{# 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 %}

Submit patient contact request

Using database: {{ db_description }}

You can request that one or more of your patients is included in a study.

{% csrf_token %} {{ form }}
{% endblock %} {% block helpurl %}{{ HelpUrl.clinician_submit_contact_request }}{% endblock %}