<select name="national_code">
<option value="">-- select one --</option>
[% FOREACH ref IN referrers %]
[% SET surname = ref.clinician.surname; SET initials = ref.clinician.initials;
SET department = ref.hospital_department.display_name %]
<option value="[% ref.clinician.national_code %]">
[% surname | html %], [% initials %] : [% department | html %]
</option>
[% END %]
<option value="C9999998">[ UNKNOWN ]</option>
</select>
[ <a href="[% app_url %]/config/clinicians">new</a> ]