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<!-- BEGIN [% component.name %] -->
  <div class="indent">
    <h4 class="blue">General assessment:</h4>

	[%
	  weight_loss_selection = questionnaire.symptoms.weight_loss;
	  have_result = weight_loss_selection ? 1 : 0;
	  DEFAULT weight_loss_selection =
		c.get_meta_data('Outreach::QuestionnaireSymptoms').column('weight_loss').default;
	%]
	
    <table class="xborders">
	  <tr> 
		<td class="title" align="right" valign="top">
		  Weight loss: [% error_weight_loss %]
		</td> 
		<td valign="top">
		[% weight_loss_opts = {
			Y => 'yes',
			N => 'no',
			U => 'not stated',
		  };
		  FOREACH opt IN ['Y' 'N' 'U']; # PROCESS dumper.tt dump = opt.value  %]
		  <div>
			<input type="radio" name="weight_loss" value="[% opt %]"
			  [% 'checked' IF weight_loss_selection.match(opt) %] />
			  <span class="[% have_result AND weight_loss_selection.match(opt)
				? 'bold' : 'normal' %]">[% weight_loss_opts.item(opt) | ucfirst %]
			  </span>
		  </div>
		[% END %]
      </td>
	</tr>

	[%
	  night_sweats_selection = questionnaire.symptoms.night_sweats;
	  have_result = night_sweats_selection ? 1 : 0;
	  DEFAULT night_sweats_selection =
		c.get_meta_data('Outreach::QuestionnaireSymptoms').column('night_sweats').default;
	%]
	
	<tr> 
	  <td class="title" align="right" valign="top">
		Night sweats: [% error_night_sweats %]
	  </td> 
	  <td valign="top">
		[% FOREACH opt IN ['none' 'occasional' 'frequent' 'drenching' 'unstated'] %]
		  <div>
			<input type="radio" name="night_sweats" value="[% opt %]"
			  [% 'checked' IF night_sweats_selection.match(opt) %] />
			  <span class="[% have_result AND night_sweats_selection.match(opt)
				? 'bold' : 'normal' %]">[% opt | ucfirst %]</span>
		  </div>
		[% END %]
	  </td>
	</tr> 
	</table>
  </div>
<!-- BEGIN [% component.name %] -->