{literal} {/literal}
Starting Date
{html_select_date start_year="-10" end_year="+5" time=$prescription->start_date prefix="start_date_"}
Provider
{html_options name="provider_id" options=$prescription->provider->utility_provider_array() selected=$prescription->provider->get_id()}
Patient Name
{$prescription->patient->get_name_display()}
Drug
Quantity
Medicine Units
{html_options options=$prescription->unit_array selected=$prescription->unit}
Take
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}
Refill
{html_options name="refills" options=$prescription->refills_array selected=$prescription->refills}
units
Substitution
{html_options name="substitute" options=$prescription->substitute_array selected=$prescription->substitute}
Notes
{$prescription->note}