[[static_erefill_header.html]]


<form name="frm" action="$viewnhpatients_url"  method="post">

{$error{
<font color="#ff0000">$error</font><br>
<a href="#" onclick="Javascript: history.back(1);">Click here to return back to the order form</a>
}}



<div id="content">
	<div class="container">
		<div class="row-fluid">
			<div class="">
				<div class="pull-right log-section">Welcome <strong><span class="user-name">$loginname</span></strong>  <a href="logout.php"><span class="icon-in-link"><i class="fa fa-unlock"></i> </span>Logout </a></div>
				<h2 class="title-divider">
				  <span>Order <span class="de-em">Confirmation</span></span>
				</h2>

<!-- Prescription table start -->
						<div class="row">
							<div class="">
								<div class="row-fluid shade">
									<div class="row">
										<div class="col-md-6">
											<p><strong>$store_name</strong></p><br />
											<p><strong>Phone: $store_phone</strong>
											$store_address,  $store_city</p>
										</div>
										<div class="col-md-6"></div>
									</div>
								</div>
								<div class="row-fluid">
									<div class="col-md-12 div-bordered">
										<P><strong>Thank-you $patient_firstname $patient_lastname </strong><br />
										
									</div>
									<div class="row-fluid div-bordered">
										<div class="col-md-12 div-bordered" >
											<P><strong>You have successfully ordered the prescription(s) marked <span style="color: green;">Ordered</span></strong></P>
											<P><strong>If any of your orders <span style="color: red;">Failed</span>, please contact your pharmacy by phone at $store_phone.</strong></P>
										</div>
									</div>
								</div>
							</div>
						</div>
						<!-- Prescription table end -->


						<p>&nbsp;</p>
                                         <div class="row">
                                           <div class="">
						 	<div class="row-fluid">
						       	<div class="col-md-12 div-bordered" style="background-color:#C9C9C9;">
								    <table class="footable table demo table-bordered toggle-arrow">
		 	                     			<thead>
						  			   <tr>
										<th data-toggle="true" >
											Rx Number
										</th>
										<th data-toggle="true">
											Drug Name
  										</th>
                                                                      <th data-toggle="true">
											Status
  										</th>

	 								   </tr>
						      			</thead>
									<tbody>
							   		   $rxs_main
									</tbody>
								   </table>
							  	</div>
							</div>
						 </div>
					      </div>


					<div class="row">
                                 		<div style="margin:10px 5px;">
                             		  <table>
            					     <tr>
                                                  <td>
                                                    <a href="$backtonhpatient_url" class="btn btn-primary"><i class="fa fa-arrow-right"></i> Back to Patient List</a>

  				   	              <!--   <button type="submit" class="btn btn-primary"><i class="fa fa-check"></i> Back to Patient List</button> -->
							 </td>
						     </tr>
				 	         </table>

                                 		</div>
                                 
					</div>
				
			</div>
		</div>
	</div>
</div>
<input type="hidden" name="store" value="$store_storeidentifier">
<input type="hidden" name="nhid" value="$nhid">


</form>

[[static_footer.html]]




<<rxs>>
<tr>
  <td style="width: 10%">
    <div class="row-fluid">
	
	<div class="col-md-4">
		<p><strong>$rxs_rxnumber</strong></p>
	</div>
    </div>
   </td>
   <td>
    <div class="row-fluid">
	
	<div>
		<p><strong>$rxs_drugname</strong></p>
	</div>
    </div>
   </td>
   <td>
    <div class="row-fluid">
	
	<div>
             <p><span style="color: $rxs_color;"><b>$rxs_status</b></span></p>
	</div>
    </div>
   </td>

</tr>


  








                   

<</rxs>>