$LDRequestTo $formtitle $LDDepartment $TP_checkbox_1 $LDVisitRequested $TP_checkbox_2 $LDPatCanBeOrdered $batch_nr $TP_img_barcode | $TP_img_patient_label
$LDDiagnosesInquiries $TP_vspacer_1 <$TP_block_1> $TP_diagnosis_quiry
$LDDate : $TP_send_date $TP_calender_1 | $LDDoctor <$TP_input_1 type="text" name="send_doctor" size=40 maxlength=40 value="$TP_send_doctor"> $TP_send_doctor_x
$LDDeptReport $TP_vspacer_2 <$TP_block_2 name="result" cols=80 rows=10 wrap="physical">$TP_result
$LDDate : $TP_report_date $TP_calendar_2 | $LDDoctor <$TP_input_2 type="text" name="result_doctor" size=40 maxlength=40 value="$TP_result_doctor"> $TP_result_doctor_x