[% META title = 'Request » New' -%]
<!-- BEGIN request/add_new.tt -->
[% # PROCESS dumper.tt dump = c.cfg('msg').dfv_msgs %]
[% # PROCESS dumper.tt dump = additional_options %]
[% # PROCESS dumper.tt dump = practitioners %]
[% # PROCESS dumper.tt dump = error_codes %]
[% # PROCESS dumper.tt dump = c.stash.errs %]
[% # PROCESS dumper.tt dump = case.as_tree %]
<h2 class="header">New request</h2>
[% IF dfv_errors %]
<p class="error">[% c.cfg('msg').dfv_errors %]</p>
[% END %]
[% IF practitioners; # gp referral
PROCESS site/autosuggest.tt;
ELSE;
PROCESS site/autosuggest.tt
varname = 'referrer_name'
param_id = 'referrer_id'
param_name = 'referrer_name'
method_name = 'get_clinicians'
optional_params = [ "source_id=${case.referral_source_id}" ]
watermark = 'no';
END;
%]
<script type="text/javascript">
jQuery( function() {
$("#is_valid_date_min").Watermark("min");
$("#is_valid_date_hour").Watermark("hr");
$("#is_valid_date_day").Watermark("dd");
$("#is_valid_date_month").Watermark("mm");
$("#is_valid_date_year").Watermark("yyyy");
} );
</script>
[% BLOCK validate_date; IF c.cfg('use_cgi_ajax') %]
onChange="do_ajax(
['is_valid_date_day','is_valid_date_month','is_valid_date_year',
is_valid_date_hour','is_valid_date_min' ],
['bad_datetime']
); return true;"
[% END; END %]
[% new_request_dfv_js %]
[% PROCESS request/patient_data.tt %]
<h4>Request details:</h4>
<form method="post" action="[% app_url %]/request/new_request/[% case.id %]"
name="new_requests" id="new_requests" [% new_request_onsubmit %]>
<input type="hidden" name="referral_source_id" value="[% case.referral_source_id %]" />
<input type="hidden" name="patient_id" value="[% case.patient_id %]" />
<div class="indent">
<table>
<tr>
<td class="label">Lab No:</td>
<td class="content">
<input class="field" type="text" name="request_number" id="is_valid_request_no"
[% IF c.cfg('use_cgi_ajax') %]
onChange="do_ajax(['is_valid_request_no'], ['bad_labno']); return true;"
[% END %] [% site.html.on_focus %] size="12" />
[% error_request_number %]
<span class="ajax_error"><em id="bad_labno"></em></span>
</td>
</tr>
<tr>
<td class="label">Specimen:</td>
<td class="content">
<input class="field" type="text" name="specimen" size="12" id="is_valid_specimen"
[% IF c.cfg('use_cgi_ajax') %]
onChange="do_ajax(['is_valid_specimen'], ['bad_specimen']); return true;"
[% END %] [% site.html.on_focus %] />
[% error_specimen %]
<span class="ajax_error"><em id="bad_specimen"></em></span>
</td>
</tr>
<tr>
<td class="label">Taken:</td>
<td class="content">
<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 %] />
<b>@</b>
<input type="text" name="hour" size="2" id="is_valid_date_hour"
value="[% c.query.param('hour') %]"
[% PROCESS validate_date %] maxlength="2" class="[% class %]"
[% site.html.on_focus %] />
<input type="text" name="minute" size="2" id="is_valid_date_min"
value="[% c.query.param('minute') %]"
[% PROCESS validate_date %] maxlength="2" class="[% class %]"
[% site.html.on_focus %] />
[% UNLESS error_day || error_year # set if date invalid %]
<span class="ajax_error"><em id="bad_datetime"></em></span>
[% END %]
[% error_day || error_year # set if date invalid %]
</td>
</tr>
<tr>
[% IF practitioners %]
<td class="label">GP:</td>
<td class="content">
<select name="referrer_code">
<option value="">--select one--</option>
[% FOREACH entry IN practitioners.keys.sort %]
<option value="[% practitioners.item(entry) %]">
[% entry %]
</option>
[% END %]
<option value="[% default_code %]">[UNLISTED GP]</option>
</select>
[% error_referrer_code %]
</td>
[% ELSE %]
<td class="label">Clinician:</td>
<td class="search_bar">
<input style="width: 150px" type="text" name="_referrer" id="referrer_name" />
<input type="hidden" name="referrer_code" id="referrer_id" />
[% IF error_referrer_code %]
[% error_referrer_code %]
[% ELSE %]
[ <a href="[% app_url %]/config/clinicians"
target="_blank">new</a> ]
[% END %]
</td>
[% END %]
</tr>
<tr>
<td class="label">Trial/study:</td>
<td class="content">
<select name="trial_id" id="trial_id" [% site.html.on_focus %]>
<option value=""> </option>
[% FOREACH trial IN trials %]
[% NEXT UNLESS trial.active.match('yes') # skip inactive %]
<option value="[% trial.id %]">
[% trial.trial_name %]
</option>
[% END %]
</select>
[% error_trial_id %]
<span class="box">Trial No:</span>
<input class="field" type="text" name="trial_number" size="12"
[% site.html.on_focus %] />
[% error_trial_number %]
</td>
</tr>
<tr>
<td class="label">External Ref:</td>
<td class="content">
[% class = error_specimen.match(c.cfg('msg').dfv_msgs.need_block_ref)
? 'input_error' : 'field' %]
<input class="[% class %]" type="text" name="external_reference"
size="25" [% site.html.on_focus %] />
[% error_external_reference %]
</td>
</tr>
</table>
</div>
[% PROCESS request/request_options.tt %]
[% PROCESS request/request_consent.tt %]
[% PROCESS request/errors.tt %]
<p class="indent">[% site.html.submit %] [% site.html.reset %]</p>
</form>
[% PROCESS site/field_focus.tt form_name = 'new_requests',
field_name = 'request_number' %]
<!-- END request/add_new.tt -->