  <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>
