when_is_your_projected_recovery (type: esriFieldTypeDate, alias: When is your projected recovery date?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
do_you_have_adequate_transporta (type: esriFieldTypeString, alias: Do you have adequate transportation?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [YES - I have a vehicle and I ca: YES - I have a vehicle and I can drive/ have a driver], [NO - I do not have a vehicle OR: NO - I do not have a vehicle OR no one is present who can drive it])
are_you_mobile_without_any_assi (type: esriFieldTypeString, alias: Are you mobile without any assistance?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true, Coded Values: [YES - I am fully mobile and abl: YES - I am fully mobile and able to walk without restrictions], [NO - I need a walker, wheelchai: NO - I need a walker, wheelchair or other device to move freely], [NO - I am limited to bed rest o: NO - I am limited to bed rest or otherwise immobile])
field_15 (type: esriFieldTypeString, alias: Do you need any of the following special equipment?, SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
field_15_other (type: esriFieldTypeString, alias: Other - Do you need any of the following special equipment?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
field_16 (type: esriFieldTypeString, alias: Do you have any of the following special needs?, SQL Type: sqlTypeOther, length: 1000, nullable: true, editable: true)
field_16_other (type: esriFieldTypeString, alias: Other - Do you have any of the following special needs?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
other_special_medical_equipment (type: esriFieldTypeString, alias: Other special medical equipment or needs?, SQL Type: sqlTypeOther, length: 255, nullable: true, editable: true)
Templates:
Name: New Feature
Description:
Drawing Tool: esriFeatureEditToolNone
Prototype: