HTML Preview Client Service page number 1.
CSRI CPA/10 years on
Version @ 24 November 1997
1
Client Time period Date of interview / /
d d m m y y
1. SOCIODEMOGRAPHIC INFORMATION
1.1 Date of birth / /
d d m m y y
1.2 Sex 1 Female
2 Male
1.3 Marital status 1 Single/unmarried
(from a legal perspective) 2 Married
3 Separated
4 Divorced
5 Widow/widower
9 Not known
1.4 What is your ethnic group?
(Refer to manual for assistance) Ethnic group _________________________
1.5 Country of birth Country
(Refer to coding sheet)
1.6 Mother tongue
1 National language
2 Other language (but having good knowledge of national language)
3 Other language (and having poor or no knowledge of national language)
1.7 Number of years of schooling
in general education Number of years schooling
1.8 Highest completed level of 1 Primary education or less
education 2 Secondary education
3 Tertiary / further education
4 Other general education
9 Not known
1.9 What further education or Specific vocational training (< 1 year)
vocational training have you Specific vocational training (> 1 year)
completed or are doing now? Tertiary level qualification /diploma
(Tick all boxes that apply) University degree (undergraduate)
University higher degree (postgraduate)
Other vocational training
CLIENT SERVICE RECEIPT INVENTORY (CSRI)
Care Programme approach and 10 year follow-up of the CinC Initiative