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[text name="variable_1" default="DATA"]
Pt. met with counselor for an individual session. [checkbox name="variable_1" value="Counselor|Pt."][textarea name="variable_1" default="sample text"]
Pt.[checkbox name="variable_1" value="reported|inquired"][textarea name="variable_1" default="sample text"][checkbox name="variable_1" value="Counselor|Pt."][textarea name="variable_1" default="Insert Text"] [checkbox name="variable_1" value="Counselor|Pt."][textarea name="variable_1" default="INSERT TEXT"][checkbox name="variable_1" value="Counselor|Pt."][textarea name="variable_1" default="INSERT TEXT"]
ASSESSMENT
Pt.appeared [select name="variable_1" value="coherent|semi-responsive|under the influence"] during the session. Pt. appears to be in [select name="variable_1" value="pre-contemplative|contemplative|maintenance|action"]state of change as evidenced by [textarea name="Did the Pt. have any indentifiable needs?" default="Insert Text"].
Pt. [textarea name="variable_1" default="Additional Information"]
[text name="variable_1" default="PLAN"]
Pt. will [checklist name="variable_1" value="continue|discontinue"] meeting with counselor for individual sessions.[checklist name="variable_1" value="Pt.|Counselor|Pt.and Counselor"] [textarea name="variable_1" default="sample text"][checklist name="variable_1" value="Pt.|Counselor|Pt.and Counselor"] [textarea name="variable_1" default="sample text"][checklist name="variable_1" value="Pt.|Counselor|Pt.and Counselor"] [textarea name="variable_1" default="Additional Information"]

Pt. met with counselor for an individual session.
Pt.
ASSESSMENT
Pt.appeared during the session. Pt. appears to be in state of change as evidenced by .
Pt.

Pt. will meeting with counselor for individual sessions.
Result - Copy and paste this output: