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