[% content_only = 1 # no html wrappers %] [% # PROCESS dumper.tt dump = packs %] Outreach Pack Dispatches [% FOREACH entry IN packs; # LAST UNLESS loop.first; # PROCESS dumper.tt dump = entry %]
[% INCLUDE worklist/local/outreach/request_form.tt; INCLUDE worklist/local/outreach/eq5d_form.tt; # INCLUDE worklist/local/outreach/cover_letter.tt; # pointless !! %]

[% entry.first_name | ucfirst %] [% entry.last_name | upper %] :: [% INCLUDE site/nhs_number.tt nhs_number = entry.nhs_number %] :: [% entry.dob.strftime('%d.%b.%Y') %]

Please complete this form and return it with the blood samples. In case of any problems with samples or symptoms, please contact [% c.cfg('settings').service_telno %] and ask to speak to someone about Outreach.

[% # entry.questionnaire; INCLUDE "worklist/local/outreach/${entry.questionnaire}_questionnaire.tt"; %]

If you have any other symptoms that you think may be related to the blood disorder, please record them overleaf. You should also discuss it with your GP if it is a persistent problem that is concerning you.

Please also complete the general health questionnaire

[% INCLUDE worklist/local/outreach/address.tt %]
[% INCLUDE worklist/local/outreach/path_request_forms.tt %]
[% END %]