<!-- BEGIN register/default.tt -->
[% META title = 'Registration » Search for Patient Details' -%]
[% # PROCESS dumper.tt dump = c.stash.errs %]
<script type="text/javascript" src="/js/jquery.watermarkinput.js"></script>
<script type="text/javascript">
jQuery( function() {
$("#is_valid_date_day").Watermark("dd");
$("#is_valid_date_month").Watermark("mm");
$("#is_valid_date_year").Watermark("yyyy");
} );
</script>
<h3>Search For Patient Details</h3>
[% # PROCESS site/form_validator.tt profile = 'patient_data' # can't do dates in future %]
[% IF dfv_errors %]
<p class="error">[% c.cfg('msg').dfv_errors %]</p>
[% END %]
[% patient_search_data_dfv_js # doesn't work with 'require_some' %]
[% INCLUDE site/snippets/help.tt file = 'patientsearch' %]
<div id="registration">
<form method="get" action="[% app_url %]/register/patient_search"
name="register" id="register" [% patient_search_data_onsubmit %]>
<div class="name">
<p id="registration_format">
<u>FORMAT</U>: last name, followed by (optional) first name or first initial, comma-separated
</p>
<p>Name:
[% IF error_name; class = 'input_error'; ELSE; class = 'field'; END %]
<input type="text" class="[% class %]" name="name" size="20" value="[% c.query.param('name') %]"
[% site.html.on_focus %] />
[% error_name %]
</p>
</div>
[% BLOCK validate_date; IF c.cfg('use_cgi_ajax') %]
onChange="do_ajax(
['is_valid_date_day','is_valid_date_month','is_valid_date_year'],
['bad_date']
); return true;"
[% END; END %]
<div class="dob">
[% SET class = error_year || error_day ? 'input_error' : 'field' %]
<p class="[% class %]" align="center">
<u>FORMAT</U>: dd / mm / yyyy
</p>
<p>
[% IF error_year || error_day %]
<span class="dfv_errors">invalid »</span>
[% END %] D.o.B:
<input type="text" name="day" size="2" id="is_valid_date_day"
value="[% c.query.param('day') %]" [% PROCESS validate_date %]
maxlength="2" class="[% class %]" [% site.html.on_focus %] />
<input type="text" name="month" size="2" id="is_valid_date_month"
value="[% c.query.param('month') %]" [% PROCESS validate_date %]
maxlength="2" class="[% class %]" [% site.html.on_focus %] />
<input type="text" name="year" size="4" id="is_valid_date_year"
value="[% c.query.param('year') %]" [% PROCESS validate_date %]
maxlength="4" class="[% class %]" [% site.html.on_focus %] />
<span class="ajax_error"><em id="bad_date"></em></span>
</p>
</div>
<div class="patient_id">
<p id="registration_submit_format">
[% site.html.submit %]
[% site.html.reset %]
</p>
<p>Unit/NHS No:
[% IF error_patient_id; class = 'input_error'; ELSE; class = 'field'; END %]
<input type="text" class="[% class %]" name="patient_no" size="15"
value="[% c.query.param('patient_no') %]" [% site.html.on_focus %] />
</p>
</div>
</form>
[% IF c.cfg('settings').have_online_requests %]
<form method="get" action="[% app_url %]/register/online_request_form"
name="request_form" id="request_form">
<h5>Online Request Form:</h5>
<div class="req_form">
<p>ID:
<input type="text" class="" name="id" size="25" />
[% site.html.submit %]
</p>
</div>
</form>
[% END %]
</div>
<script type="text/javascript">
<!--
document.getElementById('register').name.focus();
//-->
</script>
<!-- END register/default.tt -->