# Twelve blank local-source review fields

A separate adult paper source-review slip has twelve truly blank answer areas: practical question; primary provider/source; source publication/update date; actual check date; exact narrow fact with units/place/limits; unknowns; source fact versus invented teaching example; actual action/visit/search if separately done; ownership/permission/allowed use; child-safe nonpersonal version; full words alternative; next review date. It has no automatic browsing, retrieval, submitted observation or prefilled local result. A completed factual brochure note and the blank capture remain visibly different.

## Practical question

[Empty adult writing space]

## Primary provider/source

[Empty adult writing space]

## Source publication/update date

[Empty adult writing space]

## Actual check date

[Empty adult writing space]

## Exact narrow fact with units/place/limits

[Empty adult writing space]

## Unknowns

[Empty adult writing space]

## Source fact versus invented teaching example

[Empty adult writing space]

## Actual action/visit/search if separately done

[Empty adult writing space]

## Ownership/permission/allowed use

[Empty adult writing space]

## Child-safe nonpersonal version

[Empty adult writing space]

## Full words alternative

[Empty adult writing space]

## Next review date

[Empty adult writing space]