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

[% FOREACH ref IN referrers %]
    <option value="[% ref.national_code %]">[% ref.name | html %]</option>
[% END %]
    <option value="G9999998">[ UNKNOWN ]</option>
</select>

[ <a href="[% app_url %]/config/general-practitioners">new</a> ]