<form method="get" action="[% app_url %]/config/[% referrer_type %]/search"
name="find_referrer" id="find_referrer">
<table>
<tr>
<td class="label">Surname:</td>
<td>
<input type="text" name="name" value="[% c.query.param('name') %]" />
[% error_name %]
</td>
</tr>
<tr>
<td class="label">Code:</td>
<td>
<input type="text" name="national_code" value="[% c.query.param('national_code') %]" />
[% error_national_code %]
</td>
</tr>
[% IF _referrer_type == 'general-practitioners' # TODO: mangle query params %]
<tr>
<td class="label">Practice address:</td>
<td>
<input type="text" name="practice_address"
value="[% c.query.param('practice_address') %]" />
[% error_practice_address %]
</td>
</tr>
[% END %]
<tr>
<td class="borderless" colspan="2" align="center">[% site.html.submit %]</td>
</tr>
</table>
</form>