<%%DETAIL_VIEW_TITLE%%>

<%%VALUE(id)%%>
<%%COMBOTEXT(date)%%>
<%%VALUE(first_name)%%>
<%%VALUE(last_name)%%>
<%%VALUE(reason)%%>
<%%VALUE(date_of_last_menstrual_cycle)%%>
<%%VALUE(weight)%%>
<%%VALUE(emergency_contact_number)%%>
<%%VALUE(phone_number)%%>
<%%COMBOTEXT(status)%%>