[% META title = 'Registration » Register New Patient' -%]

Register new patient

[% # PROCESS dumper.tt dump = maybe_duplicate %] [% js_new_patient_dfv_js %] [% IF dfv_errors %]

[% c.cfg('msg').dfv_errors %]

[% IF error_patient_id %] [% END %] [% END %] [% PROCESS site/autosuggest.tt %]
[% PROCESS patient/pas.tt IF pas_query %] [% PROCESS patient/pds.tt IF pds_query %] [% PROCESS patient/duplicate.tt IF maybe_duplicate %]
[% SET class = error_patient_id ? 'input_error' : 'field' %] [% BLOCK validate_date; IF c.cfg('use_cgi_ajax') %] onChange="do_ajax( ['is_valid_date_day','is_valid_date_month','is_valid_date_year'], ['bad_date'] ); return true;" [% END; END %] [% SET class = error_year || error_day ? 'input_error' : 'field' %] [% BLOCK validate_patient; IF c.cfg('use_cgi_ajax') %] onChange="do_ajax( ['last_name', 'first_name', 'is_valid_nhsno', 'is_valid_date_day', 'is_valid_date_month', 'is_valid_date_year', 'unit_number'], ['bad_patient']); return true;" [% END; END %] [% SET class = error_patient_id ? 'input_error' : 'field' %]
Last Name: [% error_last_name %]
First Name: [% error_first_name %]
Middle Name(s): [% error_middle_name %]
NHS No: [% error_nhs_number %]
DoB: [% UNLESS error_day || error_year # set if date invalid %] [% END %] [% error_day || error_year # set if date invalid %]
Gender: [% FOREACH entry IN ['M','F','U'] %] [% entry %] [% END %] [% error_gender %]
Source: [% IF error_referral_source_id %] [% error_referral_source_id %] [% ELSE %] [ new ] [% END %]
Unit number: [% error_unit_number %]
[% IF c.query.param('_skip_pas') # flag to skip pas query if already done %] [% END %] [% IF nhs_number_duplicate # set in duplicate.tt %]

Duplicate NHS number must be resolved before record can be submitted.

[% ELSE %]

[% site.html.submit %] [% site.html.reset %]

[% END %]

[% site.html.back_button %]