{$pagetitle}

{BEGIN top_block}

{$pagetitlelabel receipts 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} {BEGIN cellblock_grid_c3} {END cellblock_grid_c3}

{BEGIN invoice_num_fieldblock}

{BEGIN invoice_num_label}{$label receipts invoice_num }{END invoice_num_label}

{$invoice_num_editcontrol}

{END invoice_num_fieldblock} {BEGIN nrn_pn_fieldblock}

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

{$nrn_pn_editcontrol}

{END nrn_pn_fieldblock} {BEGIN patient_fname_fieldblock}

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

{$patient_fname_editcontrol}

{END patient_fname_fieldblock} {BEGIN patient_lname_fieldblock}

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

{$patient_lname_editcontrol}

{END patient_lname_fieldblock} {BEGIN gender_fieldblock}

{BEGIN gender_label}{$label receipts gender }{END gender_label}

{$gender_editcontrol}

{END gender_fieldblock} {BEGIN comp_test_code_fieldblock}

{BEGIN comp_test_code_label}{$label receipts comp_test_code }{END comp_test_code_label}

{$comp_test_code_editcontrol}

{END comp_test_code_fieldblock} {BEGIN labtest_list_fieldblock}

{BEGIN labtest_list_label}{$label receipts labtest_list }{END labtest_list_label}

{$labtest_list_editcontrol}

{END labtest_list_fieldblock} {BEGIN created_by_fieldblock}

{BEGIN created_by_label}{$label receipts created_by }{END created_by_label}

{$created_by_editcontrol}

{END created_by_fieldblock} {BEGIN comp_test_name_fieldblock}

{BEGIN comp_test_name_label}{$label receipts comp_test_name }{END comp_test_name_label}

{$comp_test_name_editcontrol}

{END comp_test_name_fieldblock} {BEGIN total_fieldblock}

{BEGIN total_label}{$label receipts total }{END total_label}

{$total_editcontrol}

{END total_fieldblock} {BEGIN inv_date_fieldblock}

{BEGIN inv_date_label}{$label receipts inv_date }{END inv_date_label}

{$inv_date_editcontrol}

{END inv_date_fieldblock} {BEGIN inv_time_fieldblock}

{BEGIN inv_time_label}{$label receipts inv_time }{END inv_time_label}

{$inv_time_editcontrol}

{END inv_time_fieldblock} {BEGIN ref_doc_fieldblock}

{BEGIN ref_doc_label}{$label receipts ref_doc }{END ref_doc_label}

{$ref_doc_editcontrol}

{END ref_doc_fieldblock} {BEGIN inv_status_fieldblock}

{BEGIN inv_status_label}{$label receipts inv_status }{END inv_status_label}

{$inv_status_editcontrol}

{END inv_status_fieldblock} {BEGIN comp_logo_fieldblock}

{BEGIN comp_logo_label}{$label receipts comp_logo }{END comp_logo_label}

{$comp_logo_editcontrol}

{END comp_logo_fieldblock} {BEGIN amt_paid_fieldblock}

{BEGIN amt_paid_label}{$label receipts amt_paid }{END amt_paid_label}

{$amt_paid_editcontrol}

{END amt_paid_fieldblock} {BEGIN balance_fieldblock}

{BEGIN balance_label}{$label receipts balance }{END balance_label}

{$balance_editcontrol}

{END balance_fieldblock} {BEGIN doc_address_fieldblock}

{BEGIN doc_address_label}{$label receipts doc_address }{END doc_address_label}

{$doc_address_editcontrol}

{END doc_address_fieldblock} {BEGIN patient_address_fieldblock}

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

{$patient_address_editcontrol}

{END patient_address_fieldblock} {BEGIN comp_address_fieldblock}

{BEGIN comp_address_label}{$label receipts comp_address }{END comp_address_label}

{$comp_address_editcontrol}

{END comp_address_fieldblock} {BEGIN comp_email_fieldblock}

{BEGIN comp_email_label}{$label receipts comp_email }{END comp_email_label}

{$comp_email_editcontrol}

{END comp_email_fieldblock} {BEGIN comp_telenum_fieldblock}

{BEGIN comp_telenum_label}{$label receipts comp_telenum }{END comp_telenum_label}

{$comp_telenum_editcontrol}

{END comp_telenum_fieldblock} {BEGIN comp_fax_fieldblock}

{BEGIN comp_fax_label}{$label receipts comp_fax }{END comp_fax_label}

{$comp_fax_editcontrol}

{END comp_fax_fieldblock} {BEGIN comp_name_fieldblock}

{BEGIN comp_name_label}{$label receipts comp_name }{END comp_name_label}

{$comp_name_editcontrol}

{END comp_name_fieldblock} {BEGIN payment_meth_fieldblock}

{BEGIN payment_meth_label}{$label receipts payment_meth }{END payment_meth_label}

{$payment_meth_editcontrol}

{END payment_meth_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}