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D: Client is a [comment memo="Age"][text name="variable_1" default=""] year old, [comment memo="Marital Status"][text name="variable_2" default=""], [comment memo="Race/Ethnicity"][text name="variable_3" default=""], [comment memo="Reported Gender"][text name="variable_4" default=""] with a reported history of drug use that began at age [comment memo="Age of First Use of any Substance"][text name="variable_5" default=""] and opiate use that began around age [comment memo="Age of First Use of any opiate"][text name="variable_6" default=""]. Client has [comment memo="Number of Children- use no if none"][text name="variable_20" default=""] children. Client reports [comment memo="Living Environment and who they live with"][text name="variable_7" default=""]. Client reports living environment [select name="variable_8" value="is|is not"] safe, stable, and drug free. Client reports [comment memo="Current Medical Conditions"][text name="variable_9" default=""], with the last PCP visit being [comment memo="Last PCP Visit"][text name="variable_10" default=""], and reported [comment memo="Current medications"][text name="variable_11" default=""] when asked about current medications prescribed. Client reports [select name="variable_11" value="no history of being diagnosed past or present|history of being diagnosed past or present with|current symptoms of"] mental health conditions. Client [select name="variable_12" value="reports|denies"] DTS/DTO at this time. Client [select name="variable_13" value="reports|denies"] experience of or being a witness to domestic violence in the last 12 months.

Client reports employment status as [comment memo="Employment Status, Job Title, Full Time or Part Time, and if they are actively seeking current/better employment"][text name="variable_14" default=""]. Client reported highest level of education as [comment memo="Highest Formal Education"][text name="variable_15" default=""] and reports they [select name="variable_16" value="are|are not"] currently enrolled in a vocation/education program. Client reports participation in social or cultural activities which include [comment memo="Social/Cultural/Community Participation"][text name="variable_17" default=""]. Client reports [comment memo="Natural/Family Supports"][text name="variable_18" default=""] and [select name="variable_19" value="does|does not"] want family involved in treatment at this time.
D: Client is a Age year old, Marital Status, Race/Ethnicity, Reported Gender with a reported history of drug use that began at age Age of First Use of any Substance and opiate use that began around age Age of First Use of any opiate. Client has Number of Children- use no if none children. Client reports Living Environment and who they live with. Client reports living environment safe, stable, and drug free. Client reports Current Medical Conditions, with the last PCP visit being Last PCP Visit, and reported Current medications when asked about current medications prescribed. Client reports mental health conditions. Client DTS/DTO at this time. Client experience of or being a witness to domestic violence in the last 12 months.

Client reports employment status as Employment Status, Job Title, Full Time or Part Time, and if they are actively seeking current/better employment. Client reported highest level of education as Highest Formal Education and reports they currently enrolled in a vocation/education program. Client reports participation in social or cultural activities which include Social/Cultural/Community Participation. Client reports Natural/Family Supports and want family involved in treatment at this time.
Result - Copy and paste this output: