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<!-- BEGIN [% component.name %] -->
	[% # PROCESS dumper.tt dump = outreach.menu_options %]
  <div class="indent">
    <h4 class="blue">Pain:</h4>
    
    <table class="xborders">
	  <tr> 
		<td class="title" align="right" valign="top">
		  Assessment: [% error_pain %]
		</td> 
		<td valign="top">
		  <div>
			<input type="radio" name="pain" value="none"
			  [% 'checked' IF questionnaire.symptoms.pain == 'none' %] />  None
		  </div>
		  <div>
			<input type="radio" name="pain" value="stable"
			  [% 'checked' IF questionnaire.symptoms.pain == 'stable' %] /> Stable
		  </div>
		  <div>
			<input type="radio" name="pain" value="unstable"
			  [% 'checked' IF questionnaire.symptoms.pain == 'unstable' %] />
			  New or worsening
		  </div>
		</td>      
	  </tr> 

	  <tr> 
		<td class="title" align="right" valign="top">
		  Location: [% pain_option_id %]
		</td> 
		<td valign="top">
		  [% FOREACH opt IN outreach.menu_options.pain_options;            
                is_selected = questionnaire.pain.item(opt.key) ? 1 : 0 %]
		  <div>
			<input type="checkbox" name="pain_option_id" value="[% opt.key %]"
			  [% 'checked' IF is_selected %] />
                <span class="[% is_selected ? 'bold' : 'normal' %]">
                    [% opt.value.replace('_', ' ') %]
                </span>
		  </div>
		  [% END %]
		</td>      
	  </tr> 
	</table>
  </div>
<!-- END [% component.name %] -->