Number of chronic problems (arthritis pain, etc.)
*
un
aa
Number of accidents or fractures ver veek
a
a
‘ Questionnaire for Clinic Xay Holder - Page 6
57.
Number of other problems (please specify)
58.
39.
How many times during the year do you have a medical emergenc7
which you camnot take care of here?
Are you able to make radio contact for medical consultcation in the event
of a medical emergenc7?
( ]
Yes ——————»
How long dces it usually take before you are talxing to
a paysictan?
hours
{ ]
Yo
Why noc?
~———»
{ ]
{ ]
{ ]
60.
Lack of reliable radio contact
Lack of available physician to concact
Other (please. specify)
Describe radio commmication system:
{ ]
[ ]
( ]
Nome in clinic serving area
Twoeway radio ae clinic
Twoeway radio at other locacion ——<->
(please specify location)
(please specify distance from clinic in kilometers)
61.
Can the twoeway radio contact Majuro or Ebeyt on a regular basis?
( ]
{ ]
62.
Yes
No
Are home visits conducted by clinic staff?
( ]
[ ]
Yes ——» How many times per month?
No