---
FieldType: Text
FieldName: client_last_name
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: client_DOB_day
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: client_DOB_month
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: client_DOB_year
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: client_address
FieldFlags: 4096
FieldJustification: Left
---
FieldType: Text
FieldName: client_address_country
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: client_postcode
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: client_first_name
FieldFlags: 0
FieldJustification: Left
---
FieldType: Button
FieldName: contact_email_check
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Text
FieldName: contact_email
FieldFlags: 0
FieldJustification: Left
---
FieldType: Button
FieldName: contact_tel_check
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Text
FieldName: contact_tel
FieldFlags: 0
FieldJustification: Left
---
FieldType: Button
FieldName: contact_letter_home
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Y
---
FieldType: Button
FieldName: contact_letter_correspondence
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Text
FieldName: contact_correspondence_addres
FieldFlags: 4096
FieldJustification: Left
---
FieldType: Text
FieldName: contact_correspondence_country
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: contact_correspondence_postcode
FieldFlags: 0
FieldJustification: Left
---
FieldType: Button
FieldName: contact_video_check
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Y
---
FieldType: Text
FieldName: client_preferred_name
FieldFlags: 0
FieldJustification: Left
---
FieldType: Button
FieldName: contact_necessary_radio
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: client_address
FieldStateOption: correspondence_addres
---
FieldType: Button
FieldName: contact_format_braille
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Button
FieldName: contact_format_large
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Button
FieldName: contact_format_audio
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Y
---
FieldType: Button
FieldName: contact_format_other
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Text
FieldName: contact_format_other_text
FieldFlags: 0
FieldJustification: Left
---
FieldType: Button
FieldName: contact_format_na
FieldFlags: 0
FieldJustification: Left
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Button
FieldName: help_complete
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: No
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Text
FieldName: help_first_name
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: help_last_name
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: help_telephone
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: help_email
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: help_contact_type
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: help_contact_firm
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: identity_documents
FieldFlags: 0
FieldJustification: Left
---
FieldType: Button
FieldName: identity_radio
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: Find
FieldStateOption: Later
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Button
FieldName: ti_aps
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: No
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Button
FieldName: ti_aps_confirm
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: No
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Button
FieldName: ti_ds1500
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: No
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Button
FieldName: ti_professional_check
FieldFlags: 33587200
FieldValue: Y
FieldJustification: Left
FieldStateOption: No
FieldStateOption: Off
FieldStateOption: Y
---
FieldType: Button
FieldName: ti_nhs_number_check
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: No
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Text
FieldName: ti_nhs_number
FieldFlags: 0
FieldJustification: Left
---
FieldType: Button
FieldName: ti_prof_type
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: Consultant
FieldStateOption: District
FieldStateOption: GP
FieldStateOption: Off
FieldStateOption: Specialist
---
FieldType: Text
FieldName: ti_prof_name
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: ti_prof_place
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: ti_prof_address
FieldFlags: 4096
FieldJustification: Left
---
FieldType: Text
FieldName: ti_prof_email
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: ti_prof_tel
FieldFlags: 0
FieldJustification: Left
---
FieldType: Button
FieldName: ben_check
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: No
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Text
FieldName: ben_name
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: ben_DOB_day
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: ben_DOB_month
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: ben_DOB_year
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: ben_address
FieldFlags: 4096
FieldJustification: Left
---
FieldType: Text
FieldName: ben_tel
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: ben_email
FieldFlags: 0
FieldJustification: Left
---
FieldType: Button
FieldName: redress_type
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: Fixed
FieldStateOption: Individual
FieldStateOption: Off
---
FieldType: Text
FieldName: cs_1_name
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: cs_1_typ
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: cs_1_date
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: cs_2_name
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: cs_2_type
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: cs_2_date
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: cs_3_name
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: cs_3_type
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: cs_3_date
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: cs_4_name
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: cs_4_type
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: cs_4_date
FieldFlags: 0
FieldJustification: Left
---
FieldType: Button
FieldName: aps
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: No
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Button
FieldName: aps_confirm
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: No
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Button
FieldName: supporting_documents
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: Find
FieldStateOption: Later
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Button
FieldName: name_change_care_check
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: No
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Text
FieldName: name_change_care
FieldFlags: 0
FieldJustification: Left
---
FieldType: Button
FieldName: legal_name_change_check
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: No
FieldStateOption: Off
FieldStateOption: Y
---
FieldType: Text
FieldName: legal_name_change
FieldFlags: 0
FieldJustification: Left
---
FieldType: Button
FieldName: name_change_doc
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: Find
FieldStateOption: No
FieldStateOption: Off
FieldStateOption: Yes
---
FieldType: Button
FieldName: payment
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: No
FieldStateOption: Off
FieldStateOption: Unsure
FieldStateOption: Yes
---
FieldType: Text
FieldName: payment_date_day
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: payment_date_month
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: payment_date_year
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: payment_organisation
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: payment_amount
FieldFlags: 0
FieldJustification: Left
---
FieldType: Button
FieldName: cc
FieldFlags: 33587200
FieldJustification: Left
FieldStateOption: No
FieldStateOption: Off
FieldStateOption: Unsure
FieldStateOption: Yes
---
FieldType: Text
FieldName: bank_name
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: bank_sort_cod
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: bank_account_numb
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: bank_reference
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: bank_bic
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: bank_clearing_cod
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: bank_iban
FieldFlags: 0
FieldJustification: Left
---
FieldType: Text
FieldName: date
FieldFlags: 0
FieldJustification: Left