IDENTIFICATION: | |||
1. | File number |
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2. | Hospital | 1. CHRACERH 2. YCH |
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3. | Initials of first and last name |
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SOCIODEMOGRAPHIC PROFILE: | |||
4. | Age: | 1. ≤15 years 2. 16 - 20 years 3. 21 - 25 years 4. 26 - 30 years 5. 31 - 35 years 6. >35 years |
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5. | Marital status | 1. Single 2. Married 3. Divorced 4. Widow |
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6. | Religion | 1. Catholic 2. Muslim 3. Protestant 4. Pentecostal 5. Jehovah’s Witness 6. Presbyterian |
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7. | Region of origin | 1. Adamawa 2. Central 3. East 4. Far North 5. North 6. Litorral 7. Northwest 8. South 9. Southwest 10. West 11. Foreign |
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8. | Socio-professional class | 1. Private sector employee 2. State employee 3. Unemployed woman |
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9. | Level of education | 1. None 2. Primary 3. Secondary 4. Superior |
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10. | Residence |
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