B. Client Exit Interview
this interview is based on prior informed consent by the
client (see appendix 1 for a sample consent form)
1a
province/region
1f
Service from which client is exiting
family planning
Management of Stis
Maternal and newborn care
prevention of unsafe abortion and
management of post-abortion care
Hiv counselling and testing
Management of oi or Hiv infection
other (specify):
don't know
1b
district
1c
facility
1d
interview number
1g
Sex of client
female
Male
1e
date of interview
dd/MM/YYYY
2
What is your age?
Summary :
Client Exit Interview this interview is based on prior informed consent by the client (see appendix 1 for a sample consent form) 1a province/region 1f Service from which client is exiting family planning Management of Stis Maternal and newborn care prevention of unsafe abortion and management of post-abortion care Hiv counselling and testing Management of oi or Hiv infection other (specify): don't know 1b district 1c facility 1d interview number 1g Sex of client female Male 1e date of interview dd/MM/YYYY 2 What is your age?
Tags :
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