{php}html_header_show();{/php} {literal} {/literal}
{if $DRUG_ARRAY_VALUES} {/if} {if $SIMPLIFIED_PRESCRIPTIONS && !$prescription->size} {else} {/if} {if $WEIGHT_LOSS_CLINIC} {else} {/if}
{xl t='Currently Active'} get_active() > 0} checked{/if} />
{xl t='Starting Date'} {html_select_date field_order="DMY" start_year="-10" end_year="+5" time=$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'}
  {xl t='in-house'}
{xl t='Quantity'}
{xl t='Medicine Units'}
{xl t='Take'} {if $SIMPLIFIED_PRESCRIPTIONS && !$prescription->form && !$prescription->route && !$prescription->interval} {else} {/if}
{xl t='Refills'} {html_options name="refills" options=$prescription->refills_array selected=$prescription->refills} {if $SIMPLIFIED_PRESCRIPTIONS} {else}     {xl t='# of tablets:'} {/if}
{xl t='Notes'}
{xl t='Add to Medication List'} {html_radios name="medication" options=$prescription->medication_array selected=$prescription->medication}
{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}