Atoll Name
Island Name
clinic Vame
Clinie Location
Interviewer Name
CLINIC FACILITIES FORM
Describe clinic location in ralation to other facilisies, te.J stores,
docks, airstrip, homes.
Sketch a map on back of chis page inodicaring ralative location of clinic.
Describe boundaries of clinic sarving area.
(If clinic se
g 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. If ¢
adjacent islands, name all islands in the atoll.) Skercch a
this page.
feet by
feet
Outside dimensions of building.
tnt td hd bt
ares eo el
Building wall material:
Weod
Brick
Concreta biock
Stone
Masonite
Other (please specity)
ae es re
Roof material:
Metal
Woed and tar composite shingles
Thateh
Tile
Other (please specify)
ic serves
map on back of