atoll Name
Island Name
ciiaic Nama
Clinte Locacion
Interviewer Name
CLINIC FACILITIES FORM
L.
Deseribe clinic Locarion in ralarion to other faciliries, ie.
2.
Describe boundaries of clinic serving area.
(If clinic serving area is
part of an island, describe what part and how many other clinics are on
island. Name island if clinic serves only one island. I clinic serves
adjacent islands, name all islands in the atoll.)
this page.
3.
feet by
beret teed Geen fener ree? bee
ra rsa en~s aes ess
c~
Skerch a map on back of
Outside dimensions of building.
Wood
Brick
Conereta block
Stone
Masonite
Other (please svecify)
Roof material:
eee er
5.
feet
Butiding wall material:
bee Bed Gel Ge bd
4
stores,
docks, airstrip, homes.
Sketch a map on back of this page indicaring ralative location of clinic.
Metal
Weed and tar composite shingles
Thatch
Tile
Other (please specity)