{# crate_anon/crateweb/consent/templates/clinician_contact_request_submit.html #}
{% extends "base.html" %}
{% comment %}
template parameters:
form: Form
db_description: str
permitted_to_contact_discharged_patients_for_n_days: int
permitted_to_contact_discharged_patients_for_n_years: str
{% endcomment %}
{% block content %}
<h1>Submit patient contact request</h1>
<div>Using database: <b>{{ db_description }}</b></div>
<p>You can request that one or more of your patients is included in a study.</p>
<div class="warning">
<ul>
<li>Please make sure you only enter details of patients under
your care.
</li>
<li>CPFT has ethics approval to contact patients for up
to {{ permitted_to_contact_discharged_patients_for_n_days }} days
({{ permitted_to_contact_discharged_patients_for_n_years }} years)
after discharge, without specific consent. Please do not enter
details for patients who have been discharged longer ago than this
unless they specifically consented to being contacted after discharge.
</li>
</ul>
</div>
<form action="{% url 'clinician_contact_request' %}" method="post">
{% csrf_token %}
<table class="formtable">
{{ form }}
</table>
<input type="submit" value="Submit" />
</form>
{% endblock %}
{% block helpurl %}{{ HelpUrl.clinician_submit_contact_request }}{% endblock %}