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BSN: Husn: HSN

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Saudia Sansawi
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14 views2 pages

BSN: Husn: HSN

Uploaded by

Saudia Sansawi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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BSN: HUSN: HSN:

LASTNAME FNAME MNAME RELA SE BDAY LCR STAT CAN HIGH NUCL REL. HAVE CARD NUMBER SOLO SENI DISABI PREGN BREA TYPE
TION X REGIST US REA GRADE? EAR TO NATION PSRENT OR/ LITY/W ANT? SRFEE OF
SHIP ER? D/W FAM HEAD AL ID? / WIT ITH ID? DING DISAB
RITE BELO OF WITH H ? ILITY
? NG? NUCLE ID? ID?
AR

OFW HEALTH CURRE CURRENT ATTEN WHY NOT DID WORK THOUGH LOCATIO PRIMARY WHAT BASIS OF IS A IS A ANY DID WHE OPERAT IS THERE AGE IN
? PROBLE NT GRADE? D ATTENDIN ATLEAST 1 DID NOT N OF OCCUPATIO INDUSTRY PAYMENT FARMER? FISHERFOL MEMBER AVAIL RE? ION BELOE 5 MONTHS/
M? ATTEN ALIVE? G HOUR PAST WORK. DID WORK N PSIC? K? GET SICK? MEDICAL TIMBA YEARS SEX
DING SCHOOL? WEEK? HAVE PSOC? TREATM NG OLD
SCHOO BUSNESS OR EN? PLUS? DIED?
L? WORK PAST
WEEK?
WORRIE UNABLE EAT SKIP ATE DID DID INTERN BENEFIC RECEIVE 4PS? SENIOR TUPAD? SOURCE SOURCE SOURCE TOILET WHERE HANDW WATER
D NOT TO EAT FEW MEAL? LESS? HAVE EXPEREI ET IARY OF D ? OF OF OF FACILIT LOCATE ASHING FOR
HAVING HEALTH KINDS FINANCI NCE ACCESS INSURA BENEFIT WATER DRINGK WATER Y? D? ? HANDW
FOOD Y OF AL ANY /WHAT BCE. SSS S? SUPPLY ING? LOCATE ASHING
FOOD ACCOU DISASTE TYPE? PHILHE ? D? ?
ONLY NT? R? ALTH.
GSIS?

AREA HOW TENURE WHAT ENERGY USED APPLIA VEHICLE


OF THE MANY STATUS YEAR USED COOKIN NCES S?
OF THE BEDRO ? HOUSE FOR G?
HOUSIN OMS CONTR LIGHTNI
G UNIT? ACTED? NG?

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