[[static_erefill_header.html]]


<form name="frm" action="$viewpharmacies_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"></div>
				<h2 class="title-divider">
				  <span>Order <span class="de-em">Results</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><br />
											<p><strong>Phone: $store_phone</strong></p>
											$store_address,  $store_city</p>
										</div>
										<div class="col-md-6"></div>
									</div>
								</div>
								<div class="row-fluid">
									
									<div class="row-fluid div-bordered">
										<div class="col-md-12 div-bordered" >
											<P><strong>See Statuses Below.  Please contact your pharmacy by phone at $store_phone if you are having trouble</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">
											Status
  										</th>

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

			</div>
		</div>
	</div>
</div>



</form>
[[static_footer.html]]

<<orderitems>>

<tr bgcolor="#EEEEFF">
  <td width="10%">
    <div class="row-fluid">
	
	<div class="col-md-4">
		<p><strong>$orderitems_rxnumber</strong></p>
	</div>
    </div>
   </td>
   <td>
    <div class="row-fluid">

	<div>
		<p><font color="$rxs_color"><b>$orderitems_message</b></font></p>
	</div>
    </div>
   </td>

</tr>
<</orderitems>>