CM6 PUBLIC SECTOR GOVT. HOSPITAL 1 PROBE: GOVT. HEALTH CENTRE 2 ANYWHERE ELSE? GOVT. HEALTH POST 3 COMMUNITY WORKER 4 MOBILE / OUTREACH CLINIC 5 CIRCLE ALL PROVIDERS MENTIONED, OTHER PUBLIC (SPECIFY) BUT DO NOT PROMPT WITH ANY SUGGESTIONS. PROBE TO IDENTIFY EACH TYPE OF PRIVATE MEDICAL SECTOR SOURCE. PRIVATE HOSPITAL / CLINIC 7 PRIVATE PHYSICIAN 8 IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE PHARMACY 9 PRIVATE SECTOR, WRITE THE NAME OF MOBILE CLINIC 10 THE PLACE. OTHER PRIVATE MEDICAL (SPECIFY) OTHER SOURCE RELATIVE / FRIEND 12 SHOP 13 TRADITIONAL PRACTITIONER 14 OTHER (SPECIFY) __________________________________96 CM7 Was (NAME) given any medicine to YES 1 treat this illness? NO 2 END 98 END DON’T KNOW CM8 (NAME) ANTIBIOTIC PILL / SYRUP 1 INJECTION 2 PROBE: ANY OTHER MEDICINE? ANTI-MALARIALS 3 CIRCLE ALL MEDICINES GIVEN. WRITE PARACETAMOL / PANADOL / BRAND NAME(S) OF ALL MEDICINES ACETAMINOPHEN 4 MENTIONED. ASPIRIN 5 IBUPROFEN 6 OTHER (SPECIFY) (NAMES OF MEDICINES) 98 DON’T KNOW
CM6 PROBE: ANYWHERE ELSE? CIRCLE ALL PROVIDERS MENTIONED, BUT DO NOT PROMPT WITH ANY SUGGESTIONS. PROBE TO IDENTIFY EACH TYPE OF SOURCE. IF UNABLE TO DETERMINE IF PUBLIC OR PRIVATE SECTOR, WRITE THE NAME OF THE PLACE. PUBLIC SECTOR GOVT. HOSPITAL 1 GOVT. HEALTH CENTRE 2 GOVT. HEALTH POST 3 COMMUNITY WORKER 4 MOBILE / OUTREACH CLINIC 5 OTHER PUBLIC (SPECIFY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL / CLINIC 7 PRIVATE PHYSICIAN 8 PRIVATE PHARMACY 9 MOBILE CLINIC 10 OTHER PRIVATE MEDICAL (SPECIFY) OTHER SOURCE RELATIVE / FRIEND 12 SHOP 13 TRADITIONAL PRACTITIONER 14 OTHER (SPECIFY) __________________________________96 CM7 Was (NAME) given any medicine to treat this illness? YES 1 NO 2 DON’T KNOW 98 END END CM8 (NAME) PROBE: ANY OTHER MEDICINE? CIRCLE ALL MEDICINES GIVEN. WRITE BRAND NAME(S) OF ALL MEDICINES MENTIONED. (NAMES OF MEDICINES) ANTIBIOTIC PILL / SYRUP 1 INJECTION 2 ANTI-MALARIALS 3 PARACETAMOL / PANADOL / ACETAMINOPHEN 4 ASPIRIN 5 IBUPROFEN 6 OTHER (SPECIFY) DON’T KNOW 98