{php}html_header_show();{/php} {literal} {/literal}
{xl t='Currently Active'}
get_active() > 0} checked{/if} />
{xl t='Starting Date'}
{html_select_date field_order="DMY" 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'}
{if $DRUG_ARRAY_VALUES}
{xl t='in-house'}
{html_options values=$DRUG_ARRAY_VALUES output=$DRUG_ARRAY_OUTPUT}
{/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}
{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 $WEIGHT_LOSS_CLINIC}
{else}
{xl t='Add to Medication List'}
{html_radios name="medication" options=$prescription->medication_array selected=$prescription->medication}
{/if}
{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}