<form action="/admin/document_templates/2" class="formtastic document_template" id="edit_document_template_2" method="post"><div style="margin:0;padding:0;display:inline"><input name="_method" type="hidden" value="put" /><input name="authenticity_token" type="hidden" value="WtzaApkH5wvC/V4ey9g0BTwN80fkgVyh4F5aGj6qC64=" /></div>
          
          <li class="string required" id="document_template_name_input"><label for="document_template_name">Name<abbr title="required">*</abbr></label><input id="document_template_name" maxlength="255" name="document_template[name]" size="50" type="text" value="Follow Up Letter" /></li>
          <li class="text required" id="document_template_description_input"><label for="document_template_description">Description<abbr title="required">*</abbr></label><textarea cols="40" id="document_template_description" name="document_template[description]" rows="20">Follow Up</textarea></li>
          <li class="boolean required" id="document_template_enabled_input"><label for="document_template_enabled"><input name="document_template[enabled]" type="hidden" value="0" /><input checked="checked" id="document_template_enabled" name="document_template[enabled]" type="checkbox" value="1" />Enabled<abbr title="required">*</abbr></label></li>
          <li class="text required" id="document_template_header_input"><label for="document_template_header">Header<abbr title="required">*</abbr></label><textarea cols="40" id="document_template_header" name="document_template[header]" rows="20">&lt;div style=&quot;text-align: center;&quot;&gt;&lt;img vspace=&quot;5&quot; src=&quot;http://mtmqa.pharmmd.com/skins/MTM/logo.gif&quot; alt=&quot;&quot; /&gt;&lt;/div&gt;&#x000A;&lt;div style=&quot;text-align: center;&quot;&gt;216 Centerview Drive, Suite 390 &amp;diams; Brentwood, TN 37027&lt;/div&gt;&#x000A;&lt;div style=&quot;text-align: center;&quot;&gt;P 866-850-4159 &amp;diams; F 615-690-0837 &amp;diams; www.pharmmd.com&lt;/div&gt;</textarea></li>
 
          <li class="boolean required" id="document_template_hide_header_first_page_input"><label for="document_template_hide_header_first_page"><input name="document_template[hide_header_first_page]" type="hidden" value="0" /><input id="document_template_hide_header_first_page" name="document_template[hide_header_first_page]" type="checkbox" value="1" />Hide Header on First Page<abbr title="required">*</abbr></label></li>
          <li class="boolean required" id="document_template_hide_header_odd_pages_input"><label for="document_template_hide_header_odd_pages"><input name="document_template[hide_header_odd_pages]" type="hidden" value="0" /><input id="document_template_hide_header_odd_pages" name="document_template[hide_header_odd_pages]" type="checkbox" value="1" />Hide Header on Odd Pages<abbr title="required">*</abbr></label></li>
          <li class="boolean required" id="document_template_hide_header_even_pages_input"><label for="document_template_hide_header_even_pages"><input name="document_template[hide_header_even_pages]" type="hidden" value="0" /><input id="document_template_hide_header_even_pages" name="document_template[hide_header_even_pages]" type="checkbox" value="1" />Hide Header on Even Pages<abbr title="required">*</abbr></label></li>
          <li class="text required" id="document_template_body_input"><label for="document_template_body">Body<abbr title="required">*</abbr></label><textarea cols="40" id="document_template_body" name="document_template[body]" rows="20">&lt;p&gt;Dear $FirstName $LastName,&lt;/p&gt;&#x000A;&lt;p&gt;It was a pleasure to talk to you on &lt;b&gt;${Today::MMM dd, yyyy} &lt;/b&gt;. I wanted to write to you to summarize what we discussed and to provide you with further information as we discussed.&lt;/p&gt;&#x000A;&lt;p&gt;&lt;b&gt;Call Summary:&lt;/b&gt;&amp;nbsp;&lt;br /&gt;&#x000A;&lt;!-- Assessment/Plan --&gt;&lt;/p&gt;&#x000A;&lt;div style=&quot;page-break-inside: avoid;&quot;&gt;&#x000A;&lt;div&gt;$InterventionAssessment&lt;/div&gt;&#x000A;${NotNull::InterventionPlan::[&#x000A;&lt;div&gt;$InterventionPlan&lt;/div&gt;&#x000A;]}${IfDataSet::DrugInteractions::[&#x000A;&lt;table cellspacing=&quot;0&quot; cellpadding=&quot;3&quot; border=&quot;0&quot; style=&quot;border: 1px solid rgb(102, 102, 102); padding: 0pt 5px; width: 100%; border-collapse: collapse; background-color: rgb(255, 255, 255); page-break-inside: avoid;&quot; class=&quot;dtpDetailTable&quot;&gt;&#x000A;    &lt;tbody&gt;&#x000A;        &lt;tr&gt;&#x000A;            &lt;th style=&quot;border-bottom: 1px solid rgb(51, 51, 51); font-size: 10px; color: rgb(255, 255, 255); font-family: verdana; background-color: rgb(153, 153, 153); text-align: left;&quot;&gt;Drug&lt;/th&gt;&#x000A;            &lt;th style=&quot;border-bottom: 1px solid rgb(51, 51, 51); font-size: 10px; color: rgb(255, 255, 255); font-family: verdana; background-color: rgb(153, 153, 153); text-align: left;&quot;&gt;Interaction Class (ingredients)&lt;/th&gt;&#x000A;            &lt;th style=&quot;border-bottom: 1px solid rgb(51, 51, 51); font-size: 10px; color: rgb(255, 255, 255); font-family: verdana; background-color: rgb(153, 153, 153); text-align: left;&quot;&gt;Observation&lt;/th&gt;&#x000A;            &lt;th style=&quot;border-bottom: 1px solid rgb(51, 51, 51); font-size: 10px; color: rgb(255, 255, 255); font-family: verdana; background-color: rgb(153, 153, 153); text-align: right;&quot;&gt;Interacting Class (ingredients)&lt;/th&gt;&#x000A;        &lt;/tr&gt;&#x000A;        &lt;tr&gt;&#x000A;            &lt;td valign=&quot;top&quot; style=&quot;border-bottom: 1px solid rgb(204, 204, 204); padding: 2px 3px 1px; font-size: 10px; font-family: arial;&quot;&gt;$DrugName&lt;/td&gt;&#x000A;            &lt;td valign=&quot;top&quot; style=&quot;border-bottom: 1px solid rgb(204, 204, 204); padding: 2px 3px 1px; font-size: 10px; font-family: arial;&quot;&gt;$InteractionClassName ($InteractionClassIngredients)&lt;/td&gt;&#x000A;            &lt;td valign=&quot;top&quot; style=&quot;border-bottom: 1px solid rgb(204, 204, 204); padding: 2px 3px 1px; font-size: 10px; font-family: arial;&quot;&gt;$Observation&lt;/td&gt;&#x000A;            &lt;td valign=&quot;top&quot; style=&quot;border-bottom: 1px solid rgb(204, 204, 204); padding: 2px 3px 1px; font-size: 10px; font-family: arial;&quot;&gt;$InteractingClassName ($InteractingClassIngredients)&lt;/td&gt;&#x000A;        &lt;/tr&gt;&#x000A;    &lt;/tbody&gt;&#x000A;&lt;/table&gt;&#x000A;]}${IfDataSet::DrugTherapyProblemInterventions::[ &lt;br /&gt;&#x000A;&lt;table cellspacing=&quot;0&quot; cellpadding=&quot;3&quot; border=&quot;0&quot; style=&quot;border: 1px solid rgb(102, 102, 102); padding: 0pt 5px; width: 100%; border-collapse: collapse; background-color: rgb(255, 255, 255); page-break-inside: avoid;&quot; class=&quot;dtpDetailTable&quot;&gt;&#x000A;    &lt;tbody&gt;&#x000A;        &lt;tr&gt;&#x000A;            &lt;th align=&quot;left&quot; style=&quot;border-bottom: 1px solid rgb(51, 51, 51); font-size: 10px; color: rgb(255, 255, 255); font-family: verdana; background-color: rgb(153, 153, 153); text-align: left;&quot;&gt;Drug Therapy Problem&lt;/th&gt;&#x000A;            &lt;th align=&quot;left&quot; style=&quot;border-bottom: 1px solid rgb(51, 51, 51); font-size: 10px; color: rgb(255, 255, 255); font-family: verdana; background-color: rgb(153, 153, 153); text-align: left;&quot;&gt;Recommendation&lt;/th&gt;&#x000A;        &lt;/tr&gt;&#x000A;        &lt;tr&gt;&#x000A;            &lt;td valign=&quot;top&quot; rowspan=&quot;5&quot; style=&quot;border-right: 1px solid rgb(204, 204, 204); border-bottom: 1px solid rgb(204, 204, 204); padding: 2px 3px 1px; font-size: 10px; font-family: arial;&quot;&gt;&lt;b&gt;$DrugName&lt;/b&gt;&#x000A;            &lt;div style=&quot;padding-left: 6px;&quot;&gt;$Category &lt;br /&gt;&#x000A;            $SubCategory&lt;/div&gt;&#x000A;            &lt;/td&gt;&#x000A;            &lt;td valign=&quot;top&quot; style=&quot;border-bottom: 1px solid rgb(204, 204, 204); padding: 2px 3px 1px; font-size: 10px; font-family: arial;&quot;&gt;$Recommendation&lt;/td&gt;&#x000A;        &lt;/tr&gt;&#x000A;        &lt;tr&gt;&#x000A;            &lt;td valign=&quot;top&quot; style=&quot;border-bottom: 1px solid rgb(204, 204, 204); padding: 2px 3px 1px; font-size: 10px; font-family: arial;&quot;&gt;&lt;b&gt;Rationale&lt;/b&gt;&lt;/td&gt;&#x000A;        &lt;/tr&gt;&#x000A;        &lt;tr&gt;&#x000A;            &lt;td valign=&quot;top&quot; style=&quot;border-bottom: 1px solid rgb(204, 204, 204); padding: 2px 3px 1px; font-size: 10px; font-family: arial;&quot;&gt;$Rationale&lt;/td&gt;&#x000A;        &lt;/tr&gt;&#x000A;        &lt;tr&gt;&#x000A;            &lt;td valign=&quot;top&quot; style=&quot;border-bottom: 1px solid rgb(204, 204, 204); padding: 2px 3px 1px; font-size: 10px; font-family: arial;&quot;&gt;&lt;b&gt;Expected Result&lt;/b&gt;&lt;/td&gt;&#x000A;        &lt;/tr&gt;&#x000A;        &lt;tr&gt;&#x000A;            &lt;td valign=&quot;top&quot; style=&quot;border-bottom: 1px solid rgb(204, 204, 204); padding: 2px 3px 1px; font-size: 10px; font-family: arial;&quot;&gt;$ExpectedResult&lt;/td&gt;&#x000A;        &lt;/tr&gt;&#x000A;    &lt;/tbody&gt;&#x000A;&lt;/table&gt;&#x000A;]}&lt;/div&gt;&#x000A;&lt;div&gt;&amp;nbsp;&lt;/div&gt;&#x000A;&lt;!-- Assessment/Plan --&gt;&#x000A;&lt;div&gt;&amp;nbsp;&lt;/div&gt;&#x000A;&lt;div&gt;&#x000A;&lt;div&gt;&#x000A;&lt;div&gt;The purpose of this letter is two-fold. One purpose is to make sure that I documented everything correctly. If you disagree with anything here, please call so that I can correct it. The second purpose is to give you a written record of our discussion to help you manage your health and medications.&lt;/div&gt;&#x000A;&lt;/div&gt;&#x000A;&lt;/div&gt;&#x000A;&lt;p&gt;As I mentioned, &lt;b&gt;${NotNull::Company::[$Company ]}&lt;/b&gt;has contracted with us to provide you with these services at no charge. They realize that helping you to take your medications correctly will help in many ways including making happier, healthier employees and saving in pharmacy and medical costs to help keep insurance premiums down.&lt;/p&gt;&#x000A;&lt;div&gt;${IfDataSet::ContactDocument::[&#x000A;&lt;p&gt;We are committed to providing you with up to date, useful information about your medications.&amp;nbsp; After reviewing your medications, I think you will find the following information interesting:&lt;/p&gt;&#x000A;&lt;ul&gt;${Repeat::ContactDocument::[&#x000A;    &lt;li&gt;$Title ]}&lt;/li&gt;&#x000A;&lt;/ul&gt;&#x000A;]}&lt;/div&gt;&#x000A;&lt;p&gt;It is our hope that you find our services useful and enjoyable. You can call us as often as you wish to get help with your medications. &lt;b&gt;Our number is 1-866-850-4159 ext.1&amp;nbsp;and our hours for incoming calls are Monday through Friday, 8am-6pm Central time.&lt;/b&gt;&lt;/p&gt;&#x000A;&lt;p&gt;It was a real pleasure talking with you about your medications.&lt;/p&gt;&#x000A;&lt;p&gt;Sincerely,&lt;br /&gt;&#x000A;&lt;br /&gt;&#x000A;${CurrentUser::FirstName} ${CurrentUser::LastName}, ${CurrentUser::Signature} &lt;br /&gt;&#x000A;PharmMD Team&lt;/p&gt;&#x000A;&lt;div&gt;&amp;nbsp;&lt;/div&gt;</textarea></li>
 
          <li class="text required" id="document_template_footer_input"><label for="document_template_footer">Footer<abbr title="required">*</abbr></label><textarea cols="40" id="document_template_footer" name="document_template[footer]" rows="20">The footer</textarea></li>
          <li class="boolean required" id="document_template_hide_footer_first_page_input"><label for="document_template_hide_footer_first_page"><input name="document_template[hide_footer_first_page]" type="hidden" value="0" /><input id="document_template_hide_footer_first_page" name="document_template[hide_footer_first_page]" type="checkbox" value="1" />Hide Footer on First Page<abbr title="required">*</abbr></label></li>
          <li class="boolean required" id="document_template_hide_footer_odd_pages_input"><label for="document_template_hide_footer_odd_pages"><input name="document_template[hide_footer_odd_pages]" type="hidden" value="0" /><input id="document_template_hide_footer_odd_pages" name="document_template[hide_footer_odd_pages]" type="checkbox" value="1" />Hide Footer on Odd Pages<abbr title="required">*</abbr></label></li>
          <li class="boolean required" id="document_template_hide_footer_even_pages_input"><label for="document_template_hide_footer_even_pages"><input name="document_template[hide_footer_even_pages]" type="hidden" value="0" /><input id="document_template_hide_footer_even_pages" name="document_template[hide_footer_even_pages]" type="checkbox" value="1" />Hide Footer on Even Pages<abbr title="required">*</abbr></label></li>
 
          <li class="commit"><input id="document_template_submit" name="commit" type="submit" value="Update" /></li>
        </form>