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<!-- BEGIN [% template.name %] -->
  [% # INCLUDE dumper.tt dump = session %]
  [% # INCLUDE dumper.tt dump = request %]
  [% # INCLUDE dumper.tt dump = params %]

  [% PROCESS headers.tt; # sets header
    # INCLUDE dumper.tt dump = header %]
  
  <div class="container">
    <div class="row">
        <img src="[% request.uri_base %]/images/[% header.logos.large %]" alt=""
          class="img-responsive" border="0" align="right" />
    </div>

    <div class="row">
        <fieldset><legend>[% header.lab_name %] Request Form</legend></fieldset>
    </div>
    
    <div class="row indent">
        <h4><a href="#" id="is_trial">Request IS for clinical trial</a></h4>
        <div id="trial-content" style="display: none;">
            <p class="text-warning indent">
                Please use specific clinical trial request form.
            </p>
        </div>
        
        <h4><a href="#" id="non_trial">Request is NOT for clinical trial</a></h4>

        <div id="non-trial-content" class="indent" [% # auto-open if form submission:
            UNLESS params.nhs_number # 'u' & 'c' always %]style="display: none"[% END %]>
            <div class="btn-toolbar">
                <form method="post" action="[% request.uri_base %]/search"
                        class="col-md-4 input-group">
                    <div class="input-group-addon">NHS number:
                        [% IF errs.nhs_number %]<span class="dfv-err">invalid</span>[% END %]
                    </div>
                    <input name="nhs_number" required="" id="nhs_number" type="text"
                        class="input-medium form-control" value="[% params.nhs_number %]"
                        maxlength="150" />
                    <span class="input-group-btn">
                      <button class="btn btn-primary" id="nhsno_result"
                        type="submit"> Search</button>
                  </span>
                </form>
            </div>
        </div>
    </div>
  </div>
  
    <script type="text/javascript">
        $('#is_trial').click(function() {
            $('#trial-content').slideToggle('fast', function() {
                // ok
            });
            return false;
        });
        $('#non_trial').click(function() {
            $('#non-trial-content').slideToggle('fast', function() {
                // ok
            });
            return false;
        });
    </script>
    [% INCLUDE nhs_number_ajax.tt %]
<!-- END [% template.name %] -->