<!-- BEGIN outreach/demographics.tt -->
[% demographics = outreach.demographics;
# PROCESS dumper.tt dump = demographics %]
<form method="post" action="[% app_url %]/outreach/demographics" enctype="multipart/form-data">
<table class="indent borderless">
<tr>
<td rowspan="2" valign="top"><b>Address</b>: [% errs.address %]</td>
<td rowspan="2">
<textarea name="address" cols="25" rows="2">[% demographics.address %]</textarea>
</td>
<td><b>Post code</b>: [% errs.post_code %]</td>
<td>
<input type="text" name="post_code" size="12" value="[% demographics.post_code %]" />
</td>
[% class = demographics.dispatch_to != 'home' ? 'red' : 'normal' %]
<td class="[% class %]"><b>Dispatch to:</b> [% errs.dispatch_to %]</td>
<td>
<select name="dispatch_to">
<option value=""> </option>
[% FOREACH entry IN [ 'GP' 'home' 'alternate'] %]
<option [% 'selected' IF entry == demographics.dispatch_to %]
value="[% entry %]">[% entry %]</option>
[% END %]
</select>
</td>
</tr>
<tr>
<td><b>Telephone</b>: [% errs.telephone_no %]</td>
<td>
<input type="text" name="contact_number" size="15"
value="[% demographics.contact_number %]" />
</td>
[% class = demographics.status == 'dead' ? 'red' : 'normal' %]
<td class="[% class %]" align="right"><b>Status:</b></td>
<td>
<select name="status">
[% FOREACH entry IN [ 'alive' 'dead' ] %]
<option [% 'selected' IF entry == demographics.status %] value="[% entry %]">
[% entry %]
</option>
[% END %]
</select>
</td>
</tr>
<tr>
[% class = demographics.non_participant_practices.item(demographics.practice_id)
? 'red' : 'normal' # flag non-participant practice %]
<td class="[% class %]"><b>Practice</b>:</td>
<td colspan="5">
[% PROCESS site/autosuggest.tt %]
<input type="text" name="practice_name" id="location_name"
value="[% demographics.display_name %]"
style="width: 600px" onclick="make_blank();" />
<input type="hidden" id="source_id" name="practice_id" />
</td>
</tr>
<tr>
<td class="[% class %]" align="right"><b>GP</b>:</td>
<td colspan="5">
<select name="gp_id">
<option value="">--select one--</option>
[% FOREACH gp IN demographics.practitioners;
id = gp.first;
name = gp.last;
%]
<option value="[% id %]" [% 'selected' IF id == demographics.gp_id %]>
[% name %]
</option>
[% END %]
<option disabled>---------------</option>
<option value="[% demographics.unknown_id %]"
[% 'selected' IF demographics.gp_id == demographics.unknown_gp_id %]>
[ unlisted ]
</option>
</select>
[% IF class == 'red' %]
<span class="red">[ non-participant practice ]</span>
[% END %]
</td>
</tr>
</table>
</form>
[% IF vals.gp_address %]
<tr>
<td><b>Practice:</b></td>
<td colspan="6">
[% DEFAULT vals.gp_address = "Unknown/unlisted practice" %]
[% DEFAULT address_id = "gp_address" %]
[% IF vals.non_participant_gp; address_id = "gp_non_participating"; END %]
<span id="$address_id">$vals.gp_address</span>
<span style="color: #00f">Search new</span>
<img src="$htdocs_path/images/expand.png" name="imgnew_gp" onClick="shoh('new_gp');"
title="click to expand" alt="" />
</td>
</tr>
<td>
<select name="gp_id">
<option value=""> </option>
[% FOREACH gp IN options.gps %]
<option [% IF vals.gp_id == gp.0 %]selected[% END %] value="$gp.0">$gp.1</option>
[% END %]
<option [% IF vals.gp_id == 'G0000000' %]selected[% END %] value="G0000000">[ unlisted ]</option>
</select>
</td>
<td style="vertical-align: bottom; text-align: right" colspan="2">
<input type="submit" name="update_address" value=" Update " />
</td>
<td align="right"><b>GP</b>:
[% IF errs.gp_id %]$errs.gp_id
[% ELSIF vals.gp_address AND NOT vals.gp_id # emulate errs %]
<img src="$htdocs_path/images/error.gif" title="invalid / missing" alt="" />
[% END %]
</td>
[% END %]
[% IF vals.dispatch_to.match('alternate') || vals.alternate_address %]
<form method="post" action="$app_url" enctype="multipart/form-data">
<input type="hidden" name="rm" value="update_alternate_address" />
<input type="hidden" name="cap_form_state" value="$cap_form_state" />
<table id="alternate" border="0">
<tr>
<td><b>Alternate<br />address</b>:</td>
<td>
<textarea name="alternate_address" cols="25" rows="2">$vals.alternate_address</textarea>
</td>
<td><b>Post code</b>:</td>
<td>
<input type="text" name="alternate_post_code" size="12" value="$vals.alternate_post_code" />
</td>
<td>
<input type="submit" name="update_alternate" value=" Update " />
</td>
</tr>
</table>
</form>
[% END %]
[% IF vals.gp_address %]
[% IF options.practices %]
<div>
[% ELSE %]
<div id="new_gp" style="display: none">
[% END %]
[% INCLUDE gp_details.tmpl %]
</div>
[% END %]
<!-- END outreach/demographics.tt -->