[% # INCLUDE dumper.tt dump = # automatic = session, vars, params, request & settings # settings; # session; # request; # params; # env; # errs; # 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 ); PROCESS headers.tt; # sets header %]
HMDS [% 'BCR-ABL Monitoring' IF params.bcr_abl_req %] 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.

[% ELSE %] [% 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 %]
[% IF vars.cml_data.size; # PROCESS dumper.tt dump = vars.cml_data; USE date = DateTime(today = 1); # PROCESS dumper.tt dump = date %]

Previous BCR-ABL results [% '[last 5]' IF vars.cml_data.results.size == 5 %]

[% IF vars.cml_data.results.size %]
    [% FOREACH row IN vars.cml_data.results; delta = row.registered.delta_days(date).delta_days; class = row.result.match('BCR-ABL : ABL ratio') AND delta < vars.min_delta ? 'highlight' : 'normal'; %]
  1. [% row.registered.strftime('%d.%b.%Y') %] [[% delta %]d] [% row.result %]
    2. [% END %]
[% ELSE %]

None

[% END %]
[% BLOCK reason %]
[% IF errs.reason; errs.reason; ELSIF NOT skip_min_delta %] Last result < [% vars.min_delta %] days ago[% END %]
[% END %] [% IF vars.cml_data.date_last; delta_days = vars.cml_data.date_last.delta_days(date).delta_days; INCLUDE reason IF delta_days < vars.min_delta; ELSIF errs.reason; # errs.reason if failed validation INCLUDE reason; END; %] [% ELSIF params.reason; # form submission, passed validation INCLUDE reason skip_min_delta = 1; # skip info message END %]
[% errs.patient_number %]
[% IF errs.location_id; errs.location_id; ELSE %]
select from suggestion list (min 3 chars):
[% END %]
[% IF errs.referrer; errs.referrer; ELSE %]
select from suggestion list (min 3 chars):
[% END %]
[% errs.doi %]
[% errs.tb %]
[% errs.previous %]
[% errs.specimen %] [% DEFAULT params.specimen = 'veneous blood' IF params.bcr_abl_req %]
[% errs.sample_ref %]
[% UNLESS params.bcr_abl_req %]
[% errs.report_to %]
[% END %]
[% IF params.bcr_abl_req; INCLUDE bcr_abl_fields.tt; ELSE %]
[% errs.clinical_details %]
[% errs.treatment %]
[% END %]
[% errs.hb %]
[% errs.wbc %]
[% errs.plt %]
[% errs.lymphs %]
[% errs.neut %]
[% errs.other %]
[% errs.requested_by %]
[% errs.contact %]
[% IF generate_pdf; btn_type = 'success'; btn_label = 'Submit'; ELSE; btn_type = 'primary'; btn_label = 'Validate'; END %]