<!-- BEGIN outreach/questionnaire/swelling.tt -->
    <div class="indent">
      <h4 class="blue">Swelling assessment:</h4>
    
    <table class="xborders">
		<tr> 
			<td class="title" align="right" valign="top">Swelling, cervical:</td> 
			<td valign="top"> 
        Yes <input type="radio" name="cervical_swelling" value="Y"
          [% 'checked' IF questionnaire.cervical_swelling == 'Y' %] />
        No <input type="radio" name="cervical_swelling" value="N"
          [% 'checked' UNLESS questionnaire.cervical_swelling == 'Y' %] />
        [% error_cervical_swelling %]
			</td>      
			<td rowspan="4"> 
        <div class="bold">Details of symptoms:</div>
        <textarea name="swelling_details" rows="5"
          cols="35">[% questionnaire.details.swelling %]</textarea>
        [% error_swelling_details %]
      </td> 
		</tr> 

		<tr> 
			<td class="title" align="right" valign="top">Swelling, axillary:</td> 
			<td valign="top"> 
        Yes <input type="radio" name="axillary_swelling" value="Y"
          [% 'checked' IF questionnaire.axillary_swelling == 'Y' %] />
        No <input type="radio" name="axillary_swelling" value="N"
          [% 'checked' UNLESS questionnaire.axillary_swelling == 'Y' %] />
        [% error_axillary_swelling %]
      </td>
		</tr> 

		<tr> 
			<td class="title" align="right" valign="top">Swelling, abdominal:</td>
			<td valign="top"> 
        Yes <input type="radio" name="abdominal_swelling" value="Y"
          [% 'checked' IF questionnaire.abdominal_swelling == 'Y' %] />
        No <input type="radio" name="abdominal_swelling" value="N"
          [% 'checked' UNLESS questionnaire.abdominal_swelling == 'Y' %] />
        [% error_abdominal_swelling %]
      </td>
		</tr> 

		<tr> 
			<td class="title" align="right" valign="top">Swelling, inguinal:</td> 
			<td valign="top"> 
        Yes <input type="radio" name="inguinal_swelling" value="Y"
          [% 'checked' IF questionnaire.inguinal_swelling == 'Y' %] />
        No <input type="radio" name="inguinal_swelling" value="N"
          [% 'checked' UNLESS questionnaire.inguinal_swelling == 'Y' %] />
        [% error_inguinal_swelling %]
      </td>
		</tr> 

	</table>
  </div>
<!-- BEGIN outreach/questionnaire/swelling.tt -->