{php}html_header_show();{/php}
{literal} {/literal} {literal} {/literal} {literal} {/literal}
{xl t='Add'}/{xl t='Edit'}
{xl t='Save'}
{if $DRUG_ARRAY_VALUES} {if $prescription->get_refills() >= $prescription->get_dispensation_count()}
units, $
{else} {xl t='prescription has reached its limit of'} {$prescription->get_refills()} {xl t='refills'}. {/if} {/if}
{xl t='Back'}
{php} if ($GLOBALS['enable_amc_prompting']) { {/php}
{amcCollect amc_id='e_prescribe_amc' patient_id=$prescription->patient->id object_category='prescriptions' object_id=$prescription->id} {if not $amcCollectReturn}
{else}
{/if}
{xl t='E-Prescription?'}
{php} } {/php}
{xl t='Currently Active'}
get_active() > 0} checked{/if} />
{xl t='Starting Date'}
{html_select_date start_year="-10" end_year="+5" time=$prescription->start_date prefix="start_date_"}
{xl t='Provider'}
{html_options name="provider_id" options=$prescription->provider->utility_provider_array() selected=$prescription->provider->get_id()}
{xl t='Drug'}
({xl t='click here to search'})
{if $DRUG_ARRAY_VALUES}
{xl t='in-house'}
{html_options values=$DRUG_ARRAY_VALUES output=$DRUG_ARRAY_OUTPUT selected=$prescription->get_drug_id()}
{/if}
{xl t='Quantity'}
{if $SIMPLIFIED_PRESCRIPTIONS && !$prescription->size}
{else}
{/if}
{xl t='Medicine Units'}
{html_options options=$prescription->unit_array selected=$prescription->unit}
{xl t='Take'}
{if $SIMPLIFIED_PRESCRIPTIONS && !$prescription->form && !$prescription->route && !$prescription->interval}
{else}
{xl t='in'}
{html_options options=$prescription->form_array selected=$prescription->form}
{html_options options=$prescription->route_array selected=$prescription->route}
{html_options options=$prescription->interval_array selected=$prescription->interval}
{/if}
{xl t='Refills'}
{html_options name="refills" options=$prescription->refills_array selected=$prescription->refills} {if $SIMPLIFIED_PRESCRIPTIONS}
{else} # {xl t='of tablets'}:
{/if}
{xl t='Notes'}
{$prescription->note}
{if $WEIGHT_LOSS_CLINIC}
{xl t='Substitution'}
{html_options name="substitute" options=$prescription->substitute_array selected=$prescription->substitute}
{else}
{xl t='Add to Medication List'}
{html_radios name="medication" options=$prescription->medication_array selected=$prescription->medication} {html_options name="substitute" options=$prescription->substitute_array selected=$prescription->substitute}
{/if}
{literal} {/literal}