{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
Take in
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