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3) Name of the Clinic: 4) Name of the doctor: 5) Since how long you are in this profession: LESS THAN 1 YEAR 1-5 YEAR 5-10 YEAR GREATER THAN 10 YEAR
6) What is your average fee for a patient? Rs.0-50 Rs.50-100 Rs. 100-500 Greater than Rs.500
7) What category of patients come to you? a. Income Group: Upper Class Middle Class Lower Class
b. Gender: MALE FEMALE BOTH
c. Age: 0-10 11-20 20-30 30-40 ABOVE 40
8) From where did you get your qualification? Homeopathic Hakeem Doctor Allopathic Doctor Any Other 9) How much education did you get? Any Other Courses Illiterate Under Primary Primary Middle Matric FA 10) What types of diseases are more prevailing in this area? 11) Usually what type of medication is given to hepatitis patients in this area? 12) Do you treat hepatitis patients? YES NO 13) If yes what type of medication you prefer? 14) If not where do you refer them? Hakeem NGO Government Hospital Some Other Doctor Any Other 15) How a drug addict is treated in your locality? .
16) Do you treat such patients? YES NO 17) If yes what type of medication you prefer? 18) If not then where do you refer them? Government Hakeem NGO Hospital Some Other Doctor Any Other 19) How a HIV positive patient is treated in this area? 20) Do you treat such kind of patients? YES NO 21) If yes what type of medication you prefer? 22) If not then where do you refer them? Government Hakeem NGO Hospital Some Other Doctor Any Other 23) Who sponsor you medicine? Yourself NGO Welfare Society Government Any Other .
24) How many times do you use a single syringe? 1-3 4-7 8-11 Greater than 11 25) Do you use sterilized syringe? YES NO 26) What is your method of sterilization? 27) What types of medical representatives come here? (Or Which companies send their medical representatives to you?) 28) What are the practices being followed in this area for the betterment of reproductive health? Brochures Condoms Any Other .