[% META title = 'Admin » Edit Diagnosis Change Option' -%]

  [% # PROCESS dumper.tt dump = c.stash.errs %]

  [% diagnosis_change_dfv_js %]

	[% # PROCESS admin/request_nav.tt page = 'diagnostic-categories' %]

  <h2 align="center">Edit Diagnosis Change Option</h2>

    [% IF dfv_errors %]
    <dl>
        <dt class="error">[% c.cfg('msg').dfv_errors %]</dt>
        [% IF error_description %]
            <dd>Option name [% error_option_name %]</dd>[% END %]
        [% IF error_description %]
            <dd>Description [% error_description %]</dd>[% END %]
    </dl>
    [% END %]

    <form method="post" action="[% app_url %]/config/diagnosis-change-options/update/[% data.id %]"
        [% diagnosis_change_onsubmit %] name="diagnosis-change" id="diagnosis-change">

    <table>
        <tr>
			<th [% IF error_option_name %]class="error"[% END %]>Option name</th>
            <th [% IF error_description %]class="error"[% END %]>Description</th>
			<th [% IF error_active %]class="error"[% END %]>Active</th>
        </tr>

        <tr>
            <td>
                <input type="text" name="option_name" size="20"
                    value="[% data.option_name | html %]" />
             </td>
            <td>
                <input type="text" name="description" size="40"
                    value="[% data.description | html %]" />
             </td>
			<td>
				<select name="is_active">
				[% FOREACH option IN ['yes', 'no'] %]
                     <option value="[% option %]" [% 'selected' IF option == data.is_active %]>
                        [% option %]
                    </option>
			    [% END %]
				</select>
			</td>
             <td>
                [% site.html.submit %]
            </td>
        </tr>
    </table>

    </form>

    <p>[% site.html.back_button %]</p>