[% content_only = 1 # no html wrappers %]
[% # PROCESS dumper.tt dump = packs %]
<!-- BEGIN [% template.name %] -->
<html>
<head>
<title>Outreach Pack Dispatches</title>
<link type="text/css" rel="stylesheet" href="/css/outreach.css?v1.1" />
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
</head>
<body>
[% FOREACH entry IN packs; # LAST UNLESS loop.first;
# PROCESS dumper.tt dump = entry %]
<div style="page-break-after: always">
[%
INCLUDE worklist/local/outreach/request_form.tt;
INCLUDE worklist/local/outreach/eq5d_form.tt;
# INCLUDE worklist/local/outreach/cover_letter.tt; # pointless !!
%]
<div class="symptoms">
<div align="center">
<img src='/images/outreach_header.png' alt="" />
</div>
<p align="center">
[% entry.first_name | ucfirst %] [% entry.last_name | upper %]
:: [% INCLUDE site/nhs_number.tt nhs_number = entry.nhs_number %]
:: [% entry.dob.strftime('%d.%b.%Y') %]
</p>
<div class="details">
<p class="contact">
Please complete this form and return it with the blood samples.
In case of any problems with samples or symptoms, please contact
[% c.cfg('settings').service_telno %] and ask to speak to someone
about Outreach.
</p>
[% # entry.questionnaire;
INCLUDE "worklist/local/outreach/${entry.questionnaire}_questionnaire.tt";
%]
<p>
If you have any other symptoms that you think may be related to the
blood disorder, please record them overleaf. You should also discuss
it with your GP if it is a persistent problem that is concerning you.
</p>
<p>
<b>Please also complete the general health questionnaire</b>
</p>
</div>
[% INCLUDE worklist/local/outreach/address.tt %]
</div>
</div>
<div>
[% INCLUDE worklist/local/outreach/path_request_forms.tt %]
</div>
[% END %]
</body>
</html>
<!-- END [% template.name %] -->