a. Address_____
[] REG [Region]
[] CWD [Changwat Province]
[] AMP [Amphoe District]
[] TMB [Tambon Sub-district]
Region, Province, District, Sub-district
Record code of Region, Province, District, Sub-district in the check box provided, the same as in the PHC1 form. For example: region 2, province 56, district 01, sub-district 06 can be recorded as:
REG 2
CWD 56
AMP 01
TMB 06