数据传送表
国家：_____________________________________
国内比赛地区：写明编码（见附录9）：
________________________________________________________________________________________________
总参赛人数：________________________________________________________
随访原始抽样样本量__________________________________________________
随访剔除人数：（＝死亡＋迁出＋<18岁人数）：_____________________________
应随访人数：________________________________________________________
随访应答人数：______________________________________________________
随访样本编号范围（ID号）：___________________________________________
样本的抽样方法：______________________________________________________
随访资料收集方法：____________________________________________________
资料收集起止日期：____________________________________________________
联系人：
姓名：________________________________________________________________
地址：________________________________________________________________
电话：________________________________________________________________
传真：________________________________________________________________
E-Mail：_____________________________________________________________
