= $this->extend($_SESSION['userrole'].'/layout/form.php') ?> = $this->section('content') ?>
Patient Information
| MR# |
|
||
| Patient Name | |||
| BirthDate | |||
| Sex | |||
| Address | |||
| Phone# | |||
Order Information
| Visit# | Visit Date | ||
| Treating Doctor | |||
| Payer Name | |||
Tests
| =$i+1;?> |