[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?

YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.

NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ENTER OTHER:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

ENTER OTHER:

[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8