templates/pharmacies/general_edit.html

   1 <form name="pharmacy" method="post" action="{$FORM_ACTION}">
   2 <!-- it is important that the hidden form_id field be listed first, when it is called is populates any old information attached with the id, this allows for partial edits
   3                 if it were called last, the settings from the form would be overwritten with the old information-->
   4 <input type="hidden" name="form_id" value="{$pharmacy->id}" />
   5 <table CELLSPACING="0" CELLPADDING="3">
   6 <tr>
   7         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >Name</td>
   8         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
   9                 <input type="text" size="40" name="name" value="{$pharmacy->name}"/>
  10         </td>
  11 </tr>
  12 <tr>
  13         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >Address</td>
  14         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
  15                 <input type="text" size="40" name="address_line1" value="{$pharmacy->address->line1}"/>
  16         </td>
  17 </tr>
  18 <tr>
  19         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >Address</td>
  20         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
  21                 <input type="text" size="40" name="address_line2" value="{$pharmacy->address->line2}"/>
  22         </td>
  23 </tr>
  24 <tr>
  25         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >City, State Zip</td>
  26         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
  27                 <input type="text" size="25" name="city" value="{$pharmacy->address->city}"/> , <input type="text" size="2" maxlength="2" name="state" value="{$pharmacy->address->state}"/> <input type="text" size="5" name="zip" value="{$pharmacy->address->zip}"/>
  28         </td>
  29 </tr>
  30 <tr>
  31         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >Email</td>
  32         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
  33                 <input TYPE="TEXT" NAME="email" SIZE="35" VALUE="{$pharmacy->email}"/>
  34         </td>
  35 </tr>
  36 <tr>
  37         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >Phone</td>
  38         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
  39                 <input TYPE="TEXT" NAME="phone" SIZE="12" VALUE="{$pharmacy->get_phone()}"/>
  40         </td>
  41 </tr>
  42 <tr>
  43         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >Fax</td>
  44         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
  45                 <input TYPE="TEXT" NAME="fax" SIZE="12" VALUE="{$pharmacy->get_fax()}"/>
  46         </td>
  47 </tr>
  48
  49 <tr>
  50         <td COLSPAN="1" ALIGN="LEFT" VALIGN="MIDDLE" >Default Method</td>
  51         <td COLSPAN="2" ALIGN="LEFT" VALIGN="MIDDLE" >
  52                 <select name="transmit_method">{html_options options=$pharmacy->transmit_method_array selected=$pharmacy->transmit_method}</select>
  53         </td>
  54 </tr>
  55 <tr>
  56         <td><br /><input type="submit" value="Update" /></td>
  57 </tr>
  58 </table>
  59 <input type="hidden" name="id" value="{$pharmacy->id}" />
  60 <input type="hidden" name="process" value="{$PROCESS}" />
  61 </form>