[% META title = 'Admin » Edit Referral Source' -%]
<!-- BEGIN admin/config/referralsources/edit.tt -->
[% # PROCESS dumper.tt dump = data %]
[% # PROCESS admin/system_nav.tt page = 'trials' %]
[% referral_sources_dfv_js %]
[% PROCESS admin/referral_nav.tt page = 'referral-sources' %]
<h2 align="center">Edit Referral Source Details</h2>
[% IF dfv_errors %]
<p class="error">[% c.config('msg').dfv_errors %]</p>
[% END %]
<form method="post" action="[% app_url %]/config/referral-sources/update/[% data.id %]" [% referral_sources_onsubmit %]
name="referral-source" id="referral-source">
<table>
<tr>
<td class="label">Org. Code:</td>
<td class="content">
<input type="text" name="organisation_code" size="6"
value="[% data.organisation_code | html %]" />
[% error_organisation_code %]
</td>
</tr>
<tr>
<td class="label">Display Name:</td>
<td class="content">
<input type="text" name="display_name" size="80" value="[% data.display_name | html %]" />
[% error_display_name %]
</td>
</tr>
<tr>
<td class="label">Parent Org. Code:</td>
<td class="content">
<select name="parent_organisation_id">
<option value=""> </option>
[% FOREACH type IN [ 'hospital', 'practice' ] %]
<optgroup label="[% type | upper %]">
[% FOREACH entry IN parent_organisations %]
[% NEXT UNLESS
entry.referral_type.description.match(type) %]
<option value="[% entry.id %]"
[% 'selected' IF entry.id == data.parent_organisation_id %]>
[% entry.parent_code %] :: [% entry.description | html %]
</option>
[% END %]
</optgroup>
[% END %]
</select>
[% error_parent_organisation_id %]
</td>
</tr>
<tr>
<td class="label">Location Type:</td>
<td class="content">
<select name="referral_type">
[% FOREACH option IN ['hospital', 'practice'] %]
<option value="[% option %]" [% 'selected' IF option == data.referral_type.description %]>
[% option %]
</option>
[% END %]
</select>
[% error_referral_type %]
</td>
</tr>
<tr>
<td class="label">Active:</td>
<td>
<select name="is_active">
[% FOREACH option IN ['yes', 'no'] %]
<option value="[% option %]" [% 'selected' IF option == source.is_active %]>
[% option %]
</option>
[% END %]
</select>
[% error_is_active %]
</td>
</tr>
<tr class="borderless">
<td colspan="2" align="right">[% site.html.submit %]</td>
</tr>
</table>
</form>
<p>[% site.html.back_button %]</p>
<!-- END admin/config/referralsources/edit.tt -->