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~~ <br />17. IS YOUR «PERSON» OVER 18 YEARS OF AGE? <br />Select YES or NO based on the response. <br />Special Instructions: Use appropriate relationship when referring to person diagnosed with <br />cancer. If yes, go to the next question.. If no, skip to Question 22. <br />18. IS YOUR «PERSON» AVAILABLE FOR AN INTERVIEW? <br />Select YES or NO based on the response. <br />Special Instructions: If no, go to the next question. If yes, ask to speak with that person and <br />skip to Question 22. Inhoduce yourself to the new interviewee and tell them the purpose of the <br />survey. <br />19. IS YOUR «PERSON» DECEASED? <br />Select YES or NO based on the response. <br />Special Insri-uctions: Ask question politely.. Use appropriate relationship when referring to <br />person diagnosed with cancer. If yes, go to next question. If no, skip to Question 22, <br />20. WHAT WAS YOUR «PERSON'S» DATE OF DEATH? <br />Record the month, date, and year person died.. <br />Special Instructions: Use appropriate relationship when refen7ng to person diagnosed with <br />cancer. <br />Data Entrv Format: MM/L)D/YYYY <br />21. WHERE DID YOUR «PERSON» LIVE AT THEIR TIME OF DEATH? <br />Record staCe or country lived in at time of death? <br />Special Inshuctions: Use appropriate relationship when referring to person diagnosed with <br />cancer. <br />22. MAY WE INTERVIEW YOU ABOUT YOUR «PERSON'S» CANCER <br />DIAGNOSIS? <br />Select YES or NO based on the response. <br />~ecial Instructions: If no thank them for their time and end interview <br />23. WHAT IS YOUR «PERSON'S» NAME? <br />Record first and last name of person interviewee is reporting on. <br />24. WHAT IS YOUR «PERSON'S» DOB? <br />Record date of birth of person diagnosed with cancer. <br />Data Entry Format: MNI/DD/YYYY <br />25. WHAT IS YOUR «PERSON'S» GENDER? <br />We may not need to ask this question <br />Record gender of the person diagnosed with cancer. <br />26. WHAT IS YOUR «PERSON'S» RACE? <br />Record race of person diagnosed with cancer, <br />Special Instructions: If asked why racial information is needed, explain that certain ethnicities <br />have a higher risk for cancer than others. <br />Page 30 of 47 <br />