[% # INCLUDE dumper.tt dump = # automatic = session, vars, params, request & settings # settings; # session; # request; # params; # env; # vars; %] [% # pds_.tt also sets pds_code param & 'is_validated' if SMSP-0000 IF pds.size; pds_display = PROCESS pds.tt; END; # flag for loading info and setting submit button text: generate_pdf = ( params.item('_skip_pds') || is_validated ); %]
LCC Logo
HMDS Request Form
[load new request form] [% IF vars.found_patient.match('yes') %] Matching patient details found please check and amend if necessary [% ELSIF vars.found_patient.match('no'); # use para for extra spacing: %]

No matching patient details found

[% END %]
[% IF errs %]

Form validation failed, please correct error(s) below:

[% ELSIF generate_pdf %]

Form passed validation. Please check details are correct and re-submit. The completed request form will open in a new tab/window as a PDF. Please print it and send with your specimen(s) to the laboratory at the address provided.

[% END %]
[% IF pds.size %]
[% pds_display %]
[% END %]
[% class = vars.found_patient.match('yes') ? 'found' : 'normal' %]
[% errs.nhs_number %]
[% errs.last_name %]
[% errs.first_name %]
[% errs.middle_name %]
[% errs.day OR errs.month OR errs.year %] [% INCLUDE dateselect.tt %]
[% errs.gender %]
[% errs.patient_number %]
[% errs.location %]
[% errs.referrer %]
[% errs.doi %]
[% errs.tb %]
[% errs.previous %]
[% errs.specimen %]
[% errs.sample_ref %]
[% errs.report_to %]
[% errs.clinical_details %]
[% errs.treatment %]
[% errs.hb %]
[% errs.wbc %]
[% errs.plt %]
[% errs.lymphs %]
[% errs.neut %]
[% errs.other %]
[% errs.taken_by %]
[% errs.contact %]
[% errs.datetime %]
[% IF generate_pdf; btn_type = 'success'; btn_label = 'Submit'; ELSE; btn_type = 'primary'; btn_label = 'Validate'; END %]