SQL Advance
Client Name:
{{ client.fname }} {{ client.lname }}
Select Unit:
{{ place_str }}
{% for unit in units %}
{{unit.unit_id}} -- {{ unit.unit_lname }}
{% endfor %}
Demographic Data
Alias(es):
Allergy:
Address:
Apartment:
City:
State:
Postal Code:
Phone:
Mobile Phone:
Other Phone:
Sex Assigned at Birth:
{% for sex in sex_list %}
{{ sex[:60] }}{% if sex|length > 60 %}...{% endif %}
{% endfor %}
Gender Identity:
{% for value in gender_list %}
{{ value[:60] }}{% if value|length > 60 %}...{% endif %}
{% endfor %}
Sexual Orientation:
{% for value in orient_list %}
{{ value[:60] }}{% if value|length > 60 %}...{% endif %}
{% endfor %}
Race (Identity):
{% for value in race_list %}
{{ value[:60] }}{% if value|length > 60 %}...{% endif %}
{% endfor %}
Black (Detail):
{% for value in race_detail %}
{{ value[:60] }}{% if value|length > 60 %}...{% endif %}
{% endfor %}
Asian (Detail):
{% for value in asian_list %}
{{ value[:60] }}{% if value|length > 60 %}...{% endif %}
{% endfor %}
Pacific Islander (Detail):
{% for value in pacific_list %}
{{ value[:60] }}{% if value|length > 60 %}...{% endif %}
{% endfor %}
Ethnicity (Identity):
{% for value in ethnic_list %}
{{ value[:60] }}{% if value|length > 60 %}...{% endif %}
{% endfor %}
Hispanic/Latino (Detail):
{% for value in ethnic_detail %}
{{ value[:60] }}{% if value|length > 60 %}...{% endif %}
{% endfor %}
Place of Birth:
US Citizen:
{% for value in bool_list %}
{{ value[:60] }}{% if value|length > 60 %}...{% endif %}
{% endfor %}
Veteran:
{% for value in bool_list %}
{{ value[:60] }}{% if value|length > 60 %}...{% endif %}
{% endfor %}
Preferred Language:
{% for value in lang_list %}
{{ value[:60] }}{% if value|length > 60 %}...{% endif %}
{% endfor %}
Religion:
{% for value in religion_list %}
{{ value[:60] }}{% if value|length > 60 %}...{% endif %}
{% endfor %}
Marital Status:
{% for value in marital_list %}
{{ value[:60] }}{% if value|length > 60 %}...{% endif %}
{% endfor %}
Parental Status:
{% for value in parent_list %}
{{ value[:60] }}{% if value|length > 60 %}...{% endif %}
{% endfor %}
Household Composition:
{% for value in house_list %}
{{ value[:60] }}{% if value|length > 60 %}...{% endif %}
{% endfor %}
Submit
{% include '_footer.html' %}