONGOVERNMENTAL (NGO)<br />

NGO HEALTH FACILITY ........... G<br />

COMMUNITY-BASED OUTLET..H<br />

OTHER NGO _______________ I<br />

(SPECIFY)<br />

PRIVATE MEDICAL<br />

PVT. HOSPITAL.......................... J<br />

PVT.DOCTOR/CLINIC ................K<br />

PHARMACY ................................ L<br />

OTHER PVT.<br />

MEDICAL ______________ M<br />

(SPECIFY)<br />

OTHER SOURCE<br />

DRUG VENDOR..........................N<br />

SHOP ......................................... O<br />

TRAD. PRACTITIONER ..............P<br />

OTHER<br />

X<br />

(SPECIFY)<br />

480 GO BACK TO 453 IN NEXT COLUMN;<br />

OR, IF NO MORE BIRTHS, GO TO<br />

481.<br />

GO BACK TO 453 IN NEXT<br />

COLUMN; OR, IF NO MORE BIRTHS,<br />

GO TO 481.

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