Assessment & Plan Elements
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Gender[select name="variable_1" value="Male |Female|Other"]
[checkbox name="variable_1" value="Pet|Adopted Child|Foster Child|Pregnancy |Miscarriage| Abortion|Death|Twins|Identical Twins|Family Relationships"]
Relationship Status
[select name="variable_1" value="Marriage|Separation in fact|Legal separation|Divorce|Engagement|Engagement and cohabitation|Engagement and separation|Nullity|Legal cohabitation|Legal cohabitation and separation in fact|Legal cohabitation and official (legal) separation|Committed relationship|Cohabitation|Cohabitation and separation|Non-sentimental cohabitation|Non-sentimental cohabitation and separation|Casual relationship or dating (short-term)|Casual relationship and separation|Temporary relation / One night stand|Love Affair"]

Emotional Relationships
[checklist name="variable_1" value="Indifferent / Apathetic|Distant / Poor|Cutoff / Estranged|Cutoff Repaired|Discord / Conflict|Hate|Harmony|Friendship / Close|Best Friends / Very Close|Love|In Love|Emotional Connection /Spiritual Relationship|Hostile|Distant-Hostile|Close-Hostile|Fused-Hostile|Fused|Distrust|Violence|Distant-Violence|Close-Violence|Fused-Violence|Focused On|Focused On Negatively|Abuse|Physical Abuse|Emotional Abuse|Sexual Abuse|Neglect (abuse)"]
Relationship [checklist name="variable_1" value="Never Met|Manipulative|Controlling|Jealous|Fan/Admirer|Limerence|Plain / Normal"]
Gender

Relationship Status


Emotional Relationships

Relationship

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