Client Signatures: [CLIENT_SIGNATURES]
Staff (BN User Signatures): [TEMPLATE_SIGNATURES]
Related Contact Signatures: [CONTACT_SIGNATURES]



Client Name: {XFNAME} {XMNAME} {XLNAME}



Address:
{XHOMEADDRESS}
{XHOMECITY}, {XHOMESTATE} {XHOMEZIP}



Diagnosis (DSM 5 / ICD 10):
Master - {XDIAGNOSIS}
OR
Initial  and HxPX - {XIDIAGNOSIS}



Gender: {XSEX}



Page break: {XPAGEBREAK}



[BLANK]



Report Date: {XREPORTDATE}

NOTE: Before using the next two, Signatures Automatically add a date and Time.
Current Date: {XDATE}
Time: {XTIME}