{$pagetitle}

{BEGIN top_block}

{$pagetitlelabel patient_doc_assign add}

{END top_block} {BEGIN above-grid_block}

{BEGIN message_block}

{$message}

{BEGIN message_back_button} {END message_back_button} {BEGIN view_page_button} {END view_page_button} {BEGIN edit_page_button} {END edit_page_button}

{END message_block}

{END above-grid_block} {BEGIN grid_block}

Patient Information

{BEGIN section_block} {BEGIN cellblock_section_c1} {END cellblock_section_c1}

{BEGIN pid_fieldblock}

{BEGIN pid_label}{$label patient_doc_assign pid }{END pid_label}

{$pid_editcontrol}

{END pid_fieldblock} {BEGIN identifier_fieldblock}

{BEGIN identifier_label}{$label patient_doc_assign identifier }{END identifier_label}

{$identifier_editcontrol}

{END identifier_fieldblock} {BEGIN nrn_pn_fieldblock}

{BEGIN nrn_pn_label}{$label patient_doc_assign nrn_pn }{END nrn_pn_label}

{$nrn_pn_editcontrol}

{END nrn_pn_fieldblock} {BEGIN patient_title_fieldblock}

{BEGIN patient_title_label}{$label patient_doc_assign patient_title }{END patient_title_label}

{$patient_title_editcontrol}

{END patient_title_fieldblock} {BEGIN patient_fname_fieldblock}

{BEGIN patient_fname_label}{$label patient_doc_assign patient_fname }{END patient_fname_label}

{$patient_fname_editcontrol}

{END patient_fname_fieldblock} {BEGIN patient_m_initial_fieldblock}

{BEGIN patient_m_initial_label}{$label patient_doc_assign patient_m_initial }{END patient_m_initial_label}

{$patient_m_initial_editcontrol}

{END patient_m_initial_fieldblock} {BEGIN patient_lname_fieldblock}

{BEGIN patient_lname_label}{$label patient_doc_assign patient_lname }{END patient_lname_label}

{$patient_lname_editcontrol}

{END patient_lname_fieldblock} {BEGIN patient_dob_fieldblock}

{BEGIN patient_dob_label}{$label patient_doc_assign patient_dob }{END patient_dob_label}

{$patient_dob_editcontrol}

{END patient_dob_fieldblock} {BEGIN patient_age_fieldblock}

{BEGIN patient_age_label}{$label patient_doc_assign patient_age }{END patient_age_label}

{$patient_age_editcontrol}

{END patient_age_fieldblock} {BEGIN patient_sex_fieldblock}

{BEGIN patient_sex_label}{$label patient_doc_assign patient_sex }{END patient_sex_label}

{$patient_sex_editcontrol}

{END patient_sex_fieldblock} {BEGIN patient_telenum_fieldblock}

{BEGIN patient_telenum_label}{$label patient_doc_assign patient_telenum }{END patient_telenum_label}

{$patient_telenum_editcontrol}

{END patient_telenum_fieldblock} {BEGIN patient_address_fieldblock}

{BEGIN patient_address_label}{$label patient_doc_assign patient_address }{END patient_address_label}

{$patient_address_editcontrol}

{END patient_address_fieldblock} {BEGIN patient_email_fieldblock}

{BEGIN patient_email_label}{$label patient_doc_assign patient_email }{END patient_email_label}

{$patient_email_editcontrol}

{END patient_email_fieldblock} {BEGIN age_category_fieldblock}

{BEGIN age_category_label}{$label patient_doc_assign age_category }{END age_category_label}

{$age_category_editcontrol}

{END age_category_fieldblock} {BEGIN org_fieldblock}

{BEGIN org_label}{$label patient_doc_assign org }{END org_label}

{$org_editcontrol}

{END org_fieldblock}

{END section_block}

{BEGIN cellblock_grid_c3} {END cellblock_grid_c3}

{BEGIN doc_code_fieldblock}

{BEGIN doc_code_label}{$label patient_doc_assign doc_code }{END doc_code_label}

{$doc_code_editcontrol}

{END doc_code_fieldblock} {BEGIN doc_id_fieldblock}

{BEGIN doc_id_label}{$label patient_doc_assign doc_id }{END doc_id_label}

{$doc_id_editcontrol}

{END doc_id_fieldblock} {BEGIN doc_name_fieldblock}

{BEGIN doc_name_label}{$label patient_doc_assign doc_name }{END doc_name_label}

{$doc_name_editcontrol}

{END doc_name_fieldblock} {BEGIN doc_telenum_fieldblock}

{BEGIN doc_telenum_label}{$label patient_doc_assign doc_telenum }{END doc_telenum_label}

{$doc_telenum_editcontrol}

{END doc_telenum_fieldblock} {BEGIN doc_email_fieldblock}

{BEGIN doc_email_label}{$label patient_doc_assign doc_email }{END doc_email_label}

{$doc_email_editcontrol}

{END doc_email_fieldblock}

{END grid_block} {BEGIN below-grid_block}

Save Reset {BEGIN back_button} Back to list {END back_button} {BEGIN cancel_button} Cancel {END cancel_button}

{END below-grid_block}