[% # set some template params for easy access:
patient = data.patient_case.patient;
last_name = patient.last_name | upper;
first_name = patient.first_name | ucfirst;
middle_name = patient.middle_name | ucfirst;
source = data.patient_case.referral_source;
specimen = specimen_map.item(data.id).sample_code.join(', ');
full_name = last_name _ ', ' _ first_name _ ' ' _ middle_name;
%]
[% # PROCESS dumper.tt dump = data %]
<table>
<tr>
<td class="label">Name:</td>
<td class="content">
<input type="text" value="[% full_name %]"
size="40" class="field" [% site.html.readonly %] />
</td>
</tr>
<tr>
<td class="label">NHS No:</td>
<td class="content">
<input type="text" value="[% patient.nhs_number %]" size="12"
class="field" [% site.html.readonly %] />
<span class="box">Patient No:</span>
<input type="text" value="[% data.patient_case.unit_number %]"
size="12" class="field" [% site.html.readonly %] />
</td>
</tr>
<tr>
<td class="label">DoB:</td>
<td class="content">
<input type="text" value="[% patient.dob.strftime('%d.%b.%Y') %]"
size="12" class="field" [% site.html.readonly %] />
</tr>
<tr>
<td class="label">Lab No:</td>
<td class="content">
<input type="text" value="[% PROCESS site/lab_number.tt %]" size="12"
class="field" [% site.html.readonly %] />
<span class="box">Date:</span>
<input type="text" value="[% data.created_at.strftime('%d.%b.%Y') %]"
size="12" class="field" [% site.html.readonly %] />
</td>
</tr>
<tr>
<td class="label">Source:</td>
<td class="content">
<input type="text" value="[% source.display_name %]"
size="40" class="field" [% site.html.readonly %] />
</td>
</tr>
<tr>
[%
IF data.referrer_department.referrer.national_code.match('9999998');
referrer = 'Unknown';
ELSE;
referrer = data.referrer_department.referrer.name || 'Unknown';
END;
%]
<td class="label">Referrer:</td>
<td class="content">
<input type="text" value="[% referrer %]" size="40" class="field"
[% site.html.readonly %] />
</td>
</tr>
<tr>
<td class="label">Gender:</td>
<td class="content">
<input type="text" value="[% patient.gender %]" size="2"
class="field" [% site.html.readonly %] />
</tr>
<tr>
<td class="label">Specimen:</td>
<td class="content">
<input type="text" value="[% specimen %]"
size="30" class="field" [% site.html.readonly %] />
</td>
</tr>
<tr>
<td class="label"> Block ref:</td>
<td class="content">
<input type="text" value="" size="30" class="field"
[% site.html.readonly %] />
</td>
</tr>
</table>