---
FieldType: Text
FieldName: Q8_preferred_name
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Button
FieldName: Q10_braille
FieldFlags: 0
FieldValue: Off
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Button
FieldName: Q10_audio
FieldFlags: 0
FieldValue: Off
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Button
FieldName: Q10_na
FieldFlags: 0
FieldValue: Off
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Button
FieldName: Q10_print
FieldFlags: 0
FieldValue: Off
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Button
FieldName: Q10_language
FieldFlags: 0
FieldValue: Off
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Text
FieldName: Q10_language_is
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Button
FieldName: Q11_solicitor
FieldFlags: 49152
FieldValue: 0
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: Choice2
FieldStateOption: Off
---
FieldType: Button
FieldName: Q12_appoint
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: Choice2
FieldStateOption: Off
---
FieldType: Button
FieldName: Q14_providing_documents
FieldFlags: 49152
FieldValue: 0
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: 2
FieldStateOption: Choice2
FieldStateOption: Choice3
FieldStateOption: Off
---
FieldType: Button
FieldName: Q15 _APS
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: Choice2
FieldStateOption: Off
---
FieldType: Button
FieldName: Q16_APS_perm
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: Choice2
FieldStateOption: Off
---
FieldType: Button
FieldName: Q17_DS1500_BASRiS
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: Choice2
FieldStateOption: Off
---
FieldType: Button
FieldName: Q7_Video_for_BSL
FieldFlags: 0
FieldValue: Off
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Text
FieldName: Q14_ID_document_type
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Q19_CHI_number_is
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Button
FieldName: Q19_CHI_number
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: Choice2
FieldStateOption: Off
---
FieldType: Button
FieldName: Q20_healthcare_professional_type
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: 2
FieldStateOption: 3
FieldStateOption: Choice2
FieldStateOption: Choice3
FieldStateOption: Choice4
FieldStateOption: Off
---
FieldType: Text
FieldName: Q21_healthcare_professional_name
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Q21_healthcare_place
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Q21_healthcare_place_address
FieldFlags: 4096
FieldJustification: Left
---
FieldType: Text
FieldName: Q21_healthcare_email
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Q21_healthcare_telephone
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Button
FieldName: Q22_nominate_beneficiary?
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: Choice2
FieldStateOption: Off
---
FieldType: Text
FieldName: Q22_beneficiary_name
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Q22_beneficiary_dob_Day
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Q22_beneficiary_dob_Month
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Q22_beneficiary_dob_Year
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Q22_beneficiary_address
FieldFlags: 4096
FieldJustification: Left
---
FieldType: Text
FieldName: Q22_beneficiary_telephone
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Q22_beneficiary_email
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Button
FieldName: Q23_type_of_redress
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: Choice2
FieldStateOption: Off
---
FieldType: Text
FieldName: setting_1_name
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: setting_2_name
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: setting_3_name
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: setting_4_name
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: setting_1_type
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: setting_2_type
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: setting_3_type
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: setting_4_type
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: setting_1_date
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: setting_2_date
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: setting_3_date
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: setting_4_date
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Button
FieldName: Q25_aps
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: Choice2
FieldStateOption: Off
---
FieldType: Button
FieldName: Q26_aps_perm
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: Choice2
FieldStateOption: Off
---
FieldType: Button
FieldName: Q27_supporting_document
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: 2
FieldStateOption: Choice2
FieldStateOption: Choice3
FieldStateOption: Off
---
FieldType: Button
FieldName: Q28_known_different_name
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: Choice2
FieldStateOption: Off
---
FieldType: Text
FieldName: Q29_different_name
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Button
FieldName: Q30_legally_changed_name
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: Choice2
FieldStateOption: Off
---
FieldType: Text
FieldName: Q31_legally_been_known_by
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Button
FieldName: Q32_name_supporting_document
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: 2
FieldStateOption: Choice2
FieldStateOption: Choice3
FieldStateOption: Off
---
FieldType: Button
FieldName: Q33_relevant_payment
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: 2
FieldStateOption: Choice2
FieldStateOption: Choice3
FieldStateOption: Off
---
FieldType: Text
FieldName: Q34_payment _day
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Q34_payment_month
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Q34_payment_year
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Q35_payment_organisation
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Q36_payment_amount
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Button
FieldName: Q37_criminal_conviction
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: 2
FieldStateOption: Choice2
FieldStateOption: Choice3
FieldStateOption: Off
---
FieldType: Text
FieldName: client_name_on_account
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: client_sortcode
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: building_society_credit_union_number
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: client_account_number
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: BIC_SWIFT
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: clearing_code
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: IBAN
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: date_signed
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: signature
FieldFlags: 0
FieldJustification: Left
---
FieldType: Button
FieldName: Q18_redress_contact_healthcare
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: Choice2
FieldStateOption: Off
---
FieldType: Text
FieldName: solicitor_tel_number
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: solicitor_email_0
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: solicitor_firm_name
FieldFlags: 4096
FieldValue: MMA Legal Limited
FieldValueDefault: MMA Legal Limited
FieldJustification: Left
---
FieldType: Text
FieldName: Q13_solicitor
FieldFlags: 8388608
FieldValue: Solicitor
FieldValueDefault: Solicitor
FieldJustification: Left
---
FieldType: Text
FieldName: Q13_solicitor_last_name
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Q13_solicitor_first_name
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Button
FieldName: Q9_receive_information
FieldFlags: 49152
FieldJustification: Left
FieldStateOption: 0
FieldStateOption: 1
FieldStateOption: Choice2
FieldStateOption: Off
---
FieldType: Text
FieldName: Q7_solicitor_postcode
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Q7_solicitor_address_country
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: Q7_solicitor_address
FieldFlags: 4096
FieldJustification: Left
---
FieldType: Button
FieldName: Q7_letter_correspondence
FieldFlags: 0
FieldValue: Yes
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Button
FieldName: Q7_letter_home_address
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Text
FieldName: solicitor_tel
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Button
FieldName: Q7_telephone
FieldFlags: 0
FieldValue: Yes
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Text
FieldName: solicitor_email_1
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Button
FieldName: Q7_email
FieldFlags: 0
FieldValue: Yes
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Text
FieldName: client_first_name
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: client _last_name
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: client_DOB_day
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: client_DOB_month
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: client_DOB_year
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: client_address
FieldFlags: 4096
FieldJustification: Left
---
FieldType: Text
FieldName: client_address_country
FieldFlags: 8388608
FieldJustification: Left
---
FieldType: Text
FieldName: client postcode
FieldFlags: 8388608
FieldJustification: Left