<!-- BEGIN [% component.name %] -->
[% # PROCESS dumper.tt dump = c.stash.errs %]
[% # PROCESS dumper.tt dump = hmrn_data.treatments %]
[% # PROCESS dumper.tt dump = hmrn_data.maps %]
<script type="text/javascript">
$(document).ready(function() {
$("#referral").validationEngine()
})
</script>
<h3 class="header">Referral pathway:</h3>
[% IF hmrn_data.referrals.size %]
<table class="indent">
<tr>
<td class="borderless"></td>
<th scope="col">Referral date</th>
<th scope="col">Referral type</th>
<th scope="col">Referred from</th>
<th scope="col">Referred to</th>
<th scope="col">Date 1st seen</th>
</tr>
[% FOREACH episode IN hmrn_data.referrals %]
<tr>
<td>[% loop.count %]</td>
<td>
<input type="text" value="[% episode.referral_date.strftime('%d.%b.%Y') %]" [% site.html.readonly %] />
</td>
<td>
<input type="text" value="[% episode.referral_type %]" [% site.html.readonly %] />
</td>
<td>
<input type="text" value="[% episode.referred_from %]" [% site.html.readonly %] />
</td>
<td>
<input type="text" value="[% episode.referred_to %]" [% site.html.readonly %] />
</td>
<td>
<input type="text" value="[% episode.date_first_seen.strftime('%d.%b.%Y') %]"
[% site.html.readonly %] />
</td>
[% IF user_can_enter_data %]
<td>
<a href="[% app_url %]/hmrn_data/edit_referral/[% data.id %]/[% episode.id %]">
edit
</a>
</td>
[% END %]
</tr>
[% END %]
</table>
[% ELSE %]
<p class="indent info">No referral data recorded</p>
[% END %]
[% IF user_can_enter_data %]
<p class="title">
[% div_name = 'new_referral'; INCLUDE site/snippets/toggleview.tt %]
Add new entry
</p>
[% IF # provide a name="error" for internal anchor:
error_referral_date ||
error_referral_type_id ||
error_from_source_id ||
error_to_source_id ||
error_date_first_seen
%]<a name="error"><span> </span></a>[% END %]
<div class="[% dfv_errors ? 'visible' : 'itemhidden' %]" id="[% div_name %]">
[% # PROCESS dumper.tt dump = c.validate('hmrn_referral') # use this for validation %]
<form method="post" name="referral" id="referral"
action="[% app_url %]/hmrn_data/referral_pathway/[% data.id %]/[% patient.id %]">
<table class="indent">
<tr>
<td class="label">Referral date:</td>
<td class="content">
<input type="text" name="referral_date" id="referral_date" size="10"
class="validate[ajax[ajaxDate]] datepicker" />
[% error_referral_date %]
</td>
</tr>
<tr>
<td class="label">Referral type:</td>
<td class="content">
<select name="referral_type_id" class="validate[required]"
id="referral_type_id">
<option value=""></option>
[% FOREACH key IN hmrn_data.maps.referral_types.keys.sort %]
<option value="[% hmrn_data.maps.referral_types.$key %]">
[% key %]
</option>
[% END %]
</select>
[% error_referral_type_id %]
</td>
</tr>
<tr>
<td class="label">Referred from:</td>
<td class="content">
<select name="from_source_id" id="from_source_id" class="validate[required]">
<option value=""></option>
[% FOREACH key IN hmrn_data.maps.referral_sources.keys.sort %]
<option value="[% hmrn_data.maps.referral_sources.$key %]">
[% key %]
</option>
[% END %]
</select>
[% error_from_source_id %]
</td>
</tr>
<tr>
<td class="label">Referred to:</td>
<td class="content">
<select name="to_source_id" id="to_source_id" class="validate[required]">
<option value=""></option>
[% FOREACH key IN hmrn_data.maps.referral_sources.keys.sort %]
<option value="[% hmrn_data.maps.referral_sources.$key %]">
[% key %]
</option>
[% END %]
</select>
[% error_to_source_id %]
</td>
</tr>
<tr>
<td class="label">Date 1st seen:</td>
<td class="content">
<input type="text" name="date_first_seen" id="date_first_seen" size="10"
class="validate[ajax[ajaxDate]] datepicker" />
[% error_date_first_seen %]
</td>
</tr>
[% INCLUDE hmrn_submit %]
</table>
</form>
</div>
[% END %]
<!-- END [% component.name %] -->