Last name
<%%SELECT%%><%%VALUE(last_name)%%><%%ENDSELECT%%>
First name
<%%SELECT%%><%%VALUE(first_name)%%><%%ENDSELECT%%>
Gender
<%%SELECT%%><%%VALUE(gender)%%><%%ENDSELECT%%>
Sexual orientation
<%%SELECT%%><%%VALUE(sexual_orientation)%%><%%ENDSELECT%%>
Age
<%%SELECT%%><%%VALUE(age)%%><%%ENDSELECT%%>
Image
State
<%%SELECT%%><%%VALUE(state)%%><%%ENDSELECT%%>
Mobile
<%%SELECT%%><%%VALUE(mobile)%%><%%ENDSELECT%%>
Tobacco usage
<%%SELECT%%><%%VALUE(tobacco_usage)%%><%%ENDSELECT%%>
Alcohol Intake
<%%SELECT%%><%%VALUE(alcohol_intake)%%><%%ENDSELECT%%>
History
<%%SELECT%%><%%VALUE(history)%%><%%ENDSELECT%%>
Surgical history
<%%SELECT%%><%%VALUE(surgical_history)%%><%%ENDSELECT%%>
Obstetric history
<%%SELECT%%><%%VALUE(obstetric_history)%%><%%ENDSELECT%%>
Genetic diseases
<%%SELECT%%><%%VALUE(genetic_diseases)%%><%%ENDSELECT%%>