Writer attempted call to re-engage client to treatment due to [select name="variable_1" value="24 hour|72 hour|7 day| "] absence from program.
[checkbox name="variable_2" value="Call could not be completed due to number not being on file.|Call could not be completed due to number being out of service.|Call was connected, was not answered, and a message was left for client to call clinic.|Call was connected but message could not be left due to voicemail box.|Call connected and was answered by"][comment memo="Add information here if call was answered or leave blank"][textarea name="variable_3" default=""]
[checkbox name="variable_4" value="Writer will attempt re-engagement x2 more.|Writer will attempted re-engagement x1 more.|Writer will prepare and send re-engagement letter to address on file.|Writer will staff client to determine if contact information is accurate."] [comment memo="If other follow-up is needed use text box to explain, or leave blank if not needed"][text name="variable_5" default=""]
Result - Copy and paste this output: