This survey was developed in conjunction with the California Maternal, Child and Adolescent Health Action (MCAH ACTION) rural caucus and have been developed to help counties obtain information about the health of women, adolescents and children. The Core Survey includes five modules - dental health, asthma, childhood obesity, habits during pregnancy and family violence. The Adolescent Health Survey can be utilized as a stand-alone survey. In addition, the surveys and their respective modules are available in English and Spanish.
Documents on this page are Microsoft Word documents unless otherwise noted.
Module 1 - Dental Health (English ) (Spanish)
Module 2 - Asthma (English ) (Spanish)
Module 3 - Childhood Obesity ( English) (Spanish)
Module 4 - Habits During Pregnancy (English) (Spanish)
Module 5 - Family Violence (English) (Spanish)
Data Entry Templates
Important: Do not download the template again, after entering survey data. If you decide to re-download the template, PLEASE create a new name for it. If you do not change the name of the database, YOUR DATA WILL BE LOST!
Adolescent Health Survey (zip)