
<select name="national_code">
<option value="">-- select one --</option>

[% FOREACH ref IN referrers %]
    [% SET surname = ref.clinician.surname; SET initials = ref.clinician.initials;
        SET department = ref.hospital_department.display_name %]
    <option value="[% ref.clinician.national_code %]">
    [% surname | html %], [% initials %] : [% department | html %]
    </option>
[% END %]
    <option value="C9999998">[ UNKNOWN ]</option>
</select>

[ <a href="[% app_url %]/config/clinicians">new</a> ]
