<select name="national_code">
<option value="">-- select one --</option>
[% FOREACH ref IN referrers %]
<option value="[% ref.national_code %]">[% ref.name | html %]</option>
[% END %]
<option value="G9999998">[ UNKNOWN ]</option>
</select>
[ <a href="[% app_url %]/config/general-practitioners">new</a> ]