<!-- BEGIN search/referral_source_search.tt -->
	<form method="get" action="[% app_url %]/config/referral-sources/search"
	  name="find_referral_source" id="find_referral_source">
  	<table>
		<tr>
			<td class="label">Location name:</td>
			<td>
				<input type="text" name="display_name" value="[% c.query.param('display_name') %]" />
				[% IF error_display_name %]
					[% error_display_name %]
				[% ELSE %]
					'%' for all
				[% END %]
			</td>
		</tr>

		<tr>
			<td class="label">Organisation Code:</td>
			<td>
				<input type="text" name="organisation_code" value="[% c.query.param('organisation_code') %]" />
				[% error_organisation_code %]
			</td>
		</tr>
		<tr>
			<td class="label">Location type:</td>
			<td>
				<select name="referral_type_id">
					<option value="">--select one--</option>
					<option value="4">hospital</option>
					<option value="5">practice</option>
				</select>
				[% error_location_type_id %]
			</td>
		</tr>
        <tr>
            <td class="borderless" colspan="2" align="center">[% site.html.submit %]</td>
        </tr>
	</table>
  </form>
<!-- END search/referral_source_search.tt -->
