CÃÂºram V7 User Interface

First Name	[First Forename]	First Name	[First Forename]
Last Name	[Surname]	Last Name	[Surname]
Gender	[Male]	Gender	[Male]
Date Of Birth	[Date]	Date Of Birth	[Date]
Address	[Value]	Address	[Value]
Phone Number	[Value]	Phone Number	[Value]
Marital Status	[Single]	Marital Status	[Single]
Mother's Birth Last Name	[Surname]	Mother's Birth Last Name	[Surname]
Status	[Active]	Status	[Active]
Nationality	[American]	Nationality	[American]
Country/Region of Birth	[United States]	Country/Region of Birth	[United States]
Ethnic Origin	[Hispanic or Latino]	Ethnic Origin	[Hispanic or Latino]
Race	[field-value]	Race	[field-value]
Indigenous Group	[field-value]	Indigenous Group	[field-value]

Reason