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<!-- BEGIN [% component.name %] -->
  <div class="indent">
    <h4 class="blue">General assessment:</h4>
    
	[% weight_loss_selection = questionnaire.symptoms.weight_loss %]
	
    <table class="xborders">
	  <tr> 
		<td class="title" align="right" valign="top">
		  Weight loss: [% error_weight_loss %]
		</td> 
		<td valign="top">
		  <div>
			<input type="radio" name="weight_loss" value="Y"
			  [% 'checked' IF weight_loss_selection.match('Y') %] />
			  <span class="[% weight_loss_selection.match('Y') ? 'bold' : 'normal' %]">
				Yes</span>
		  </div>
		  <div>
			<input type="radio" name="weight_loss" value="N"
			  [% 'checked' IF weight_loss_selection.match('N') %] />
			  <span class="[% weight_loss_selection.match('N') ? 'bold' : 'normal' %]">
				No</span>		
		  </div>
		  <div>
			<input type="radio" name="weight_loss" value="U"
			  [% 'checked' IF weight_loss_selection.match('U')
				OR NOT questionnaire.symptoms.weight_loss %] />
 			  <span class="[% weight_loss_selection.match('U') ? 'bold' : 'normal' %]">
	  			Not stated</span>
		  </div>
      </td>
	</tr>

	<tr> 
	  <td class="title" align="right" valign="top">Night sweats:</td> 
	  <td valign="top"> 
		<select name="night_sweats"> 
		  <option value="">--select one--</option> 
          [% FOREACH opt IN outreach.menu_options.sweats %]
			<option value="[% opt %]"
		        [% 'selected' IF questionnaire.symptoms.night_sweats == opt %]>
		      [% opt %]
		    </option>
          [% END %]          
		</select>
        [% error_night_sweats %]
	  </td>
	</tr> 
	</table>
  </div>
<!-- BEGIN [% component.name %] -->