{php}html_header_show();{/php} {literal} {/literal}
{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 Finder'} {if $DRUG_ARRAY_VALUES}   {/if}
{xl t='Form' } {xl t='Route'} {xl t='Intvl'} {xl t='Per' }
{xl t='Drug' } {xl t='Qty' } {xl t='Size' } {xl t='Units'} {xl t='Take' } {xl t='Refs' } {xl t='Sub' }
[{xl t='Add Row'}]
{xl t='Notes'}
{xl t='Add to Medication List'} {html_radios name="medication" options=$prescription->medication_array selected=$prescription->medication}
{literal}