%%[begin:contact]%%
%%[preamble]%%
( )
( )
%%[city,input_text,class=form-control]%%
%%[state,input_text,size=3,class=form-control]%%
%%[zip,input_text,onblur=zipcode_lookup(this.value),class=form-control]%%
%%[county,input_text,class=form-control]%%
%%[gender,gender]%%
%%[hispanic,yes_no,checkbox,label=Hispanic]%%
%%[ethnicity,ethnicity]%%
%%[race,race]%%
%%[language,language]%%
%%[residence,residence]%%
%%[living_independently,living_independently]%%
%%[marital,marital]%%
Aliases
%%[alias_list]%% Edit Aliases
Actions
Merge Duplicate Records Create New Case
%%[contact_id,input_hidden]%% %%[case_id,input_hidden]%% %%[screen_id,input_hidden]%% %%[intake_id,input_hidden]%% %%[relation_code,input_hidden]%% %%[con_url,input_hidden]%%

Caselist for %%[full_name]%%

%%[case_list]%%
%%[ajax_init.js,javascript]%% %%[zip-server-ajax.js,javascript,parse]%% %%[contact_full.js,javascript]%% %%[end:contact]%% %%[begin:alias]%%
Name: %%[full_name]%%
ID: %%[state_d]%%
%%[end:alias]%% %%[begin:flex_header]%%
%%[end:flex_header]%% %%[begin:flex_row]%% %%[end:flex_row]%% %%[begin:flex_footer]%%
Role Case Number Atty. Office Open Date Close Date Closing Code Status Code
%%[role]%% %%[number]%% %%[atty_name]%% %%[office text]%% %%[open_date]%% %%[close_date]%% %%[close_code text]%% %%[status text source=case_status]%% %%[problem]%%
%%[end:flex_footer]%% %%[begin:intake_header]%% %%[end:intake_header]%% %%[begin:intake_row]%% %%[end:intake_row]%% %%[begin:intake_footer]%%
Intake ID Income Assets % of Poverty Citizenship
%%[intake_id]%% $%%[income]%% $%%[assets]%% %%[poverty]%% % %%[citizen text]%%

%%[end:intake_footer]%%