[% META title = 'Patient &raquo; Delete Patient Case' -%]

    [% # PROCESS admin/user_nav.tt page = 'user_list' %]
	[% # PROCESS dumper.tt dump = c.param('id') %]
	
    <h3>Confirm you really want to delete this case:</h3>

   <form method="post" action="[% app_url %]/patient/delete_case/[% case.id %]" />

    <p class="indent">
		[% case.referral_source.display_name %] [ [% case.unit_number %] ]
        <input type="checkbox" name="confirm_delete" value="1"> 
		<input type='submit' value='Delete' name='.submit' class='button' />
    </p>

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