# REVISIONDATA

ACTIONTIME: 2015-02-12 14:54:27
SOURCE:
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<TABLE style="width: 543px;" class="fieldGrid">
  <TBODY>
  {BEGIN formid_fieldblock}<TR class="{$fielddispclass_formid}" data-fieldname="formid">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_1_fieldblock}{BEGIN Remark_1_fieldblock}<TR class="{$fielddispclass_Remark_1}" data-fieldname="Remark_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_1_label}{END Remark_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_1_fieldblock}{BEGIN Drug_2_fieldblock}<TR class="{$fielddispclass_Drug_2}" data-fieldname="Drug_2">
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  {END Drug_2_fieldblock}{BEGIN QtyReceived_2_fieldblock}<TR class="{$fielddispclass_QtyReceived_2}" data-fieldname="QtyReceived_2">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_2_fieldblock}{BEGIN Qty_Dispensed_2_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_2}" data-fieldname="Qty_Dispensed_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_2_label}{END Qty_Dispensed_2_label}</TD>
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_2_fieldblock}{BEGIN Remark_2_fieldblock}<TR class="{$fielddispclass_Remark_2}" data-fieldname="Remark_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_2_label}{END Remark_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
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    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_3_label}{END QtyReceived_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
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    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_3_label}{END QtySOH_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_3_fieldblock}{BEGIN Remark_3_fieldblock}<TR class="{$fielddispclass_Remark_3}" data-fieldname="Remark_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_3_label}{END Remark_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
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  {END Drug_4_fieldblock}{BEGIN QtyReceived_4_fieldblock}<TR class="{$fielddispclass_QtyReceived_4}" data-fieldname="QtyReceived_4">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_4_fieldblock}{BEGIN Qty_Dispensed_4_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_4}" data-fieldname="Qty_Dispensed_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_4_label}{END Qty_Dispensed_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_4_fieldblock}{BEGIN QtySOH_4_fieldblock}<TR class="{$fielddispclass_QtySOH_4}" data-fieldname="QtySOH_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_4_label}{END QtySOH_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_4_fieldblock}{BEGIN Remark_4_fieldblock}<TR class="{$fielddispclass_Remark_4}" data-fieldname="Remark_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_4_label}{END Remark_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_4_fieldblock}{BEGIN Drug_5_fieldblock}<TR class="{$fielddispclass_Drug_5}" data-fieldname="Drug_5">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_5_fieldblock}{BEGIN QtyReceived_5_fieldblock}<TR class="{$fielddispclass_QtyReceived_5}" data-fieldname="QtyReceived_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_5_label}{END QtyReceived_5_label}</TD>
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    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_5_label}{END Qty_Dispensed_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_5_fieldblock}{BEGIN QtySOH_5_fieldblock}<TR class="{$fielddispclass_QtySOH_5}" data-fieldname="QtySOH_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_5_label}{END QtySOH_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_5_fieldblock}{BEGIN Remark_5_fieldblock}<TR class="{$fielddispclass_Remark_5}" data-fieldname="Remark_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_5_label}{END Remark_5_label}</TD>
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  {END Remark_5_fieldblock}{BEGIN Drug_6_fieldblock}<TR class="{$fielddispclass_Drug_6}" data-fieldname="Drug_6">
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  {END Drug_6_fieldblock}{BEGIN QtyReceived_6_fieldblock}<TR class="{$fielddispclass_QtyReceived_6}" data-fieldname="QtyReceived_6">
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  {END QtyReceived_6_fieldblock}{BEGIN Qty_Dispensed_6_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_6}" data-fieldname="Qty_Dispensed_6">
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  {END Qty_Dispensed_6_fieldblock}{BEGIN QtySOH_6_fieldblock}<TR class="{$fielddispclass_QtySOH_6}" data-fieldname="QtySOH_6">
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  {END QtySOH_6_fieldblock}{BEGIN Remark_6_fieldblock}<TR class="{$fielddispclass_Remark_6}" data-fieldname="Remark_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_6_label}{END Remark_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_6_fieldblock}{BEGIN Drug_7_fieldblock}<TR class="{$fielddispclass_Drug_7}" data-fieldname="Drug_7">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_7_fieldblock}{BEGIN QtyReceived_7_fieldblock}<TR class="{$fielddispclass_QtyReceived_7}" data-fieldname="QtyReceived_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_7_label}{END QtyReceived_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_7_fieldblock}{BEGIN Qty_Dispensed_7_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_7}" data-fieldname="Qty_Dispensed_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_7_label}{END Qty_Dispensed_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_7_fieldblock}{BEGIN QtySOH_7_fieldblock}<TR class="{$fielddispclass_QtySOH_7}" data-fieldname="QtySOH_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_7_label}{END QtySOH_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_7_fieldblock}{BEGIN Remark_7_fieldblock}<TR class="{$fielddispclass_Remark_7}" data-fieldname="Remark_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_7_label}{END Remark_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_7_fieldblock}{BEGIN Drug_8_fieldblock}<TR class="{$fielddispclass_Drug_8}" data-fieldname="Drug_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_8_label}{END Drug_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_8_fieldblock}{BEGIN QtyReceived_8_fieldblock}<TR class="{$fielddispclass_QtyReceived_8}" data-fieldname="QtyReceived_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_8_label}{END QtyReceived_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_8_fieldblock}{BEGIN Qty_Dispensed_8_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_8}" data-fieldname="Qty_Dispensed_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_8_label}{END Qty_Dispensed_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_8_fieldblock}{BEGIN QtySOH_8_fieldblock}<TR class="{$fielddispclass_QtySOH_8}" data-fieldname="QtySOH_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_8_label}{END QtySOH_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_8_fieldblock}{BEGIN Remark_8_fieldblock}<TR class="{$fielddispclass_Remark_8}" data-fieldname="Remark_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_8_label}{END Remark_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_8_fieldblock}{BEGIN Drug_9_fieldblock}<TR class="{$fielddispclass_Drug_9}" data-fieldname="Drug_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_9_label}{END Drug_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_9_fieldblock}{BEGIN QtyReceived_9_fieldblock}<TR class="{$fielddispclass_QtyReceived_9}" data-fieldname="QtyReceived_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_9_label}{END QtyReceived_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_9_fieldblock}{BEGIN Qty_Dispensed_9_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_9}" data-fieldname="Qty_Dispensed_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_9_label}{END Qty_Dispensed_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_9_fieldblock}{BEGIN QtySOH_9_fieldblock}<TR class="{$fielddispclass_QtySOH_9}" data-fieldname="QtySOH_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_9_label}{END QtySOH_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_9_fieldblock}{BEGIN Remark_9_fieldblock}<TR class="{$fielddispclass_Remark_9}" data-fieldname="Remark_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_9_label}{END Remark_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_9_fieldblock}{BEGIN Drug_10_fieldblock}<TR class="{$fielddispclass_Drug_10}" data-fieldname="Drug_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_10_label}{END Drug_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_10_fieldblock}{BEGIN QtyReceived_10_fieldblock}<TR class="{$fielddispclass_QtyReceived_10}" data-fieldname="QtyReceived_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_10_label}{END QtyReceived_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_10_fieldblock}{BEGIN Qty_Dispensed_10_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_10}" data-fieldname="Qty_Dispensed_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_10_label}{END Qty_Dispensed_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_10_fieldblock}{BEGIN QtySOH_10_fieldblock}<TR class="{$fielddispclass_QtySOH_10}" data-fieldname="QtySOH_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_10_label}{END QtySOH_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_10_fieldblock}{BEGIN Remark_10_fieldblock}<TR class="{$fielddispclass_Remark_10}" data-fieldname="Remark_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_10_label}{END Remark_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_10_fieldblock}{BEGIN Drug_11_fieldblock}<TR class="{$fielddispclass_Drug_11}" data-fieldname="Drug_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_11_label}{END Drug_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_11_fieldblock}{BEGIN QtyReceived_11_fieldblock}<TR class="{$fielddispclass_QtyReceived_11}" data-fieldname="QtyReceived_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_11_label}{END QtyReceived_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_11_fieldblock}{BEGIN Qty_Dispensed_11_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_11}" data-fieldname="Qty_Dispensed_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_11_label}{END Qty_Dispensed_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_11_fieldblock}{BEGIN QtySOH_11_fieldblock}<TR class="{$fielddispclass_QtySOH_11}" data-fieldname="QtySOH_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_11_label}{END QtySOH_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_11_fieldblock}{BEGIN Remark_11_fieldblock}<TR class="{$fielddispclass_Remark_11}" data-fieldname="Remark_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_11_label}{END Remark_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_11_fieldblock}{BEGIN Drug_12_fieldblock}<TR class="{$fielddispclass_Drug_12}" data-fieldname="Drug_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_12_label}{END Drug_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_12_fieldblock}{BEGIN QtyReceived_12_fieldblock}<TR class="{$fielddispclass_QtyReceived_12}" data-fieldname="QtyReceived_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_12_label}{END QtyReceived_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_12_fieldblock}{BEGIN Qty_Dispensed_12_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_12}" data-fieldname="Qty_Dispensed_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_12_label}{END Qty_Dispensed_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_12_fieldblock}{BEGIN QtySOH_12_fieldblock}<TR class="{$fielddispclass_QtySOH_12}" data-fieldname="QtySOH_12">
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  {END Qty_Dispensed_13_fieldblock}{BEGIN QtySOH_13_fieldblock}<TR class="{$fielddispclass_QtySOH_13}" data-fieldname="QtySOH_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_13_label}{END QtySOH_13_label}</TD>
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  {END QtySOH_13_fieldblock}{BEGIN Remark_13_fieldblock}<TR class="{$fielddispclass_Remark_13}" data-fieldname="Remark_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_13_label}{END Remark_13_label}</TD>
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  {END Remark_13_fieldblock}{BEGIN Drug_14_fieldblock}<TR class="{$fielddispclass_Drug_14}" data-fieldname="Drug_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_14_label}{END Drug_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_14_fieldblock}{BEGIN QtyReceived_14_fieldblock}<TR class="{$fielddispclass_QtyReceived_14}" data-fieldname="QtyReceived_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_14_label}{END QtyReceived_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_14_fieldblock}{BEGIN Qty_Dispensed_14_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_14}" data-fieldname="Qty_Dispensed_14">
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  {END Qty_Dispensed_14_fieldblock}{BEGIN QtySOH_14_fieldblock}<TR class="{$fielddispclass_QtySOH_14}" data-fieldname="QtySOH_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_14_label}{END QtySOH_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_14_fieldblock}{BEGIN Remark_14_fieldblock}<TR class="{$fielddispclass_Remark_14}" data-fieldname="Remark_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_14_label}{END Remark_14_label}</TD>
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  {END Qty_Dispensed_15_fieldblock}{BEGIN QtySOH_15_fieldblock}<TR class="{$fielddispclass_QtySOH_15}" data-fieldname="QtySOH_15">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_15_fieldblock}{BEGIN Remark_15_fieldblock}<TR class="{$fielddispclass_Remark_15}" data-fieldname="Remark_15">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD>
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{BEGIN editbuttons}<DIV class="rnr-brickcontents style2 rnr-b-editbuttons {$brickclass_editbuttons}">
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<DIV class="rnr-buttons-left">{BEGIN save_button}<A class="rnr-button main" href="#" {$savebutton_attrs}>Save</A>{END save_button}{BEGIN reset_button}<A class="rnr-button" href="#" {$resetbutton_attrs}>Reset</A>{END reset_button}{BEGIN back_button}<A class="rnr-button" href="#" {$backbutton_attrs}>Back to list</A>{END back_button}{BEGIN close_button}<A class="rnr-button" href="#" {$closebutton_attrs}>Close 
window</A>{END close_button}{BEGIN view_page_button}<A class="rnr-button" href="#" {$view_page_button_attrs}>View</A>{END view_page_button}</DIV></DIV>{END editbuttons}</DIV>{END container_fields}</DIV></DIV>
{END container_edit}</DIV></DIV>{END container_all}</DIV>
<DIV class="rnr-middle">
<DIV class="rnr-left {$blockclass_left}"></DIV>
<DIV class="rnr-center {$blockclass_center}"></DIV>
<DIV class="rnr-right {$blockclass_right}"></DIV></DIV>
<DIV class="rnr-bottom {$blockclass_bottom}"><!--%%bottom%%--></DIV></DIV>
{$footer}{END body}</BODY></HTML>

PARAMS:
{"action":"v","lyName":"edit2","lySource":"@version=2\r\nbeginblock top \r\n\tbegincontainer vertical style=empty align=center width=500 all\r\n\t\tbegincontainer vertical style=1 align=center width=500 edit\r\n\t\t\tbrick color2 editheader\r\n\t\t\tbrick color1 message\r\n\t\t\tbegincontainer vertical color=1 style=fields fields\r\n\t\t\t\tbrick editfields\r\n\t\t\t\tbrick color2 editbuttons\r\n\t\t\tendcontainer \r\n\t\tendcontainer \r\n\t\tbegincontainer vertical style=empty width=100% details\r\n\t\t\tbrick editdetails\r\n\t\tendcontainer\r\n\tendcontainer\r\nendblock\r\n"}


ACTIONTIME: 2015-02-12 14:58:47
SOURCE:
<!DOCTYPE html>
<HTML {$html_attrs}><HEAD>
<META content="IE=Edge" http-equiv="X-UA-Compatible"><TITLE>{$pagetitle}</TITLE>
<META content="text/html; charset=utf-8" http-equiv="Content-Type">
<LINK rel="stylesheet" type="text/css" href="styles/default.css">{BEGIN rtlCSS}<LINK rel="stylesheet" type="text/css" href="styles/defaultRTL.css">{END rtlCSS}{BEGIN styleCSSFiles}<LINK rel="stylesheet" type="text/css" href="{$stylepath}">{END styleCSSFiles}{BEGIN pageCSSFiles}<LINK rel="stylesheet" type="text/css" href="{$pagestylepath}">{END pageCSSFiles}
<META name="GENERATOR" content="MSHTML 9.00.8112.16599"></HEAD>
<BODY class="{$stylename} function-edit" {$bodyattrs}>{BEGIN body}
{$header}
<DIV class="rnr-page">
<DIV class="rnr-top {$blockclass_top}">
{BEGIN container_all}
<DIV class="rnr-c rnr-cv rnr-c-all">
<DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_edit} rnr-wrapper rnr-cbw-edit">
{BEGIN container_edit}
<DIV class="rnr-c rnr-cv rnr-c-edit">
{BEGIN editheader}<DIV class="rnr-brickcontents style2 rnr-b-editheader {$brickclass_editheader}"><SPAN>	
<H1>
{$pagetitlelabel arv_pmtct edit}</H1>
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<DIV class="rnr-message">
{$message}</DIV></DIV>
{END message_block}<DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_fields} rnr-wrapper rnr-cbw-fields">
{BEGIN container_fields}
<DIV style="min-height: 2695px; min-width: 833px;" class="rnr-c rnr-cv rnr-c-fields">
<DIV class="rnr-brickcontents style1 rnr-b-editfields {$brickclass_editfields}">
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    <TD>&nbsp;</TD>
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    <TD>&nbsp;</TD></TR></TBODY></TABLE>
<TABLE style="width: 543px;" class="fieldGrid">
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  {END State_fieldblock}{BEGIN Funding_Source_fieldblock}<TR class="{$fielddispclass_Funding_Source}" data-fieldname="Funding_Source">
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  {END QtyReceived_7_fieldblock}{BEGIN Qty_Dispensed_7_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_7}" data-fieldname="Qty_Dispensed_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_7_label}{END Qty_Dispensed_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_7_fieldblock}{BEGIN QtySOH_7_fieldblock}<TR class="{$fielddispclass_QtySOH_7}" data-fieldname="QtySOH_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_7_label}{END QtySOH_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_7_fieldblock}{BEGIN Remark_7_fieldblock}<TR class="{$fielddispclass_Remark_7}" data-fieldname="Remark_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_7_label}{END Remark_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_7_fieldblock}{BEGIN Drug_8_fieldblock}<TR class="{$fielddispclass_Drug_8}" data-fieldname="Drug_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_8_label}{END Drug_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_8_fieldblock}{BEGIN QtyReceived_8_fieldblock}<TR class="{$fielddispclass_QtyReceived_8}" data-fieldname="QtyReceived_8">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_8_fieldblock}{BEGIN Qty_Dispensed_8_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_8}" data-fieldname="Qty_Dispensed_8">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_8_fieldblock}{BEGIN QtySOH_8_fieldblock}<TR class="{$fielddispclass_QtySOH_8}" data-fieldname="QtySOH_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_8_label}{END QtySOH_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_8_fieldblock}{BEGIN Remark_8_fieldblock}<TR class="{$fielddispclass_Remark_8}" data-fieldname="Remark_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_8_label}{END Remark_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_8_fieldblock}{BEGIN Drug_9_fieldblock}<TR class="{$fielddispclass_Drug_9}" data-fieldname="Drug_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_9_label}{END Drug_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_9_fieldblock}{BEGIN QtyReceived_9_fieldblock}<TR class="{$fielddispclass_QtyReceived_9}" data-fieldname="QtyReceived_9">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_9_fieldblock}{BEGIN Qty_Dispensed_9_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_9}" data-fieldname="Qty_Dispensed_9">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_9_fieldblock}{BEGIN QtySOH_9_fieldblock}<TR class="{$fielddispclass_QtySOH_9}" data-fieldname="QtySOH_9">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_9_fieldblock}{BEGIN Remark_9_fieldblock}<TR class="{$fielddispclass_Remark_9}" data-fieldname="Remark_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_9_label}{END Remark_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_9_fieldblock}{BEGIN Drug_10_fieldblock}<TR class="{$fielddispclass_Drug_10}" data-fieldname="Drug_10">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_10_fieldblock}{BEGIN QtyReceived_10_fieldblock}<TR class="{$fielddispclass_QtyReceived_10}" data-fieldname="QtyReceived_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_10_label}{END QtyReceived_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_10_fieldblock}{BEGIN Qty_Dispensed_10_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_10}" data-fieldname="Qty_Dispensed_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_10_label}{END Qty_Dispensed_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_10_fieldblock}{BEGIN QtySOH_10_fieldblock}<TR class="{$fielddispclass_QtySOH_10}" data-fieldname="QtySOH_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_10_label}{END QtySOH_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_10_fieldblock}{BEGIN Remark_10_fieldblock}<TR class="{$fielddispclass_Remark_10}" data-fieldname="Remark_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_10_label}{END Remark_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_10_fieldblock}{BEGIN Drug_11_fieldblock}<TR class="{$fielddispclass_Drug_11}" data-fieldname="Drug_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_11_label}{END Drug_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_11_fieldblock}{BEGIN QtyReceived_11_fieldblock}<TR class="{$fielddispclass_QtyReceived_11}" data-fieldname="QtyReceived_11">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_11_fieldblock}{BEGIN Qty_Dispensed_11_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_11}" data-fieldname="Qty_Dispensed_11">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_11_fieldblock}{BEGIN QtySOH_11_fieldblock}<TR class="{$fielddispclass_QtySOH_11}" data-fieldname="QtySOH_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_11_label}{END QtySOH_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_11_fieldblock}{BEGIN Remark_11_fieldblock}<TR class="{$fielddispclass_Remark_11}" data-fieldname="Remark_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_11_label}{END Remark_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_12_fieldblock}{BEGIN QtyReceived_12_fieldblock}<TR class="{$fielddispclass_QtyReceived_12}" data-fieldname="QtyReceived_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_12_label}{END QtyReceived_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_12_fieldblock}{BEGIN Qty_Dispensed_12_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_12}" data-fieldname="Qty_Dispensed_12">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_12_fieldblock}{BEGIN QtySOH_12_fieldblock}<TR class="{$fielddispclass_QtySOH_12}" data-fieldname="QtySOH_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_12_label}{END QtySOH_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_12_fieldblock}{BEGIN Remark_12_fieldblock}<TR class="{$fielddispclass_Remark_12}" data-fieldname="Remark_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_12_label}{END Remark_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_12_fieldblock}{BEGIN Drug_13_fieldblock}<TR class="{$fielddispclass_Drug_13}" data-fieldname="Drug_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_13_label}{END Drug_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_13_fieldblock}{BEGIN QtyReceived_13_fieldblock}<TR class="{$fielddispclass_QtyReceived_13}" data-fieldname="QtyReceived_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_13_label}{END QtyReceived_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_13_fieldblock}{BEGIN Qty_Dispensed_13_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_13}" data-fieldname="Qty_Dispensed_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_13_label}{END Qty_Dispensed_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_13_fieldblock}{BEGIN QtySOH_13_fieldblock}<TR class="{$fielddispclass_QtySOH_13}" data-fieldname="QtySOH_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_13_label}{END QtySOH_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_13_fieldblock}{BEGIN Remark_13_fieldblock}<TR class="{$fielddispclass_Remark_13}" data-fieldname="Remark_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_13_label}{END Remark_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_13_fieldblock}{BEGIN Drug_14_fieldblock}<TR class="{$fielddispclass_Drug_14}" data-fieldname="Drug_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_14_label}{END Drug_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_14_fieldblock}{BEGIN QtyReceived_14_fieldblock}<TR class="{$fielddispclass_QtyReceived_14}" data-fieldname="QtyReceived_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_14_label}{END QtyReceived_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_14_fieldblock}{BEGIN Qty_Dispensed_14_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_14}" data-fieldname="Qty_Dispensed_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_14_label}{END Qty_Dispensed_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_14_fieldblock}{BEGIN QtySOH_14_fieldblock}<TR class="{$fielddispclass_QtySOH_14}" data-fieldname="QtySOH_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_14_label}{END QtySOH_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_14_fieldblock}{BEGIN Remark_14_fieldblock}<TR class="{$fielddispclass_Remark_14}" data-fieldname="Remark_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_14_label}{END Remark_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_14_fieldblock}{BEGIN Drug_15_fieldblock}<TR class="{$fielddispclass_Drug_15}" data-fieldname="Drug_15">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_15_fieldblock}{BEGIN QtyReceived_15_fieldblock}<TR class="{$fielddispclass_QtyReceived_15}" data-fieldname="QtyReceived_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_15_label}{END QtyReceived_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_15_fieldblock}{BEGIN Qty_Dispensed_15_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_15}" data-fieldname="Qty_Dispensed_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_15_label}{END Qty_Dispensed_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_15_fieldblock}{BEGIN QtySOH_15_fieldblock}<TR class="{$fielddispclass_QtySOH_15}" data-fieldname="QtySOH_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_15_label}{END QtySOH_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_15_fieldblock}{BEGIN Remark_15_fieldblock}<TR class="{$fielddispclass_Remark_15}" data-fieldname="Remark_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_15_label}{END Remark_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD>
</TR>{END Remark_15_fieldblock}</TBODY></TABLE></DIV>
{BEGIN editbuttons}<DIV class="rnr-brickcontents style2 rnr-b-editbuttons {$brickclass_editbuttons}">
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<DIV class="rnr-buttons-left">{BEGIN save_button}<A class="rnr-button main" href="#" {$savebutton_attrs}>Save</A>{END save_button}{BEGIN reset_button}<A class="rnr-button" href="#" {$resetbutton_attrs}>Reset</A>{END reset_button}{BEGIN back_button}<A class="rnr-button" href="#" {$backbutton_attrs}>Back to list</A>{END back_button}{BEGIN close_button}<A class="rnr-button" href="#" {$closebutton_attrs}>Close 
 window</A>{END close_button}{BEGIN view_page_button}<A class="rnr-button" href="#" {$view_page_button_attrs}>View</A>{END view_page_button}</DIV></DIV>{END editbuttons}</DIV>{END container_fields}</DIV></DIV>
{END container_edit}</DIV></DIV>{END container_all}</DIV>
<DIV class="rnr-middle">
<DIV class="rnr-left {$blockclass_left}"></DIV>
<DIV class="rnr-center {$blockclass_center}"></DIV>
<DIV class="rnr-right {$blockclass_right}"></DIV></DIV>
<DIV class="rnr-bottom {$blockclass_bottom}"><!--%%bottom%%--></DIV></DIV>
{$footer}{END body}</BODY></HTML>

PARAMS:
{"action":"v","lyName":"edit2","lySource":"@version=2\r\nbeginblock top \r\n\tbegincontainer vertical style=empty align=center width=500 all\r\n\t\tbegincontainer vertical style=1 align=center width=500 edit\r\n\t\t\tbrick color2 editheader\r\n\t\t\tbrick color1 message\r\n\t\t\tbegincontainer vertical color=1 style=fields fields\r\n\t\t\t\tbrick editfields\r\n\t\t\t\tbrick color2 editbuttons\r\n\t\t\tendcontainer \r\n\t\tendcontainer \r\n\t\tbegincontainer vertical style=empty width=100% details\r\n\t\t\tbrick editdetails\r\n\t\tendcontainer\r\n\tendcontainer\r\nendblock\r\n"}


ACTIONTIME: 2015-02-12 14:59:16
SOURCE:
<!DOCTYPE html>
<HTML {$html_attrs}><HEAD>
<META content="IE=Edge" http-equiv="X-UA-Compatible"><TITLE>{$pagetitle}</TITLE>
<META content="text/html; charset=utf-8" http-equiv="Content-Type">
<LINK rel="stylesheet" type="text/css" href="styles/default.css">{BEGIN rtlCSS}<LINK rel="stylesheet" type="text/css" href="styles/defaultRTL.css">{END rtlCSS}{BEGIN styleCSSFiles}<LINK rel="stylesheet" type="text/css" href="{$stylepath}">{END styleCSSFiles}{BEGIN pageCSSFiles}<LINK rel="stylesheet" type="text/css" href="{$pagestylepath}">{END pageCSSFiles}
<META name="GENERATOR" content="MSHTML 9.00.8112.16599"></HEAD>
<BODY class="{$stylename} function-edit" {$bodyattrs}>{BEGIN body}
{$header}
<DIV class="rnr-page">
<DIV class="rnr-top {$blockclass_top}">
{BEGIN container_all}
<DIV class="rnr-c rnr-cv rnr-c-all">
<DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_edit} rnr-wrapper rnr-cbw-edit">
{BEGIN container_edit}
<DIV class="rnr-c rnr-cv rnr-c-edit">
{BEGIN editheader}<DIV class="rnr-brickcontents style2 rnr-b-editheader {$brickclass_editheader}"><SPAN>	
<H1>
{$pagetitlelabel arv_pmtct edit}</H1>
</SPAN></DIV>
{END editheader}{BEGIN message_block}<DIV class="rnr-brickcontents style1 rnr-b-message {$brickclass_message}">
<DIV class="rnr-message">
{$message}</DIV></DIV>
{END message_block}<DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_fields} rnr-wrapper rnr-cbw-fields">
{BEGIN container_fields}
<DIV style="min-height: 2695px; min-width: 833px;" class="rnr-c rnr-cv rnr-c-fields">
<DIV class="rnr-brickcontents style1 rnr-b-editfields {$brickclass_editfields}">
<TABLE border="1" cellSpacing="1" cellPadding="1" width="75%">
  <TBODY>
  <TR>
    <TD>&nbsp;SiteName</TD>
    <TD>&nbsp;
      {$SiteName_editcontrol}</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR>
  <TR>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR>
  <TR>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR>
  <TR>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR>
  <TR>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR></TBODY></TABLE>
<TABLE style="width: 543px;" class="fieldGrid">
  <TBODY>
  {BEGIN formid_fieldblock}<TR class="{$fielddispclass_formid}" data-fieldname="formid">
    <TD style="width: 100px;" class="rnr-label">{BEGIN formid_label}{END formid_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"></TD></TR>
  {END formid_fieldblock}{BEGIN SiteName_fieldblock}<TR class="{$fielddispclass_SiteName}" data-fieldname="SiteName">
    <TD style="width: 100px;" class="rnr-label">{BEGIN SiteName_label}{END SiteName_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END SiteName_fieldblock}{BEGIN State_fieldblock}<TR class="{$fielddispclass_State}" data-fieldname="State">
    <TD style="width: 100px;" class="rnr-label">{BEGIN State_label}{END State_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END State_fieldblock}{BEGIN Funding_Source_fieldblock}<TR class="{$fielddispclass_Funding_Source}" data-fieldname="Funding_Source">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Funding_Source_label}{END Funding_Source_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Funding_Source_fieldblock}{BEGIN Service_Type_fieldblock}<TR class="{$fielddispclass_Service_Type}" data-fieldname="Service_Type">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Service_Type_label}{END Service_Type_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Service_Type_fieldblock}{BEGIN Phase_fieldblock}<TR class="{$fielddispclass_Phase}" data-fieldname="Phase">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Phase_label}{END Phase_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Phase_fieldblock}{BEGIN IPName_fieldblock}<TR class="{$fielddispclass_IPName}" data-fieldname="IPName">
    <TD style="width: 100px;" class="rnr-label">{BEGIN IPName_label}{END IPName_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END IPName_fieldblock}{BEGIN Drug_1_fieldblock}<TR class="{$fielddispclass_Drug_1}" data-fieldname="Drug_1">
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  {END Drug_1_fieldblock}{BEGIN QtyReceived_1_fieldblock}<TR class="{$fielddispclass_QtyReceived_1}" data-fieldname="QtyReceived_1">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_1_fieldblock}{BEGIN QtySOH_1_fieldblock}<TR class="{$fielddispclass_QtySOH_1}" data-fieldname="QtySOH_1">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_1_fieldblock}{BEGIN Remark_1_fieldblock}<TR class="{$fielddispclass_Remark_1}" data-fieldname="Remark_1">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
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 window</A>{END close_button}{BEGIN view_page_button}<A class="rnr-button" href="#" {$view_page_button_attrs}>View</A>{END view_page_button}</DIV></DIV>{END editbuttons}</DIV>{END container_fields}</DIV></DIV>
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<DIV class="rnr-middle">
<DIV class="rnr-left {$blockclass_left}"></DIV>
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{$footer}{END body}</BODY></HTML>

PARAMS:
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ACTIONTIME: 2015-02-12 14:59:48
SOURCE:
<!DOCTYPE html>
<HTML {$html_attrs}><HEAD>
<META content="IE=Edge" http-equiv="X-UA-Compatible"><TITLE>{$pagetitle}</TITLE>
<META content="text/html; charset=utf-8" http-equiv="Content-Type">
<LINK rel="stylesheet" type="text/css" href="styles/default.css">{BEGIN rtlCSS}<LINK rel="stylesheet" type="text/css" href="styles/defaultRTL.css">{END rtlCSS}{BEGIN styleCSSFiles}<LINK rel="stylesheet" type="text/css" href="{$stylepath}">{END styleCSSFiles}{BEGIN pageCSSFiles}<LINK rel="stylesheet" type="text/css" href="{$pagestylepath}">{END pageCSSFiles}
<META name="GENERATOR" content="MSHTML 9.00.8112.16599"></HEAD>
<BODY class="{$stylename} function-edit" {$bodyattrs}>{BEGIN body}
{$header}
<DIV class="rnr-page">
<DIV class="rnr-top {$blockclass_top}">
{BEGIN container_all}
<DIV class="rnr-c rnr-cv rnr-c-all">
<DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_edit} rnr-wrapper rnr-cbw-edit">
{BEGIN container_edit}
<DIV class="rnr-c rnr-cv rnr-c-edit">
{BEGIN editheader}<DIV class="rnr-brickcontents style2 rnr-b-editheader {$brickclass_editheader}"><SPAN>	
<H1>
{$pagetitlelabel arv_pmtct edit}</H1>
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{END editheader}{BEGIN message_block}<DIV class="rnr-brickcontents style1 rnr-b-message {$brickclass_message}">
<DIV class="rnr-message">
{$message}</DIV></DIV>
{END message_block}<DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_fields} rnr-wrapper rnr-cbw-fields">
{BEGIN container_fields}
<DIV style="min-height: 2695px; min-width: 833px;" class="rnr-c rnr-cv rnr-c-fields">

<DIV class="rnr-brickcontents style1 rnr-b-editfields {$brickclass_editfields}">
<TABLE border="1" cellSpacing="1" cellPadding="1" width="75%">
  <TBODY>
  <TR>
    <TD>&nbsp;SiteName</TD>
    <TD>&nbsp;
      {$SiteName_editcontrol}</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR>
  <TR>
    <TD>&nbsp;Facility Code</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR>
  <TR>
    <TD>&nbsp;State</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR>
  <TR>
    <TD>&nbsp;Phase</TD>
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    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR>
  <TR>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD>
    <TD>&nbsp;</TD></TR></TBODY></TABLE>
<TABLE style="width: 543px;" class="fieldGrid">
  <TBODY>
  {BEGIN formid_fieldblock}<TR class="{$fielddispclass_formid}" data-fieldname="formid">
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    <TD style="width: 427px;" class="rnr-control style3"></TD></TR>
  {END formid_fieldblock}{BEGIN SiteName_fieldblock}<TR class="{$fielddispclass_SiteName}" data-fieldname="SiteName">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END SiteName_fieldblock}{BEGIN State_fieldblock}<TR class="{$fielddispclass_State}" data-fieldname="State">
    <TD style="width: 100px;" class="rnr-label">{BEGIN State_label}{END State_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END State_fieldblock}{BEGIN Funding_Source_fieldblock}<TR class="{$fielddispclass_Funding_Source}" data-fieldname="Funding_Source">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
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  {END Service_Type_fieldblock}{BEGIN Phase_fieldblock}<TR class="{$fielddispclass_Phase}" data-fieldname="Phase">
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  {END Phase_fieldblock}{BEGIN IPName_fieldblock}<TR class="{$fielddispclass_IPName}" data-fieldname="IPName">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_3_fieldblock}{BEGIN QtySOH_3_fieldblock}<TR class="{$fielddispclass_QtySOH_3}" data-fieldname="QtySOH_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_3_label}{END QtySOH_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_3_fieldblock}{BEGIN Remark_3_fieldblock}<TR class="{$fielddispclass_Remark_3}" data-fieldname="Remark_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_3_label}{END Remark_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_3_fieldblock}{BEGIN Drug_4_fieldblock}<TR class="{$fielddispclass_Drug_4}" data-fieldname="Drug_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_4_label}{END Drug_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_4_fieldblock}{BEGIN QtyReceived_4_fieldblock}<TR class="{$fielddispclass_QtyReceived_4}" data-fieldname="QtyReceived_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_4_label}{END QtyReceived_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_4_fieldblock}{BEGIN Qty_Dispensed_4_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_4}" data-fieldname="Qty_Dispensed_4">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
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    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_5_label}{END QtySOH_5_label}</TD>
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  {END QtySOH_5_fieldblock}{BEGIN Remark_5_fieldblock}<TR class="{$fielddispclass_Remark_5}" data-fieldname="Remark_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_5_label}{END Remark_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_5_fieldblock}{BEGIN Drug_6_fieldblock}<TR class="{$fielddispclass_Drug_6}" data-fieldname="Drug_6">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_6_fieldblock}{BEGIN QtyReceived_6_fieldblock}<TR class="{$fielddispclass_QtyReceived_6}" data-fieldname="QtyReceived_6">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_6_fieldblock}{BEGIN Qty_Dispensed_6_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_6}" data-fieldname="Qty_Dispensed_6">
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  {END Qty_Dispensed_9_fieldblock}{BEGIN QtySOH_9_fieldblock}<TR class="{$fielddispclass_QtySOH_9}" data-fieldname="QtySOH_9">
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  {END Remark_9_fieldblock}{BEGIN Drug_10_fieldblock}<TR class="{$fielddispclass_Drug_10}" data-fieldname="Drug_10">
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  {END QtySOH_11_fieldblock}{BEGIN Remark_11_fieldblock}<TR class="{$fielddispclass_Remark_11}" data-fieldname="Remark_11">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_13_fieldblock}{BEGIN Drug_14_fieldblock}<TR class="{$fielddispclass_Drug_14}" data-fieldname="Drug_14">
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  {END Qty_Dispensed_14_fieldblock}{BEGIN QtySOH_14_fieldblock}<TR class="{$fielddispclass_QtySOH_14}" data-fieldname="QtySOH_14">
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<DIV class="rnr-middle">
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<DIV class="rnr-bottom {$blockclass_bottom}"><!--%%bottom%%--></DIV></DIV>
{$footer}{END body}</BODY></HTML>


ACTIONTIME: 2015-02-12 15:02:39
SOURCE:
<!DOCTYPE html>
<HTML {$html_attrs}><HEAD>
<META content="IE=Edge" http-equiv="X-UA-Compatible"><TITLE>{$pagetitle}</TITLE>
<META content="text/html; charset=utf-8" http-equiv="Content-Type">
<LINK rel="stylesheet" type="text/css" href="styles/default.css">{BEGIN rtlCSS}<LINK rel="stylesheet" type="text/css" href="styles/defaultRTL.css">{END rtlCSS}{BEGIN styleCSSFiles}<LINK rel="stylesheet" type="text/css" href="{$stylepath}">{END styleCSSFiles}{BEGIN pageCSSFiles}<LINK rel="stylesheet" type="text/css" href="{$pagestylepath}">{END pageCSSFiles}
<META name="GENERATOR" content="MSHTML 9.00.8112.16599"></HEAD>
<BODY class="{$stylename} function-edit" {$bodyattrs}>{BEGIN body}
{$header}
<DIV class="rnr-page">
<DIV class="rnr-top {$blockclass_top}">
{BEGIN container_all}
<DIV class="rnr-c rnr-cv rnr-c-all">
<DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_edit} rnr-wrapper rnr-cbw-edit">
{BEGIN container_edit}
<DIV class="rnr-c rnr-cv rnr-c-edit">
{BEGIN editheader}<DIV class="rnr-brickcontents style2 rnr-b-editheader {$brickclass_editheader}"><SPAN>	
<H1>
{$pagetitlelabel arv_pmtct edit}</H1>
</SPAN></DIV>
{END editheader}{BEGIN message_block}<DIV class="rnr-brickcontents style1 rnr-b-message {$brickclass_message}">
<DIV class="rnr-message">
{$message}</DIV></DIV>
{END message_block}<DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_fields} rnr-wrapper rnr-cbw-fields">
{BEGIN container_fields}
<DIV style="min-height: 2695px; min-width: 833px;" class="rnr-c rnr-cv rnr-c-fields">
<DIV class="rnr-brickcontents style1 rnr-b-editfields {$brickclass_editfields}">
<TABLE style="width: auto;" class="fieldGrid">
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        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> SiteName</TD>
          <TD style="width: 227px;" rowSpan="1" colSpan="1"> 
            {$SiteName_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> </TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1"> </TD>
          <TD style="width: 126px;" rowSpan="5" colSpan="1"><IMG style="width: 124px; height: 84px;" border="0" alt="coat of arms" src="images/coat.jpg" width="242" height="207">&nbsp;&nbsp;&nbsp; </TD></TR>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> Facility Code</TD>
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            {$formid_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> Funding Source</TD>
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            {$Funding_Source_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> State</TD>
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            {$State_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> Service Type</TD>
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            {$Service_Type_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> Phase</TD>
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            {$Phase_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> IPName</TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1"> 
            {$IPName_editcontrol}</TD></TR>
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      </TD></TR></TBODY></TABLE>{END SiteName_label}</TD>
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  {END Service_Type_fieldblock}{BEGIN Phase_fieldblock}<TR class="{$fielddispclass_Phase}" data-fieldname="Phase">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_2_fieldblock}{BEGIN QtySOH_2_fieldblock}<TR class="{$fielddispclass_QtySOH_2}" data-fieldname="QtySOH_2">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_2_fieldblock}{BEGIN Remark_2_fieldblock}<TR class="{$fielddispclass_Remark_2}" data-fieldname="Remark_2">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_2_fieldblock}{BEGIN Drug_3_fieldblock}<TR class="{$fielddispclass_Drug_3}" data-fieldname="Drug_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_3_label}{END Drug_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_3_fieldblock}{BEGIN QtyReceived_3_fieldblock}<TR class="{$fielddispclass_QtyReceived_3}" data-fieldname="QtyReceived_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_3_label}{END QtyReceived_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_3_fieldblock}{BEGIN Qty_Dispensed_3_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_3}" data-fieldname="Qty_Dispensed_3">
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  {END Qty_Dispensed_3_fieldblock}{BEGIN QtySOH_3_fieldblock}<TR class="{$fielddispclass_QtySOH_3}" data-fieldname="QtySOH_3">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_3_fieldblock}{BEGIN Remark_3_fieldblock}<TR class="{$fielddispclass_Remark_3}" data-fieldname="Remark_3">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_3_fieldblock}{BEGIN Drug_4_fieldblock}<TR class="{$fielddispclass_Drug_4}" data-fieldname="Drug_4">
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  {END QtyReceived_4_fieldblock}{BEGIN Qty_Dispensed_4_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_4}" data-fieldname="Qty_Dispensed_4">
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  {END Qty_Dispensed_4_fieldblock}{BEGIN QtySOH_4_fieldblock}<TR class="{$fielddispclass_QtySOH_4}" data-fieldname="QtySOH_4">
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  {END QtySOH_4_fieldblock}{BEGIN Remark_4_fieldblock}<TR class="{$fielddispclass_Remark_4}" data-fieldname="Remark_4">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_4_fieldblock}{BEGIN Drug_5_fieldblock}<TR class="{$fielddispclass_Drug_5}" data-fieldname="Drug_5">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_5_fieldblock}{BEGIN QtyReceived_5_fieldblock}<TR class="{$fielddispclass_QtyReceived_5}" data-fieldname="QtyReceived_5">
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    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_5_fieldblock}{BEGIN Qty_Dispensed_5_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_5}" data-fieldname="Qty_Dispensed_5">
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ACTIONTIME: 2015-02-12 15:05:25
SOURCE:
<!DOCTYPE html>
<HTML {$html_attrs}><HEAD>
<META content="IE=Edge" http-equiv="X-UA-Compatible"><TITLE>{$pagetitle}</TITLE>
<META content="text/html; charset=utf-8" http-equiv="Content-Type">
<LINK rel="stylesheet" type="text/css" href="styles/default.css">{BEGIN rtlCSS}<LINK rel="stylesheet" type="text/css" href="styles/defaultRTL.css">{END rtlCSS}{BEGIN styleCSSFiles}<LINK rel="stylesheet" type="text/css" href="{$stylepath}">{END styleCSSFiles}{BEGIN pageCSSFiles}<LINK rel="stylesheet" type="text/css" href="{$pagestylepath}">{END pageCSSFiles}
<META name="GENERATOR" content="MSHTML 9.00.8112.16599"></HEAD>
<BODY class="{$stylename} function-edit" {$bodyattrs}>{BEGIN body}
{$header}
<DIV class="rnr-page">
<DIV class="rnr-top {$blockclass_top}">
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<DIV class="rnr-c rnr-cv rnr-c-all">
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<DIV class="rnr-c rnr-cv rnr-c-edit">
{BEGIN editheader}<DIV class="rnr-brickcontents style2 rnr-b-editheader {$brickclass_editheader}"><SPAN>	
<H1>
{$pagetitlelabel arv_pmtct edit}</H1>
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<DIV style="min-height: 2695px; min-width: 833px;" class="rnr-c rnr-cv rnr-c-fields">
<DIV class="rnr-brickcontents style1 rnr-b-editfields {$brickclass_editfields}">
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          <TD style="width: 231px;" rowSpan="1" colSpan="1"> </TD>
          <TD style="width: 126px;" rowSpan="5" colSpan="1"><IMG style="width: 124px; height: 84px;" border="0" alt="coat of arms" src="images/coat.jpg" width="242" height="207">&nbsp;&nbsp;&nbsp; </TD></TR>
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          <TD style="width: 122px;" rowSpan="1" colSpan="1"> Facility Code</TD>
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            {$formid_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> Funding Source</TD>
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            {$Funding_Source_editcontrol}</TD></TR>
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          <TD style="width: 122px;" rowSpan="1" colSpan="1"> State</TD>
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          <TD style="width: 112px;" rowSpan="1" colSpan="1"> Service Type</TD>
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            {$Service_Type_editcontrol}</TD></TR>
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          <TD style="width: 122px;" rowSpan="1" colSpan="1"> Phase</TD>
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            {$Phase_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> IPName</TD>
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            {$IPName_editcontrol}</TD></TR>
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          <TD style="width: 122px;" rowSpan="1" colSpan="1"> </TD>
          <TD style="width: 227px;" rowSpan="1" colSpan="1"> </TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> </TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1"> 
      </TD></TR></TBODY></TABLE>{END SiteName_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END SiteName_fieldblock}{BEGIN State_fieldblock}<TR class="{$fielddispclass_State}" data-fieldname="State">
    
    <TD style="width: 100px;" class="rnr-label">{BEGIN State_label}
      <TABLE border="1" cellSpacing="1" cellPadding="1" width="75%">
        <TBODY>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR>
        <TR>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD>
          <TD>&nbsp;</TD></TR></TBODY></TABLE>{END State_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END State_fieldblock}{BEGIN Funding_Source_fieldblock}<TR class="{$fielddispclass_Funding_Source}" data-fieldname="Funding_Source">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Funding_Source_label}{END Funding_Source_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Funding_Source_fieldblock}{BEGIN Service_Type_fieldblock}<TR class="{$fielddispclass_Service_Type}" data-fieldname="Service_Type">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Service_Type_label}{END Service_Type_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Service_Type_fieldblock}{BEGIN Phase_fieldblock}<TR class="{$fielddispclass_Phase}" data-fieldname="Phase">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Phase_label}{END Phase_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Phase_fieldblock}{BEGIN IPName_fieldblock}<TR class="{$fielddispclass_IPName}" data-fieldname="IPName">
    <TD style="width: 100px;" class="rnr-label">{BEGIN IPName_label}{END IPName_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END IPName_fieldblock}{BEGIN Drug_1_fieldblock}<TR class="{$fielddispclass_Drug_1}" data-fieldname="Drug_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_1_label}{END Drug_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_1_fieldblock}{BEGIN QtyReceived_1_fieldblock}<TR class="{$fielddispclass_QtyReceived_1}" data-fieldname="QtyReceived_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_1_label}{END QtyReceived_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_1_fieldblock}{BEGIN Qty_Dispensed_1_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_1}" data-fieldname="Qty_Dispensed_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_1_label}{END Qty_Dispensed_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_1_fieldblock}{BEGIN QtySOH_1_fieldblock}<TR class="{$fielddispclass_QtySOH_1}" data-fieldname="QtySOH_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_1_label}{END QtySOH_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_1_fieldblock}{BEGIN Remark_1_fieldblock}<TR class="{$fielddispclass_Remark_1}" data-fieldname="Remark_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_1_label}{END Remark_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_1_fieldblock}{BEGIN Drug_2_fieldblock}<TR class="{$fielddispclass_Drug_2}" data-fieldname="Drug_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_2_label}{END Drug_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_2_fieldblock}{BEGIN QtyReceived_2_fieldblock}<TR class="{$fielddispclass_QtyReceived_2}" data-fieldname="QtyReceived_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_2_label}{END QtyReceived_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_2_fieldblock}{BEGIN Qty_Dispensed_2_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_2}" data-fieldname="Qty_Dispensed_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_2_label}{END Qty_Dispensed_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_2_fieldblock}{BEGIN QtySOH_2_fieldblock}<TR class="{$fielddispclass_QtySOH_2}" data-fieldname="QtySOH_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_2_label}{END QtySOH_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_2_fieldblock}{BEGIN Remark_2_fieldblock}<TR class="{$fielddispclass_Remark_2}" data-fieldname="Remark_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_2_label}{END Remark_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_2_fieldblock}{BEGIN Drug_3_fieldblock}<TR class="{$fielddispclass_Drug_3}" data-fieldname="Drug_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_3_label}{END Drug_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_3_fieldblock}{BEGIN QtyReceived_3_fieldblock}<TR class="{$fielddispclass_QtyReceived_3}" data-fieldname="QtyReceived_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_3_label}{END QtyReceived_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_3_fieldblock}{BEGIN Qty_Dispensed_3_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_3}" data-fieldname="Qty_Dispensed_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_3_label}{END Qty_Dispensed_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_3_fieldblock}{BEGIN QtySOH_3_fieldblock}<TR class="{$fielddispclass_QtySOH_3}" data-fieldname="QtySOH_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_3_label}{END QtySOH_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_3_fieldblock}{BEGIN Remark_3_fieldblock}<TR class="{$fielddispclass_Remark_3}" data-fieldname="Remark_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_3_label}{END Remark_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_3_fieldblock}{BEGIN Drug_4_fieldblock}<TR class="{$fielddispclass_Drug_4}" data-fieldname="Drug_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_4_label}{END Drug_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_4_fieldblock}{BEGIN QtyReceived_4_fieldblock}<TR class="{$fielddispclass_QtyReceived_4}" data-fieldname="QtyReceived_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_4_label}{END QtyReceived_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_4_fieldblock}{BEGIN Qty_Dispensed_4_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_4}" data-fieldname="Qty_Dispensed_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_4_label}{END Qty_Dispensed_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_4_fieldblock}{BEGIN QtySOH_4_fieldblock}<TR class="{$fielddispclass_QtySOH_4}" data-fieldname="QtySOH_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_4_label}{END QtySOH_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_4_fieldblock}{BEGIN Remark_4_fieldblock}<TR class="{$fielddispclass_Remark_4}" data-fieldname="Remark_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_4_label}{END Remark_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_4_fieldblock}{BEGIN Drug_5_fieldblock}<TR class="{$fielddispclass_Drug_5}" data-fieldname="Drug_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_5_label}{END Drug_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_5_fieldblock}{BEGIN QtyReceived_5_fieldblock}<TR class="{$fielddispclass_QtyReceived_5}" data-fieldname="QtyReceived_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_5_label}{END QtyReceived_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_5_fieldblock}{BEGIN Qty_Dispensed_5_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_5}" data-fieldname="Qty_Dispensed_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_5_label}{END Qty_Dispensed_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_5_fieldblock}{BEGIN QtySOH_5_fieldblock}<TR class="{$fielddispclass_QtySOH_5}" data-fieldname="QtySOH_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_5_label}{END QtySOH_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_5_fieldblock}{BEGIN Remark_5_fieldblock}<TR class="{$fielddispclass_Remark_5}" data-fieldname="Remark_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_5_label}{END Remark_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_5_fieldblock}{BEGIN Drug_6_fieldblock}<TR class="{$fielddispclass_Drug_6}" data-fieldname="Drug_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_6_label}{END Drug_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_6_fieldblock}{BEGIN QtyReceived_6_fieldblock}<TR class="{$fielddispclass_QtyReceived_6}" data-fieldname="QtyReceived_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_6_label}{END QtyReceived_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_6_fieldblock}{BEGIN Qty_Dispensed_6_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_6}" data-fieldname="Qty_Dispensed_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_6_label}{END Qty_Dispensed_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_6_fieldblock}{BEGIN QtySOH_6_fieldblock}<TR class="{$fielddispclass_QtySOH_6}" data-fieldname="QtySOH_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_6_label}{END QtySOH_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_6_fieldblock}{BEGIN Remark_6_fieldblock}<TR class="{$fielddispclass_Remark_6}" data-fieldname="Remark_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_6_label}{END Remark_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_6_fieldblock}{BEGIN Drug_7_fieldblock}<TR class="{$fielddispclass_Drug_7}" data-fieldname="Drug_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_7_label}{END Drug_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_7_fieldblock}{BEGIN QtyReceived_7_fieldblock}<TR class="{$fielddispclass_QtyReceived_7}" data-fieldname="QtyReceived_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_7_label}{END QtyReceived_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_7_fieldblock}{BEGIN Qty_Dispensed_7_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_7}" data-fieldname="Qty_Dispensed_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_7_label}{END Qty_Dispensed_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_7_fieldblock}{BEGIN QtySOH_7_fieldblock}<TR class="{$fielddispclass_QtySOH_7}" data-fieldname="QtySOH_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_7_label}{END QtySOH_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_7_fieldblock}{BEGIN Remark_7_fieldblock}<TR class="{$fielddispclass_Remark_7}" data-fieldname="Remark_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_7_label}{END Remark_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_7_fieldblock}{BEGIN Drug_8_fieldblock}<TR class="{$fielddispclass_Drug_8}" data-fieldname="Drug_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_8_label}{END Drug_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_8_fieldblock}{BEGIN QtyReceived_8_fieldblock}<TR class="{$fielddispclass_QtyReceived_8}" data-fieldname="QtyReceived_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_8_label}{END QtyReceived_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_8_fieldblock}{BEGIN Qty_Dispensed_8_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_8}" data-fieldname="Qty_Dispensed_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_8_label}{END Qty_Dispensed_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_8_fieldblock}{BEGIN QtySOH_8_fieldblock}<TR class="{$fielddispclass_QtySOH_8}" data-fieldname="QtySOH_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_8_label}{END QtySOH_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_8_fieldblock}{BEGIN Remark_8_fieldblock}<TR class="{$fielddispclass_Remark_8}" data-fieldname="Remark_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_8_label}{END Remark_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_8_fieldblock}{BEGIN Drug_9_fieldblock}<TR class="{$fielddispclass_Drug_9}" data-fieldname="Drug_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_9_label}{END Drug_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_9_fieldblock}{BEGIN QtyReceived_9_fieldblock}<TR class="{$fielddispclass_QtyReceived_9}" data-fieldname="QtyReceived_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_9_label}{END QtyReceived_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_9_fieldblock}{BEGIN Qty_Dispensed_9_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_9}" data-fieldname="Qty_Dispensed_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_9_label}{END Qty_Dispensed_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_9_fieldblock}{BEGIN QtySOH_9_fieldblock}<TR class="{$fielddispclass_QtySOH_9}" data-fieldname="QtySOH_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_9_label}{END QtySOH_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_9_fieldblock}{BEGIN Remark_9_fieldblock}<TR class="{$fielddispclass_Remark_9}" data-fieldname="Remark_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_9_label}{END Remark_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_9_fieldblock}{BEGIN Drug_10_fieldblock}<TR class="{$fielddispclass_Drug_10}" data-fieldname="Drug_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_10_label}{END Drug_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_10_fieldblock}{BEGIN QtyReceived_10_fieldblock}<TR class="{$fielddispclass_QtyReceived_10}" data-fieldname="QtyReceived_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_10_label}{END QtyReceived_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_10_fieldblock}{BEGIN Qty_Dispensed_10_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_10}" data-fieldname="Qty_Dispensed_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_10_label}{END Qty_Dispensed_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_10_fieldblock}{BEGIN QtySOH_10_fieldblock}<TR class="{$fielddispclass_QtySOH_10}" data-fieldname="QtySOH_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_10_label}{END QtySOH_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_10_fieldblock}{BEGIN Remark_10_fieldblock}<TR class="{$fielddispclass_Remark_10}" data-fieldname="Remark_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_10_label}{END Remark_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_10_fieldblock}{BEGIN Drug_11_fieldblock}<TR class="{$fielddispclass_Drug_11}" data-fieldname="Drug_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_11_label}{END Drug_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_11_fieldblock}{BEGIN QtyReceived_11_fieldblock}<TR class="{$fielddispclass_QtyReceived_11}" data-fieldname="QtyReceived_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_11_label}{END QtyReceived_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_11_fieldblock}{BEGIN Qty_Dispensed_11_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_11}" data-fieldname="Qty_Dispensed_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_11_label}{END Qty_Dispensed_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_11_fieldblock}{BEGIN QtySOH_11_fieldblock}<TR class="{$fielddispclass_QtySOH_11}" data-fieldname="QtySOH_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_11_label}{END QtySOH_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_11_fieldblock}{BEGIN Remark_11_fieldblock}<TR class="{$fielddispclass_Remark_11}" data-fieldname="Remark_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_11_label}{END Remark_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_11_fieldblock}{BEGIN Drug_12_fieldblock}<TR class="{$fielddispclass_Drug_12}" data-fieldname="Drug_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_12_label}{END Drug_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_12_fieldblock}{BEGIN QtyReceived_12_fieldblock}<TR class="{$fielddispclass_QtyReceived_12}" data-fieldname="QtyReceived_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_12_label}{END QtyReceived_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_12_fieldblock}{BEGIN Qty_Dispensed_12_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_12}" data-fieldname="Qty_Dispensed_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_12_label}{END Qty_Dispensed_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_12_fieldblock}{BEGIN QtySOH_12_fieldblock}<TR class="{$fielddispclass_QtySOH_12}" data-fieldname="QtySOH_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_12_label}{END QtySOH_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_12_fieldblock}{BEGIN Remark_12_fieldblock}<TR class="{$fielddispclass_Remark_12}" data-fieldname="Remark_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_12_label}{END Remark_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_12_fieldblock}{BEGIN Drug_13_fieldblock}<TR class="{$fielddispclass_Drug_13}" data-fieldname="Drug_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_13_label}{END Drug_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_13_fieldblock}{BEGIN QtyReceived_13_fieldblock}<TR class="{$fielddispclass_QtyReceived_13}" data-fieldname="QtyReceived_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_13_label}{END QtyReceived_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_13_fieldblock}{BEGIN Qty_Dispensed_13_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_13}" data-fieldname="Qty_Dispensed_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_13_label}{END Qty_Dispensed_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_13_fieldblock}{BEGIN QtySOH_13_fieldblock}<TR class="{$fielddispclass_QtySOH_13}" data-fieldname="QtySOH_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_13_label}{END QtySOH_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_13_fieldblock}{BEGIN Remark_13_fieldblock}<TR class="{$fielddispclass_Remark_13}" data-fieldname="Remark_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_13_label}{END Remark_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_13_fieldblock}{BEGIN Drug_14_fieldblock}<TR class="{$fielddispclass_Drug_14}" data-fieldname="Drug_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_14_label}{END Drug_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_14_fieldblock}{BEGIN QtyReceived_14_fieldblock}<TR class="{$fielddispclass_QtyReceived_14}" data-fieldname="QtyReceived_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_14_label}{END QtyReceived_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_14_fieldblock}{BEGIN Qty_Dispensed_14_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_14}" data-fieldname="Qty_Dispensed_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_14_label}{END Qty_Dispensed_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_14_fieldblock}{BEGIN QtySOH_14_fieldblock}<TR class="{$fielddispclass_QtySOH_14}" data-fieldname="QtySOH_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_14_label}{END QtySOH_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_14_fieldblock}{BEGIN Remark_14_fieldblock}<TR class="{$fielddispclass_Remark_14}" data-fieldname="Remark_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_14_label}{END Remark_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_14_fieldblock}{BEGIN Drug_15_fieldblock}<TR class="{$fielddispclass_Drug_15}" data-fieldname="Drug_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_15_label}{END Drug_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_15_fieldblock}{BEGIN QtyReceived_15_fieldblock}<TR class="{$fielddispclass_QtyReceived_15}" data-fieldname="QtyReceived_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_15_label}{END QtyReceived_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_15_fieldblock}{BEGIN Qty_Dispensed_15_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_15}" data-fieldname="Qty_Dispensed_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_15_label}{END Qty_Dispensed_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_15_fieldblock}{BEGIN QtySOH_15_fieldblock}<TR class="{$fielddispclass_QtySOH_15}" data-fieldname="QtySOH_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_15_label}{END QtySOH_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_15_fieldblock}{BEGIN Remark_15_fieldblock}<TR class="{$fielddispclass_Remark_15}" data-fieldname="Remark_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_15_label}{END Remark_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD>
</TR>{END Remark_15_fieldblock}</TBODY></TABLE></DIV>
{BEGIN editbuttons}<DIV class="rnr-brickcontents style2 rnr-b-editbuttons {$brickclass_editbuttons}">
<DIV class="rnr-buttons-right">{BEGIN prev_button}<A class="rnr-button {$prevbutton_class}" href="#" {$prevbutton_attrs}>&lt;&lt;&lt;</A>{END prev_button}{BEGIN next_button}<A class="rnr-button  {$nextbutton_class}" href="#" {$nextbutton_attrs}>&gt;&gt;&gt;</A>{END next_button}</DIV>
<DIV class="rnr-buttons-left">{BEGIN save_button}<A class="rnr-button main" href="#" {$savebutton_attrs}>Save</A>{END save_button}{BEGIN reset_button}<A class="rnr-button" href="#" {$resetbutton_attrs}>Reset</A>{END reset_button}{BEGIN back_button}<A class="rnr-button" href="#" {$backbutton_attrs}>Back to list</A>{END back_button}{BEGIN close_button}<A class="rnr-button" href="#" {$closebutton_attrs}>Close 
 window</A>{END close_button}{BEGIN view_page_button}<A class="rnr-button" href="#" {$view_page_button_attrs}>View</A>{END view_page_button}</DIV></DIV>{END editbuttons}</DIV>{END container_fields}</DIV></DIV>
{END container_edit}</DIV></DIV>{END container_all}</DIV>
<DIV class="rnr-middle">
<DIV class="rnr-left {$blockclass_left}"></DIV>
<DIV class="rnr-center {$blockclass_center}"></DIV>
<DIV class="rnr-right {$blockclass_right}"></DIV></DIV>
<DIV class="rnr-bottom {$blockclass_bottom}"><!--%%bottom%%--></DIV></DIV>
{$footer}{END body}</BODY></HTML>


ACTIONTIME: 2015-02-12 15:22:50
SOURCE:
<!DOCTYPE html>
<HTML {$html_attrs}><HEAD>
<META content="IE=Edge" http-equiv="X-UA-Compatible"><TITLE>{$pagetitle}</TITLE>
<META content="text/html; charset=utf-8" http-equiv="Content-Type">
<LINK rel="stylesheet" type="text/css" href="styles/default.css">{BEGIN rtlCSS}<LINK rel="stylesheet" type="text/css" href="styles/defaultRTL.css">{END rtlCSS}{BEGIN styleCSSFiles}<LINK rel="stylesheet" type="text/css" href="{$stylepath}">{END styleCSSFiles}{BEGIN pageCSSFiles}<LINK rel="stylesheet" type="text/css" href="{$pagestylepath}">{END pageCSSFiles}
<META name="GENERATOR" content="MSHTML 9.00.8112.16599"></HEAD>
<BODY class="{$stylename} function-edit" {$bodyattrs}>{BEGIN body}
{$header}
<DIV class="rnr-page">
<DIV class="rnr-top {$blockclass_top}">
{BEGIN container_all}
<DIV class="rnr-c rnr-cv rnr-c-all">
<DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_edit} rnr-wrapper rnr-cbw-edit">
{BEGIN container_edit}
<DIV class="rnr-c rnr-cv rnr-c-edit">
{BEGIN editheader}<DIV class="rnr-brickcontents style2 rnr-b-editheader {$brickclass_editheader}"><SPAN>	
<H1>
{$pagetitlelabel arv_pmtct edit}</H1>
</SPAN></DIV>
{END editheader}{BEGIN message_block}<DIV class="rnr-brickcontents style1 rnr-b-message {$brickclass_message}">
<DIV class="rnr-message">
{$message}</DIV></DIV>
{END message_block}<DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_fields} rnr-wrapper rnr-cbw-fields">
{BEGIN container_fields}
<DIV style="min-height: 2695px; min-width: 833px;" class="rnr-c rnr-cv rnr-c-fields">
<DIV class="rnr-brickcontents style1 rnr-b-editfields {$brickclass_editfields}">
<TABLE style="width: auto;" class="fieldGrid">
  <TBODY>
  {BEGIN formid_fieldblock}<TR class="{$fielddispclass_formid}" data-fieldname="formid">
    <TD style="width: 100px;" class="rnr-label">{BEGIN formid_label}{END formid_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"></TD></TR>
  {END formid_fieldblock}{BEGIN SiteName_fieldblock}<TR class="{$fielddispclass_SiteName}" data-fieldname="SiteName">
    <TD style="width: auto;" class="rnr-label">
      {BEGIN SiteName_label}<TABLE style="width: 815px; height: 123px;" border="1" cellSpacing="1" cellPadding="1" width="708">
        <TBODY>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> SiteName</TD>
          <TD style="width: 227px;" rowSpan="1" colSpan="1"> 
            {$SiteName_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> </TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1"> </TD>
          <TD style="width: 126px;" rowSpan="5" colSpan="1"><IMG style="width: 124px; height: 84px;" border="0" alt="coat of arms" src="images/coat.jpg" width="242" height="207">&nbsp;&nbsp;&nbsp; </TD></TR>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> Facility Code</TD>
          <TD style="width: 227px;" rowSpan="1" colSpan="1"> 
            {$formid_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> Funding Source</TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1"> 
            {$Funding_Source_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> State</TD>
          <TD style="width: 227px;" rowSpan="1" colSpan="1"> 
            {$State_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> Service Type</TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1"> 
            {$Service_Type_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> Phase</TD>
          <TD style="width: 227px;" rowSpan="1" colSpan="1"> 
            {$Phase_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> IPName</TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1"> 
            {$IPName_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> </TD>
          <TD style="width: 227px;" rowSpan="1" colSpan="1"> </TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> </TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1"> 
      </TD></TR></TBODY></TABLE>{END SiteName_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END SiteName_fieldblock}{BEGIN State_fieldblock}<TR class="{$fielddispclass_State}" data-fieldname="State">
    <TD style="width: auto;" class="rnr-label">
      {BEGIN State_label}<TABLE style="width: 1136px; height: 619px;" border="1" cellSpacing="1" cellPadding="1" width="985">
        <TBODY>
        <TR style="height: 42px;">
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;S/No</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;Drugs</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;Basic Unit</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">
            <P>&nbsp;Quantity Received During </P>
            <P>the Repoting Period</P></TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;Quantity 
            Received During the Repoting Period</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">
            <P>&nbsp;Endig Balance </P>
            <P>(Physical Count)</P></TD>
          <TD style="width: 213px;" rowSpan="1" 
        colSpan="1">&nbsp;Remarks</TD></TR>
        <TR>
          <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" colSpan="7"></TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;1</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_1_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_1_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_1_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_1_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_1_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;2</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_2_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_2_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_2_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_2_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_2_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" 
          colSpan="7">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;3</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_3_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_3_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_3_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_3_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_3_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;4</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_4_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_4_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_4_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_4_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_4_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;5</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_5_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_5_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_5_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_5_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_5_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" 
          colSpan="7">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;6</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_6_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_6_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_6_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_6_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_6_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;7</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_7_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_7_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_7_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_7_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_7_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;8</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_8_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_8_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_8_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_8_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_8_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" 
          colSpan="7">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;9</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_9_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_9_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_9_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_9_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_9_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;10</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_10_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_10_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_10_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_10_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_10_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;11</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_11_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_11_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_11_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_11_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_11_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;12</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_12_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_12_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_12_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_12_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_12_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" 
          colSpan="7">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;13</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_13_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_13_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_14_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_13_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_13_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;14</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_14_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_14_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_14_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_14_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_14_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;15</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_15_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_15_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_15_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_15_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" 
            colSpan="1">&nbsp;
            {$Remark_15_editcontrol}</TD></TR>
        </TBODY></TABLE>{END State_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END State_fieldblock}{BEGIN Funding_Source_fieldblock}<TR class="{$fielddispclass_Funding_Source}" data-fieldname="Funding_Source">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Funding_Source_label}{END Funding_Source_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Funding_Source_fieldblock}{BEGIN Service_Type_fieldblock}<TR class="{$fielddispclass_Service_Type}" data-fieldname="Service_Type">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Service_Type_label}{END Service_Type_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Service_Type_fieldblock}{BEGIN Phase_fieldblock}<TR class="{$fielddispclass_Phase}" data-fieldname="Phase">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Phase_label}{END Phase_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Phase_fieldblock}{BEGIN IPName_fieldblock}<TR class="{$fielddispclass_IPName}" data-fieldname="IPName">
    <TD style="width: 100px;" class="rnr-label">{BEGIN IPName_label}{END IPName_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END IPName_fieldblock}{BEGIN Drug_1_fieldblock}<TR class="{$fielddispclass_Drug_1}" data-fieldname="Drug_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_1_label}{END Drug_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_1_fieldblock}{BEGIN QtyReceived_1_fieldblock}<TR class="{$fielddispclass_QtyReceived_1}" data-fieldname="QtyReceived_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_1_label}{END QtyReceived_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_1_fieldblock}{BEGIN Qty_Dispensed_1_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_1}" data-fieldname="Qty_Dispensed_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_1_label}{END Qty_Dispensed_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_1_fieldblock}{BEGIN QtySOH_1_fieldblock}<TR class="{$fielddispclass_QtySOH_1}" data-fieldname="QtySOH_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_1_label}{END QtySOH_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_1_fieldblock}{BEGIN Remark_1_fieldblock}<TR class="{$fielddispclass_Remark_1}" data-fieldname="Remark_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_1_label}{END Remark_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_1_fieldblock}{BEGIN Drug_2_fieldblock}<TR class="{$fielddispclass_Drug_2}" data-fieldname="Drug_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_2_label}{END Drug_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_2_fieldblock}{BEGIN QtyReceived_2_fieldblock}<TR class="{$fielddispclass_QtyReceived_2}" data-fieldname="QtyReceived_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_2_label}{END QtyReceived_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_2_fieldblock}{BEGIN Qty_Dispensed_2_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_2}" data-fieldname="Qty_Dispensed_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_2_label}{END Qty_Dispensed_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_2_fieldblock}{BEGIN QtySOH_2_fieldblock}<TR class="{$fielddispclass_QtySOH_2}" data-fieldname="QtySOH_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_2_label}{END QtySOH_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_2_fieldblock}{BEGIN Remark_2_fieldblock}<TR class="{$fielddispclass_Remark_2}" data-fieldname="Remark_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_2_label}{END Remark_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_2_fieldblock}{BEGIN Drug_3_fieldblock}<TR class="{$fielddispclass_Drug_3}" data-fieldname="Drug_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_3_label}{END Drug_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_3_fieldblock}{BEGIN QtyReceived_3_fieldblock}<TR class="{$fielddispclass_QtyReceived_3}" data-fieldname="QtyReceived_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_3_label}{END QtyReceived_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_3_fieldblock}{BEGIN Qty_Dispensed_3_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_3}" data-fieldname="Qty_Dispensed_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_3_label}{END Qty_Dispensed_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_3_fieldblock}{BEGIN QtySOH_3_fieldblock}<TR class="{$fielddispclass_QtySOH_3}" data-fieldname="QtySOH_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_3_label}{END QtySOH_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_3_fieldblock}{BEGIN Remark_3_fieldblock}<TR class="{$fielddispclass_Remark_3}" data-fieldname="Remark_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_3_label}{END Remark_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_3_fieldblock}{BEGIN Drug_4_fieldblock}<TR class="{$fielddispclass_Drug_4}" data-fieldname="Drug_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_4_label}{END Drug_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_4_fieldblock}{BEGIN QtyReceived_4_fieldblock}<TR class="{$fielddispclass_QtyReceived_4}" data-fieldname="QtyReceived_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_4_label}{END QtyReceived_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_4_fieldblock}{BEGIN Qty_Dispensed_4_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_4}" data-fieldname="Qty_Dispensed_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_4_label}{END Qty_Dispensed_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_4_fieldblock}{BEGIN QtySOH_4_fieldblock}<TR class="{$fielddispclass_QtySOH_4}" data-fieldname="QtySOH_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_4_label}{END QtySOH_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_4_fieldblock}{BEGIN Remark_4_fieldblock}<TR class="{$fielddispclass_Remark_4}" data-fieldname="Remark_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_4_label}{END Remark_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_4_fieldblock}{BEGIN Drug_5_fieldblock}<TR class="{$fielddispclass_Drug_5}" data-fieldname="Drug_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_5_label}{END Drug_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_5_fieldblock}{BEGIN QtyReceived_5_fieldblock}<TR class="{$fielddispclass_QtyReceived_5}" data-fieldname="QtyReceived_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_5_label}{END QtyReceived_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_5_fieldblock}{BEGIN Qty_Dispensed_5_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_5}" data-fieldname="Qty_Dispensed_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_5_label}{END Qty_Dispensed_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_5_fieldblock}{BEGIN QtySOH_5_fieldblock}<TR class="{$fielddispclass_QtySOH_5}" data-fieldname="QtySOH_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_5_label}{END QtySOH_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_5_fieldblock}{BEGIN Remark_5_fieldblock}<TR class="{$fielddispclass_Remark_5}" data-fieldname="Remark_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_5_label}{END Remark_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_5_fieldblock}{BEGIN Drug_6_fieldblock}<TR class="{$fielddispclass_Drug_6}" data-fieldname="Drug_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_6_label}{END Drug_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_6_fieldblock}{BEGIN QtyReceived_6_fieldblock}<TR class="{$fielddispclass_QtyReceived_6}" data-fieldname="QtyReceived_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_6_label}{END QtyReceived_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_6_fieldblock}{BEGIN Qty_Dispensed_6_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_6}" data-fieldname="Qty_Dispensed_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_6_label}{END Qty_Dispensed_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_6_fieldblock}{BEGIN QtySOH_6_fieldblock}<TR class="{$fielddispclass_QtySOH_6}" data-fieldname="QtySOH_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_6_label}{END QtySOH_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_6_fieldblock}{BEGIN Remark_6_fieldblock}<TR class="{$fielddispclass_Remark_6}" data-fieldname="Remark_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_6_label}{END Remark_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_6_fieldblock}{BEGIN Drug_7_fieldblock}<TR class="{$fielddispclass_Drug_7}" data-fieldname="Drug_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_7_label}{END Drug_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_7_fieldblock}{BEGIN QtyReceived_7_fieldblock}<TR class="{$fielddispclass_QtyReceived_7}" data-fieldname="QtyReceived_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_7_label}{END QtyReceived_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_7_fieldblock}{BEGIN Qty_Dispensed_7_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_7}" data-fieldname="Qty_Dispensed_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_7_label}{END Qty_Dispensed_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_7_fieldblock}{BEGIN QtySOH_7_fieldblock}<TR class="{$fielddispclass_QtySOH_7}" data-fieldname="QtySOH_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_7_label}{END QtySOH_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_7_fieldblock}{BEGIN Remark_7_fieldblock}<TR class="{$fielddispclass_Remark_7}" data-fieldname="Remark_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_7_label}{END Remark_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_7_fieldblock}{BEGIN Drug_8_fieldblock}<TR class="{$fielddispclass_Drug_8}" data-fieldname="Drug_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_8_label}{END Drug_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_8_fieldblock}{BEGIN QtyReceived_8_fieldblock}<TR class="{$fielddispclass_QtyReceived_8}" data-fieldname="QtyReceived_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_8_label}{END QtyReceived_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_8_fieldblock}{BEGIN Qty_Dispensed_8_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_8}" data-fieldname="Qty_Dispensed_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_8_label}{END Qty_Dispensed_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_8_fieldblock}{BEGIN QtySOH_8_fieldblock}<TR class="{$fielddispclass_QtySOH_8}" data-fieldname="QtySOH_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_8_label}{END QtySOH_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_8_fieldblock}{BEGIN Remark_8_fieldblock}<TR class="{$fielddispclass_Remark_8}" data-fieldname="Remark_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_8_label}{END Remark_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_8_fieldblock}{BEGIN Drug_9_fieldblock}<TR class="{$fielddispclass_Drug_9}" data-fieldname="Drug_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_9_label}{END Drug_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_9_fieldblock}{BEGIN QtyReceived_9_fieldblock}<TR class="{$fielddispclass_QtyReceived_9}" data-fieldname="QtyReceived_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_9_label}{END QtyReceived_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_9_fieldblock}{BEGIN Qty_Dispensed_9_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_9}" data-fieldname="Qty_Dispensed_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_9_label}{END Qty_Dispensed_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_9_fieldblock}{BEGIN QtySOH_9_fieldblock}<TR class="{$fielddispclass_QtySOH_9}" data-fieldname="QtySOH_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_9_label}{END QtySOH_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_9_fieldblock}{BEGIN Remark_9_fieldblock}<TR class="{$fielddispclass_Remark_9}" data-fieldname="Remark_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_9_label}{END Remark_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_9_fieldblock}{BEGIN Drug_10_fieldblock}<TR class="{$fielddispclass_Drug_10}" data-fieldname="Drug_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_10_label}{END Drug_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_10_fieldblock}{BEGIN QtyReceived_10_fieldblock}<TR class="{$fielddispclass_QtyReceived_10}" data-fieldname="QtyReceived_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_10_label}{END QtyReceived_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_10_fieldblock}{BEGIN Qty_Dispensed_10_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_10}" data-fieldname="Qty_Dispensed_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_10_label}{END Qty_Dispensed_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_10_fieldblock}{BEGIN QtySOH_10_fieldblock}<TR class="{$fielddispclass_QtySOH_10}" data-fieldname="QtySOH_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_10_label}{END QtySOH_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_10_fieldblock}{BEGIN Remark_10_fieldblock}<TR class="{$fielddispclass_Remark_10}" data-fieldname="Remark_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_10_label}{END Remark_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_10_fieldblock}{BEGIN Drug_11_fieldblock}<TR class="{$fielddispclass_Drug_11}" data-fieldname="Drug_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_11_label}{END Drug_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_11_fieldblock}{BEGIN QtyReceived_11_fieldblock}<TR class="{$fielddispclass_QtyReceived_11}" data-fieldname="QtyReceived_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_11_label}{END QtyReceived_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_11_fieldblock}{BEGIN Qty_Dispensed_11_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_11}" data-fieldname="Qty_Dispensed_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_11_label}{END Qty_Dispensed_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_11_fieldblock}{BEGIN QtySOH_11_fieldblock}<TR class="{$fielddispclass_QtySOH_11}" data-fieldname="QtySOH_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_11_label}{END QtySOH_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_11_fieldblock}{BEGIN Remark_11_fieldblock}<TR class="{$fielddispclass_Remark_11}" data-fieldname="Remark_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_11_label}{END Remark_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_11_fieldblock}{BEGIN Drug_12_fieldblock}<TR class="{$fielddispclass_Drug_12}" data-fieldname="Drug_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_12_label}{END Drug_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_12_fieldblock}{BEGIN QtyReceived_12_fieldblock}<TR class="{$fielddispclass_QtyReceived_12}" data-fieldname="QtyReceived_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_12_label}{END QtyReceived_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_12_fieldblock}{BEGIN Qty_Dispensed_12_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_12}" data-fieldname="Qty_Dispensed_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_12_label}{END Qty_Dispensed_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_12_fieldblock}{BEGIN QtySOH_12_fieldblock}<TR class="{$fielddispclass_QtySOH_12}" data-fieldname="QtySOH_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_12_label}{END QtySOH_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_12_fieldblock}{BEGIN Remark_12_fieldblock}<TR class="{$fielddispclass_Remark_12}" data-fieldname="Remark_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_12_label}{END Remark_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_12_fieldblock}{BEGIN Drug_13_fieldblock}<TR class="{$fielddispclass_Drug_13}" data-fieldname="Drug_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_13_label}{END Drug_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_13_fieldblock}{BEGIN QtyReceived_13_fieldblock}<TR class="{$fielddispclass_QtyReceived_13}" data-fieldname="QtyReceived_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_13_label}{END QtyReceived_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_13_fieldblock}{BEGIN Qty_Dispensed_13_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_13}" data-fieldname="Qty_Dispensed_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_13_label}{END Qty_Dispensed_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_13_fieldblock}{BEGIN QtySOH_13_fieldblock}<TR class="{$fielddispclass_QtySOH_13}" data-fieldname="QtySOH_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_13_label}{END QtySOH_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_13_fieldblock}{BEGIN Remark_13_fieldblock}<TR class="{$fielddispclass_Remark_13}" data-fieldname="Remark_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_13_label}{END Remark_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_13_fieldblock}{BEGIN Drug_14_fieldblock}<TR class="{$fielddispclass_Drug_14}" data-fieldname="Drug_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_14_label}{END Drug_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_14_fieldblock}{BEGIN QtyReceived_14_fieldblock}<TR class="{$fielddispclass_QtyReceived_14}" data-fieldname="QtyReceived_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_14_label}{END QtyReceived_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_14_fieldblock}{BEGIN Qty_Dispensed_14_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_14}" data-fieldname="Qty_Dispensed_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_14_label}{END Qty_Dispensed_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_14_fieldblock}{BEGIN QtySOH_14_fieldblock}<TR class="{$fielddispclass_QtySOH_14}" data-fieldname="QtySOH_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_14_label}{END QtySOH_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_14_fieldblock}{BEGIN Remark_14_fieldblock}<TR class="{$fielddispclass_Remark_14}" data-fieldname="Remark_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_14_label}{END Remark_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_14_fieldblock}{BEGIN Drug_15_fieldblock}<TR class="{$fielddispclass_Drug_15}" data-fieldname="Drug_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_15_label}{END Drug_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_15_fieldblock}{BEGIN QtyReceived_15_fieldblock}<TR class="{$fielddispclass_QtyReceived_15}" data-fieldname="QtyReceived_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_15_label}{END QtyReceived_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_15_fieldblock}{BEGIN Qty_Dispensed_15_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_15}" data-fieldname="Qty_Dispensed_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_15_label}{END Qty_Dispensed_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_15_fieldblock}{BEGIN QtySOH_15_fieldblock}<TR class="{$fielddispclass_QtySOH_15}" data-fieldname="QtySOH_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_15_label}{END QtySOH_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_15_fieldblock}{BEGIN Remark_15_fieldblock}<TR class="{$fielddispclass_Remark_15}" data-fieldname="Remark_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_15_label}{END Remark_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD>
</TR>{END Remark_15_fieldblock}</TBODY></TABLE></DIV>
{BEGIN editbuttons}<DIV class="rnr-brickcontents style2 rnr-b-editbuttons {$brickclass_editbuttons}">
<DIV class="rnr-buttons-right">{BEGIN prev_button}<A class="rnr-button {$prevbutton_class}" href="#" {$prevbutton_attrs}>&lt;&lt;&lt;</A>{END prev_button}{BEGIN next_button}<A class="rnr-button  {$nextbutton_class}" href="#" {$nextbutton_attrs}>&gt;&gt;&gt;</A>{END next_button}</DIV>
<DIV class="rnr-buttons-left">{BEGIN save_button}<A class="rnr-button main" href="#" {$savebutton_attrs}>Save</A>{END save_button}{BEGIN reset_button}<A class="rnr-button" href="#" {$resetbutton_attrs}>Reset</A>{END reset_button}{BEGIN back_button}<A class="rnr-button" href="#" {$backbutton_attrs}>Back to list</A>{END back_button}{BEGIN close_button}<A class="rnr-button" href="#" {$closebutton_attrs}>Close 
 window</A>{END close_button}{BEGIN view_page_button}<A class="rnr-button" href="#" {$view_page_button_attrs}>View</A>{END view_page_button}</DIV></DIV>{END editbuttons}</DIV>{END container_fields}</DIV></DIV>
{END container_edit}</DIV></DIV>{END container_all}</DIV>
<DIV class="rnr-middle">
<DIV class="rnr-left {$blockclass_left}"></DIV>
<DIV class="rnr-center {$blockclass_center}"></DIV>
<DIV class="rnr-right {$blockclass_right}"></DIV></DIV>
<DIV class="rnr-bottom {$blockclass_bottom}"><!--%%bottom%%--></DIV></DIV>
{$footer}{END body}</BODY></HTML>


ACTIONTIME: 2015-02-12 15:27:40
SOURCE:
<!DOCTYPE html>
<HTML {$html_attrs}><HEAD>
<META content="IE=Edge" http-equiv="X-UA-Compatible"><TITLE>{$pagetitle}</TITLE>
<META content="text/html; charset=utf-8" http-equiv="Content-Type">
<LINK rel="stylesheet" type="text/css" href="styles/default.css">{BEGIN rtlCSS}<LINK rel="stylesheet" type="text/css" href="styles/defaultRTL.css">{END rtlCSS}{BEGIN styleCSSFiles}<LINK rel="stylesheet" type="text/css" href="{$stylepath}">{END styleCSSFiles}{BEGIN pageCSSFiles}<LINK rel="stylesheet" type="text/css" href="{$pagestylepath}">{END pageCSSFiles}
<META name="GENERATOR" content="MSHTML 9.00.8112.16599"></HEAD>
<BODY class="{$stylename} function-edit" {$bodyattrs}>{BEGIN body}
{$header}
<DIV class="rnr-page">
<DIV class="rnr-top {$blockclass_top}">
{BEGIN container_all}
<DIV class="rnr-c rnr-cv rnr-c-all">
<DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_edit} rnr-wrapper rnr-cbw-edit">
{BEGIN container_edit}
<DIV class="rnr-c rnr-cv rnr-c-edit">
{BEGIN editheader}<DIV class="rnr-brickcontents style2 rnr-b-editheader {$brickclass_editheader}"><SPAN>	
<H1>
{$pagetitlelabel arv_pmtct edit}</H1>
</SPAN></DIV>
{END editheader}{BEGIN message_block}<DIV class="rnr-brickcontents style1 rnr-b-message {$brickclass_message}">
<DIV class="rnr-message">
{$message}</DIV></DIV>
{END message_block}<DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_fields} rnr-wrapper rnr-cbw-fields">
{BEGIN container_fields}
<DIV style="min-height: 2695px; min-width: 833px;" class="rnr-c rnr-cv rnr-c-fields">
<DIV class="rnr-brickcontents style1 rnr-b-editfields {$brickclass_editfields}">
<TABLE style="width: auto;" class="fieldGrid">
  <TBODY>
  {BEGIN formid_fieldblock}<TR class="{$fielddispclass_formid}" data-fieldname="formid">
    <TD style="width: 100px;" class="rnr-label">{BEGIN formid_label}{END formid_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"></TD></TR>
  {END formid_fieldblock}{BEGIN SiteName_fieldblock}<TR class="{$fielddispclass_SiteName}" data-fieldname="SiteName">
    <TD style="width: auto;" class="rnr-label">
      {BEGIN SiteName_label}<TABLE style="width: 815px; height: 123px;" border="1" cellSpacing="1" cellPadding="1" width="708">
        <TBODY>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> SiteName</TD>
          <TD style="width: 227px;" rowSpan="1" colSpan="1"> 
            {$SiteName_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> </TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1"> </TD>
          <TD style="width: 126px;" rowSpan="5" colSpan="1"><IMG style="width: 124px; height: 84px;" border="0" alt="coat of arms" src="images/coat.jpg" width="242" height="207">&nbsp;&nbsp;&nbsp; </TD></TR>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> Facility Code</TD>
          <TD style="width: 227px;" rowSpan="1" colSpan="1"> 
            {$formid_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> Funding Source</TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1"> 
            {$Funding_Source_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> State</TD>
          <TD style="width: 227px;" rowSpan="1" colSpan="1"> 
            {$State_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> Service Type</TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1"> 
            {$Service_Type_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> Phase</TD>
          <TD style="width: 227px;" rowSpan="1" colSpan="1"> 
            {$Phase_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> IPName</TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1"> 
            {$IPName_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> </TD>
          <TD style="width: 227px;" rowSpan="1" colSpan="1"> </TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> </TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1"> 
      </TD></TR></TBODY></TABLE>{END SiteName_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END SiteName_fieldblock}{BEGIN State_fieldblock}<TR class="{$fielddispclass_State}" data-fieldname="State">
    <TD style="width: auto;" class="rnr-label">
      {BEGIN State_label}<TABLE style="width: 1136px; height: 619px;" border="1" cellSpacing="1" cellPadding="1" width="985">
        <TBODY>
        <TR style="height: 42px;">
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;S/No</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;Drugs</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;Basic Unit</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">
            <P>&nbsp;Quantity Received During </P>
            <P>the Repoting Period</P></TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;Quantity     
                    Received During the Repoting Period</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">
            <P>&nbsp;Endig Balance </P>
            <P>(Physical Count)</P></TD>
          <TD style="width: 213px;" rowSpan="1" 
        colSpan="1">&nbsp;Remarks</TD></TR>
        <TR>
          <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" colSpan="7"></TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;1</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_1_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_1_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_1_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_1_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_1_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;2</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_2_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_2_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_2_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_2_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_2_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" 
        colSpan="7">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;3</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_3_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_3_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_3_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_3_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_3_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;4</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_4_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_4_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_4_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_4_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_4_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;5</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_5_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_5_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_5_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_5_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_5_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" 
        colSpan="7">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;6</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_6_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_6_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_6_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_6_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_6_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;7</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_7_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_7_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_7_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_7_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_7_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;8</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_8_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_8_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_8_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_8_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_8_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" 
        colSpan="7">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;9</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_9_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_9_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_9_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_9_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_9_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;10</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_10_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_10_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_10_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_10_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_10_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;11</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_11_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_11_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_11_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_11_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_11_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;12</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_12_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_12_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_12_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_12_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_12_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" 
        colSpan="7">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;13</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_13_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_13_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_14_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_13_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_13_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;14</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_14_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_14_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_14_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_14_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_14_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1">&nbsp;15</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Drug_15_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1">&nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtyReceived_15_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Qty_Dispensed_15_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$QtySOH_15_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">&nbsp;
            {$Remark_15_editcontrol}</TD></TR>
        </TBODY></TABLE>{END State_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END State_fieldblock}{BEGIN Funding_Source_fieldblock}<TR class="{$fielddispclass_Funding_Source}" data-fieldname="Funding_Source">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Funding_Source_label}{END Funding_Source_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Funding_Source_fieldblock}{BEGIN Service_Type_fieldblock}<TR class="{$fielddispclass_Service_Type}" data-fieldname="Service_Type">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Service_Type_label}{END Service_Type_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Service_Type_fieldblock}{BEGIN Phase_fieldblock}<TR class="{$fielddispclass_Phase}" data-fieldname="Phase">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Phase_label}{END Phase_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Phase_fieldblock}{BEGIN IPName_fieldblock}<TR class="{$fielddispclass_IPName}" data-fieldname="IPName">
    <TD style="width: 100px;" class="rnr-label">{BEGIN IPName_label}{END IPName_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END IPName_fieldblock}{BEGIN Drug_1_fieldblock}<TR class="{$fielddispclass_Drug_1}" data-fieldname="Drug_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_1_label}{END Drug_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_1_fieldblock}{BEGIN QtyReceived_1_fieldblock}<TR class="{$fielddispclass_QtyReceived_1}" data-fieldname="QtyReceived_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_1_label}{END QtyReceived_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_1_fieldblock}{BEGIN Qty_Dispensed_1_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_1}" data-fieldname="Qty_Dispensed_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_1_label}{END Qty_Dispensed_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_1_fieldblock}{BEGIN QtySOH_1_fieldblock}<TR class="{$fielddispclass_QtySOH_1}" data-fieldname="QtySOH_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_1_label}{END QtySOH_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_1_fieldblock}{BEGIN Remark_1_fieldblock}<TR class="{$fielddispclass_Remark_1}" data-fieldname="Remark_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_1_label}{END Remark_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_1_fieldblock}{BEGIN Drug_2_fieldblock}<TR class="{$fielddispclass_Drug_2}" data-fieldname="Drug_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_2_label}{END Drug_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_2_fieldblock}{BEGIN QtyReceived_2_fieldblock}<TR class="{$fielddispclass_QtyReceived_2}" data-fieldname="QtyReceived_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_2_label}{END QtyReceived_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_2_fieldblock}{BEGIN Qty_Dispensed_2_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_2}" data-fieldname="Qty_Dispensed_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_2_label}{END Qty_Dispensed_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_2_fieldblock}{BEGIN QtySOH_2_fieldblock}<TR class="{$fielddispclass_QtySOH_2}" data-fieldname="QtySOH_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_2_label}{END QtySOH_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_2_fieldblock}{BEGIN Remark_2_fieldblock}<TR class="{$fielddispclass_Remark_2}" data-fieldname="Remark_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_2_label}{END Remark_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_2_fieldblock}{BEGIN Drug_3_fieldblock}<TR class="{$fielddispclass_Drug_3}" data-fieldname="Drug_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_3_label}{END Drug_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_3_fieldblock}{BEGIN QtyReceived_3_fieldblock}<TR class="{$fielddispclass_QtyReceived_3}" data-fieldname="QtyReceived_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_3_label}{END QtyReceived_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_3_fieldblock}{BEGIN Qty_Dispensed_3_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_3}" data-fieldname="Qty_Dispensed_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_3_label}{END Qty_Dispensed_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_3_fieldblock}{BEGIN QtySOH_3_fieldblock}<TR class="{$fielddispclass_QtySOH_3}" data-fieldname="QtySOH_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_3_label}{END QtySOH_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_3_fieldblock}{BEGIN Remark_3_fieldblock}<TR class="{$fielddispclass_Remark_3}" data-fieldname="Remark_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_3_label}{END Remark_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_3_fieldblock}{BEGIN Drug_4_fieldblock}<TR class="{$fielddispclass_Drug_4}" data-fieldname="Drug_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_4_label}{END Drug_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_4_fieldblock}{BEGIN QtyReceived_4_fieldblock}<TR class="{$fielddispclass_QtyReceived_4}" data-fieldname="QtyReceived_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_4_label}{END QtyReceived_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_4_fieldblock}{BEGIN Qty_Dispensed_4_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_4}" data-fieldname="Qty_Dispensed_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_4_label}{END Qty_Dispensed_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_4_fieldblock}{BEGIN QtySOH_4_fieldblock}<TR class="{$fielddispclass_QtySOH_4}" data-fieldname="QtySOH_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_4_label}{END QtySOH_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_4_fieldblock}{BEGIN Remark_4_fieldblock}<TR class="{$fielddispclass_Remark_4}" data-fieldname="Remark_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_4_label}{END Remark_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_4_fieldblock}{BEGIN Drug_5_fieldblock}<TR class="{$fielddispclass_Drug_5}" data-fieldname="Drug_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_5_label}{END Drug_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_5_fieldblock}{BEGIN QtyReceived_5_fieldblock}<TR class="{$fielddispclass_QtyReceived_5}" data-fieldname="QtyReceived_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_5_label}{END QtyReceived_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_5_fieldblock}{BEGIN Qty_Dispensed_5_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_5}" data-fieldname="Qty_Dispensed_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_5_label}{END Qty_Dispensed_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_5_fieldblock}{BEGIN QtySOH_5_fieldblock}<TR class="{$fielddispclass_QtySOH_5}" data-fieldname="QtySOH_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_5_label}{END QtySOH_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_5_fieldblock}{BEGIN Remark_5_fieldblock}<TR class="{$fielddispclass_Remark_5}" data-fieldname="Remark_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_5_label}{END Remark_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_5_fieldblock}{BEGIN Drug_6_fieldblock}<TR class="{$fielddispclass_Drug_6}" data-fieldname="Drug_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_6_label}{END Drug_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_6_fieldblock}{BEGIN QtyReceived_6_fieldblock}<TR class="{$fielddispclass_QtyReceived_6}" data-fieldname="QtyReceived_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_6_label}{END QtyReceived_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_6_fieldblock}{BEGIN Qty_Dispensed_6_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_6}" data-fieldname="Qty_Dispensed_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_6_label}{END Qty_Dispensed_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_6_fieldblock}{BEGIN QtySOH_6_fieldblock}<TR class="{$fielddispclass_QtySOH_6}" data-fieldname="QtySOH_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_6_label}{END QtySOH_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_6_fieldblock}{BEGIN Remark_6_fieldblock}<TR class="{$fielddispclass_Remark_6}" data-fieldname="Remark_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_6_label}{END Remark_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_6_fieldblock}{BEGIN Drug_7_fieldblock}<TR class="{$fielddispclass_Drug_7}" data-fieldname="Drug_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_7_label}{END Drug_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_7_fieldblock}{BEGIN QtyReceived_7_fieldblock}<TR class="{$fielddispclass_QtyReceived_7}" data-fieldname="QtyReceived_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_7_label}{END QtyReceived_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_7_fieldblock}{BEGIN Qty_Dispensed_7_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_7}" data-fieldname="Qty_Dispensed_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_7_label}{END Qty_Dispensed_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_7_fieldblock}{BEGIN QtySOH_7_fieldblock}<TR class="{$fielddispclass_QtySOH_7}" data-fieldname="QtySOH_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_7_label}{END QtySOH_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_7_fieldblock}{BEGIN Remark_7_fieldblock}<TR class="{$fielddispclass_Remark_7}" data-fieldname="Remark_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_7_label}{END Remark_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_7_fieldblock}{BEGIN Drug_8_fieldblock}<TR class="{$fielddispclass_Drug_8}" data-fieldname="Drug_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_8_label}{END Drug_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_8_fieldblock}{BEGIN QtyReceived_8_fieldblock}<TR class="{$fielddispclass_QtyReceived_8}" data-fieldname="QtyReceived_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_8_label}{END QtyReceived_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_8_fieldblock}{BEGIN Qty_Dispensed_8_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_8}" data-fieldname="Qty_Dispensed_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_8_label}{END Qty_Dispensed_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_8_fieldblock}{BEGIN QtySOH_8_fieldblock}<TR class="{$fielddispclass_QtySOH_8}" data-fieldname="QtySOH_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_8_label}{END QtySOH_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_8_fieldblock}{BEGIN Remark_8_fieldblock}<TR class="{$fielddispclass_Remark_8}" data-fieldname="Remark_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_8_label}{END Remark_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_8_fieldblock}{BEGIN Drug_9_fieldblock}<TR class="{$fielddispclass_Drug_9}" data-fieldname="Drug_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_9_label}{END Drug_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_9_fieldblock}{BEGIN QtyReceived_9_fieldblock}<TR class="{$fielddispclass_QtyReceived_9}" data-fieldname="QtyReceived_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_9_label}{END QtyReceived_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_9_fieldblock}{BEGIN Qty_Dispensed_9_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_9}" data-fieldname="Qty_Dispensed_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_9_label}{END Qty_Dispensed_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_9_fieldblock}{BEGIN QtySOH_9_fieldblock}<TR class="{$fielddispclass_QtySOH_9}" data-fieldname="QtySOH_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_9_label}{END QtySOH_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_9_fieldblock}{BEGIN Remark_9_fieldblock}<TR class="{$fielddispclass_Remark_9}" data-fieldname="Remark_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_9_label}{END Remark_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_9_fieldblock}{BEGIN Drug_10_fieldblock}<TR class="{$fielddispclass_Drug_10}" data-fieldname="Drug_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_10_label}{END Drug_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_10_fieldblock}{BEGIN QtyReceived_10_fieldblock}<TR class="{$fielddispclass_QtyReceived_10}" data-fieldname="QtyReceived_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_10_label}{END QtyReceived_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_10_fieldblock}{BEGIN Qty_Dispensed_10_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_10}" data-fieldname="Qty_Dispensed_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_10_label}{END Qty_Dispensed_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_10_fieldblock}{BEGIN QtySOH_10_fieldblock}<TR class="{$fielddispclass_QtySOH_10}" data-fieldname="QtySOH_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_10_label}{END QtySOH_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_10_fieldblock}{BEGIN Remark_10_fieldblock}<TR class="{$fielddispclass_Remark_10}" data-fieldname="Remark_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_10_label}{END Remark_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_10_fieldblock}{BEGIN Drug_11_fieldblock}<TR class="{$fielddispclass_Drug_11}" data-fieldname="Drug_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_11_label}{END Drug_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_11_fieldblock}{BEGIN QtyReceived_11_fieldblock}<TR class="{$fielddispclass_QtyReceived_11}" data-fieldname="QtyReceived_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_11_label}{END QtyReceived_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_11_fieldblock}{BEGIN Qty_Dispensed_11_fieldblock}<TR style="height: 498px;" class="{$fielddispclass_Qty_Dispensed_11}" data-fieldname="Qty_Dispensed_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_11_label}{END Qty_Dispensed_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_11_fieldblock}{BEGIN QtySOH_11_fieldblock}<TR class="{$fielddispclass_QtySOH_11}" data-fieldname="QtySOH_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_11_label}{END QtySOH_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_11_fieldblock}{BEGIN Remark_11_fieldblock}<TR class="{$fielddispclass_Remark_11}" data-fieldname="Remark_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_11_label}{END Remark_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_11_fieldblock}{BEGIN Drug_12_fieldblock}<TR class="{$fielddispclass_Drug_12}" data-fieldname="Drug_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_12_label}{END Drug_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_12_fieldblock}{BEGIN QtyReceived_12_fieldblock}<TR class="{$fielddispclass_QtyReceived_12}" data-fieldname="QtyReceived_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_12_label}{END QtyReceived_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_12_fieldblock}{BEGIN Qty_Dispensed_12_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_12}" data-fieldname="Qty_Dispensed_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_12_label}{END Qty_Dispensed_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_12_fieldblock}{BEGIN QtySOH_12_fieldblock}<TR class="{$fielddispclass_QtySOH_12}" data-fieldname="QtySOH_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_12_label}{END QtySOH_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_12_fieldblock}{BEGIN Remark_12_fieldblock}<TR class="{$fielddispclass_Remark_12}" data-fieldname="Remark_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_12_label}{END Remark_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_12_fieldblock}{BEGIN Drug_13_fieldblock}<TR class="{$fielddispclass_Drug_13}" data-fieldname="Drug_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_13_label}{END Drug_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_13_fieldblock}{BEGIN QtyReceived_13_fieldblock}<TR class="{$fielddispclass_QtyReceived_13}" data-fieldname="QtyReceived_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_13_label}{END QtyReceived_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_13_fieldblock}{BEGIN Qty_Dispensed_13_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_13}" data-fieldname="Qty_Dispensed_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_13_label}{END Qty_Dispensed_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_13_fieldblock}{BEGIN QtySOH_13_fieldblock}<TR class="{$fielddispclass_QtySOH_13}" data-fieldname="QtySOH_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_13_label}{END QtySOH_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_13_fieldblock}{BEGIN Remark_13_fieldblock}<TR class="{$fielddispclass_Remark_13}" data-fieldname="Remark_13">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_13_label}{END Remark_13_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_13_fieldblock}{BEGIN Drug_14_fieldblock}<TR class="{$fielddispclass_Drug_14}" data-fieldname="Drug_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_14_label}{END Drug_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_14_fieldblock}{BEGIN QtyReceived_14_fieldblock}<TR class="{$fielddispclass_QtyReceived_14}" data-fieldname="QtyReceived_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_14_label}{END QtyReceived_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_14_fieldblock}{BEGIN Qty_Dispensed_14_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_14}" data-fieldname="Qty_Dispensed_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_14_label}{END Qty_Dispensed_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_14_fieldblock}{BEGIN QtySOH_14_fieldblock}<TR class="{$fielddispclass_QtySOH_14}" data-fieldname="QtySOH_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_14_label}{END QtySOH_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_14_fieldblock}{BEGIN Remark_14_fieldblock}<TR class="{$fielddispclass_Remark_14}" data-fieldname="Remark_14">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_14_label}{END Remark_14_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Remark_14_fieldblock}{BEGIN Drug_15_fieldblock}<TR class="{$fielddispclass_Drug_15}" data-fieldname="Drug_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_15_label}{END Drug_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Drug_15_fieldblock}{BEGIN QtyReceived_15_fieldblock}<TR class="{$fielddispclass_QtyReceived_15}" data-fieldname="QtyReceived_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_15_label}{END QtyReceived_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtyReceived_15_fieldblock}{BEGIN Qty_Dispensed_15_fieldblock}<TR style="height: auto;" class="{$fielddispclass_Qty_Dispensed_15}" data-fieldname="Qty_Dispensed_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_15_label}{END Qty_Dispensed_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END Qty_Dispensed_15_fieldblock}{BEGIN QtySOH_15_fieldblock}<TR class="{$fielddispclass_QtySOH_15}" data-fieldname="QtySOH_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_15_label}{END QtySOH_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD></TR>
  {END QtySOH_15_fieldblock}{BEGIN Remark_15_fieldblock}<TR class="{$fielddispclass_Remark_15}" data-fieldname="Remark_15">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_15_label}{END Remark_15_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3">&nbsp;</TD>
</TR>{END Remark_15_fieldblock}</TBODY></TABLE></DIV>
{BEGIN editbuttons}<DIV class="rnr-brickcontents style2 rnr-b-editbuttons {$brickclass_editbuttons}">
<DIV class="rnr-buttons-right">{BEGIN prev_button}<A class="rnr-button {$prevbutton_class}" href="#" {$prevbutton_attrs}>&lt;&lt;&lt;</A>{END prev_button}{BEGIN next_button}<A class="rnr-button  {$nextbutton_class}" href="#" {$nextbutton_attrs}>&gt;&gt;&gt;</A>{END next_button}</DIV>
<DIV class="rnr-buttons-left">{BEGIN save_button}<A class="rnr-button main" href="#" {$savebutton_attrs}>Save</A>{END save_button}{BEGIN reset_button}<A class="rnr-button" href="#" {$resetbutton_attrs}>Reset</A>{END reset_button}{BEGIN back_button}<A class="rnr-button" href="#" {$backbutton_attrs}>Back to list</A>{END back_button}{BEGIN close_button}<A class="rnr-button" href="#" {$closebutton_attrs}>Close 
 window</A>{END close_button}{BEGIN view_page_button}<A class="rnr-button" href="#" {$view_page_button_attrs}>View</A>{END view_page_button}</DIV></DIV>{END editbuttons}</DIV>{END container_fields}</DIV></DIV>
{END container_edit}</DIV></DIV>{END container_all}</DIV>
<DIV class="rnr-middle">
<DIV class="rnr-left {$blockclass_left}"></DIV>
<DIV class="rnr-center {$blockclass_center}"></DIV>
<DIV class="rnr-right {$blockclass_right}"></DIV></DIV>
<DIV class="rnr-bottom {$blockclass_bottom}"><!--%%bottom%%--></DIV></DIV>
{$footer}{END body}</BODY></HTML>


ACTIONTIME: 2015-02-12 15:27:50
SOURCE:
<!DOCTYPE html>
<HTML {$html_attrs}>
  <HEAD>
    <META content="IE=Edge" http-equiv="X-UA-Compatible">
    <TITLE>
      {$pagetitle}
    </TITLE>
    <META content="text/html; charset=utf-8" http-equiv="Content-Type">
    <LINK rel="stylesheet" type="text/css" href="styles/default.css">
    {BEGIN rtlCSS}
      <LINK rel="stylesheet" type="text/css" href="styles/defaultRTL.css">
    {END rtlCSS}
    {BEGIN styleCSSFiles}
      <LINK rel="stylesheet" type="text/css" href="{$stylepath}">
    {END styleCSSFiles}
    {BEGIN pageCSSFiles}
      <LINK rel="stylesheet" type="text/css" href="{$pagestylepath}">
    {END pageCSSFiles}
    <META name="GENERATOR" content="MSHTML 9.00.8112.16599">
  </HEAD>
  <BODY class="{$stylename} function-edit" {$bodyattrs}>
    {BEGIN body}
      {$header}
      <DIV class="rnr-page">
        <DIV class="rnr-top {$blockclass_top}">
          {BEGIN container_all}
            <DIV class="rnr-c rnr-cv rnr-c-all">
              <DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_edit} rnr-wrapper rnr-cbw-edit">
                {BEGIN container_edit}
                  <DIV class="rnr-c rnr-cv rnr-c-edit">
                    {BEGIN editheader}
                      <DIV class="rnr-brickcontents style2 rnr-b-editheader {$brickclass_editheader}">
                        <SPAN>
                          <H1>
                            {$pagetitlelabel arv_pmtct edit}
                          </H1>
                        </SPAN>
                      </DIV>
                    {END editheader}
                    {BEGIN message_block}
                      <DIV class="rnr-brickcontents style1 rnr-b-message {$brickclass_message}">
                        <DIV class="rnr-message">
                          {$message}
                        </DIV>
                      </DIV>
                    {END message_block}
                    <DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_fields} rnr-wrapper rnr-cbw-fields">
                      {BEGIN container_fields}
                        <DIV style="min-height: 2695px; min-width: 833px;" class="rnr-c rnr-cv rnr-c-fields">
                          <DIV class="rnr-brickcontents style1 rnr-b-editfields {$brickclass_editfields}">
                            <TABLE style="width: auto;" class="fieldGrid">
                              <TBODY>
                                {BEGIN formid_fieldblock}
                                  <TR class="{$fielddispclass_formid}" data-fieldname="formid">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN formid_label}
                                      {END formid_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                    </TD>
                                  </TR>
                                {END formid_fieldblock}
                                {BEGIN SiteName_fieldblock}
                                  <TR class="{$fielddispclass_SiteName}" data-fieldname="SiteName">
                                    <TD style="width: auto;" class="rnr-label">
                                      {BEGIN SiteName_label}
                                        <TABLE style="width: 815px; height: 123px;" border="1" cellSpacing="1" cellPadding="1" width="708">
                                          <TBODY>
                                            <TR>
                                              <TD style="width: 122px;" rowSpan="1" colSpan="1">
                                                SiteName
                                              </TD>
                                              <TD style="width: 227px;" rowSpan="1" colSpan="1">
                                                {$SiteName_editcontrol}
                                              </TD>
                                              <TD style="width: 112px;" rowSpan="1" colSpan="1">
                                              </TD>
                                              <TD style="width: 231px;" rowSpan="1" colSpan="1">
                                              </TD>
                                              <TD style="width: 126px;" rowSpan="5" colSpan="1">
                                                <IMG style="width: 124px; height: 84px;" border="0" alt="coat of arms" src="images/coat.jpg" width="242" height="207">
                                                &nbsp;&nbsp;&nbsp;
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 122px;" rowSpan="1" colSpan="1">
                                                Facility Code
                                              </TD>
                                              <TD style="width: 227px;" rowSpan="1" colSpan="1">
                                                {$formid_editcontrol}
                                              </TD>
                                              <TD style="width: 112px;" rowSpan="1" colSpan="1">
                                                Funding Source
                                              </TD>
                                              <TD style="width: 231px;" rowSpan="1" colSpan="1">
                                                {$Funding_Source_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 122px;" rowSpan="1" colSpan="1">
                                                State
                                              </TD>
                                              <TD style="width: 227px;" rowSpan="1" colSpan="1">
                                                {$State_editcontrol}
                                              </TD>
                                              <TD style="width: 112px;" rowSpan="1" colSpan="1">
                                                Service Type
                                              </TD>
                                              <TD style="width: 231px;" rowSpan="1" colSpan="1">
                                                {$Service_Type_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 122px;" rowSpan="1" colSpan="1">
                                                Phase
                                              </TD>
                                              <TD style="width: 227px;" rowSpan="1" colSpan="1">
                                                {$Phase_editcontrol}
                                              </TD>
                                              <TD style="width: 112px;" rowSpan="1" colSpan="1">
                                                IPName
                                              </TD>
                                              <TD style="width: 231px;" rowSpan="1" colSpan="1">
                                                {$IPName_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 122px;" rowSpan="1" colSpan="1">
                                              </TD>
                                              <TD style="width: 227px;" rowSpan="1" colSpan="1">
                                              </TD>
                                              <TD style="width: 112px;" rowSpan="1" colSpan="1">
                                              </TD>
                                              <TD style="width: 231px;" rowSpan="1" colSpan="1">
                                              </TD>
                                            </TR>
                                          </TBODY>
                                        </TABLE>
                                      {END SiteName_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END SiteName_fieldblock}
                                {BEGIN State_fieldblock}
                                  <TR class="{$fielddispclass_State}" data-fieldname="State">
                                    <TD style="width: auto;" class="rnr-label">
                                      {BEGIN State_label}
                                        <TABLE style="width: 1136px; height: 619px;" border="1" cellSpacing="1" cellPadding="1" width="985">
                                          <TBODY>
                                            <TR style="height: 42px;">
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;S/No
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;Drugs
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;Basic Unit
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                <P>
                                                  &nbsp;Quantity Received During
                                                </P>
                                                <P>
                                                  the Repoting Period
                                                </P>
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;Quantity Received During the Repoting Period
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                <P>
                                                  &nbsp;Endig Balance
                                                </P>
                                                <P>
                                                  (Physical Count)
                                                </P>
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" 
        colSpan="1">
                                                &nbsp;Remarks
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" colSpan="7">
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;1
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_1_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_1_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_1_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_1_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_1_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;2
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_2_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_2_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_2_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_2_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_2_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" 
        colSpan="7">
                                                &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;3
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_3_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_3_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_3_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_3_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_3_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;4
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_4_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_4_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_4_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_4_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_4_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;5
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_5_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_5_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_5_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_5_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_5_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" 
        colSpan="7">
                                                &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;6
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_6_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_6_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_6_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_6_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_6_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;7
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_7_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_7_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_7_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_7_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_7_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;8
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_8_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_8_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_8_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_8_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_8_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" 
        colSpan="7">
                                                &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;9
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_9_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_9_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_9_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_9_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_9_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;10
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_10_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_10_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_10_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_10_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_10_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;11
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_11_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_11_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_11_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_11_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_11_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;12
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_12_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_12_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_12_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_12_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_12_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" 
        colSpan="7">
                                                &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;13
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_13_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_13_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_14_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_13_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_13_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;14
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_14_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_14_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_14_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_14_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_14_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;15
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_15_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_15_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_15_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_15_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_15_editcontrol}
                                              </TD>
                                            </TR>
                                          </TBODY>
                                        </TABLE>
                                      {END State_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END State_fieldblock}
                                {BEGIN Funding_Source_fieldblock}
                                  <TR class="{$fielddispclass_Funding_Source}" data-fieldname="Funding_Source">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Funding_Source_label}
                                      {END Funding_Source_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Funding_Source_fieldblock}
                                {BEGIN Service_Type_fieldblock}
                                  <TR class="{$fielddispclass_Service_Type}" data-fieldname="Service_Type">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Service_Type_label}
                                      {END Service_Type_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Service_Type_fieldblock}
                                {BEGIN Phase_fieldblock}
                                  <TR class="{$fielddispclass_Phase}" data-fieldname="Phase">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Phase_label}
                                      {END Phase_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Phase_fieldblock}
                                {BEGIN IPName_fieldblock}
                                  <TR class="{$fielddispclass_IPName}" data-fieldname="IPName">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN IPName_label}
                                      {END IPName_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END IPName_fieldblock}
                                {BEGIN Drug_1_fieldblock}
                                  <TR class="{$fielddispclass_Drug_1}" data-fieldname="Drug_1">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Drug_1_label}
                                      {END Drug_1_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Drug_1_fieldblock}
                                {BEGIN QtyReceived_1_fieldblock}
                                  <TR class="{$fielddispclass_QtyReceived_1}" data-fieldname="QtyReceived_1">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtyReceived_1_label}
                                      {END QtyReceived_1_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtyReceived_1_fieldblock}
                                {BEGIN Qty_Dispensed_1_fieldblock}
                                  <TR class="{$fielddispclass_Qty_Dispensed_1}" data-fieldname="Qty_Dispensed_1">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Qty_Dispensed_1_label}
                                      {END Qty_Dispensed_1_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Qty_Dispensed_1_fieldblock}
                                {BEGIN QtySOH_1_fieldblock}
                                  <TR class="{$fielddispclass_QtySOH_1}" data-fieldname="QtySOH_1">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtySOH_1_label}
                                      {END QtySOH_1_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtySOH_1_fieldblock}
                                {BEGIN Remark_1_fieldblock}
                                  <TR class="{$fielddispclass_Remark_1}" data-fieldname="Remark_1">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Remark_1_label}
                                      {END Remark_1_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Remark_1_fieldblock}
                                {BEGIN Drug_2_fieldblock}
                                  <TR class="{$fielddispclass_Drug_2}" data-fieldname="Drug_2">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Drug_2_label}
                                      {END Drug_2_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Drug_2_fieldblock}
                                {BEGIN QtyReceived_2_fieldblock}
                                  <TR class="{$fielddispclass_QtyReceived_2}" data-fieldname="QtyReceived_2">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtyReceived_2_label}
                                      {END QtyReceived_2_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtyReceived_2_fieldblock}
                                {BEGIN Qty_Dispensed_2_fieldblock}
                                  <TR class="{$fielddispclass_Qty_Dispensed_2}" data-fieldname="Qty_Dispensed_2">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Qty_Dispensed_2_label}
                                      {END Qty_Dispensed_2_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Qty_Dispensed_2_fieldblock}
                                {BEGIN QtySOH_2_fieldblock}
                                  <TR class="{$fielddispclass_QtySOH_2}" data-fieldname="QtySOH_2">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtySOH_2_label}
                                      {END QtySOH_2_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtySOH_2_fieldblock}
                                {BEGIN Remark_2_fieldblock}
                                  <TR class="{$fielddispclass_Remark_2}" data-fieldname="Remark_2">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Remark_2_label}
                                      {END Remark_2_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Remark_2_fieldblock}
                                {BEGIN Drug_3_fieldblock}
                                  <TR class="{$fielddispclass_Drug_3}" data-fieldname="Drug_3">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Drug_3_label}
                                      {END Drug_3_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Drug_3_fieldblock}
                                {BEGIN QtyReceived_3_fieldblock}
                                  <TR class="{$fielddispclass_QtyReceived_3}" data-fieldname="QtyReceived_3">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtyReceived_3_label}
                                      {END QtyReceived_3_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtyReceived_3_fieldblock}
                                {BEGIN Qty_Dispensed_3_fieldblock}
                                  <TR class="{$fielddispclass_Qty_Dispensed_3}" data-fieldname="Qty_Dispensed_3">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Qty_Dispensed_3_label}
                                      {END Qty_Dispensed_3_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Qty_Dispensed_3_fieldblock}
                                {BEGIN QtySOH_3_fieldblock}
                                  <TR class="{$fielddispclass_QtySOH_3}" data-fieldname="QtySOH_3">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtySOH_3_label}
                                      {END QtySOH_3_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtySOH_3_fieldblock}
                                {BEGIN Remark_3_fieldblock}
                                  <TR class="{$fielddispclass_Remark_3}" data-fieldname="Remark_3">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Remark_3_label}
                                      {END Remark_3_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Remark_3_fieldblock}
                                {BEGIN Drug_4_fieldblock}
                                  <TR class="{$fielddispclass_Drug_4}" data-fieldname="Drug_4">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Drug_4_label}
                                      {END Drug_4_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Drug_4_fieldblock}
                                {BEGIN QtyReceived_4_fieldblock}
                                  <TR class="{$fielddispclass_QtyReceived_4}" data-fieldname="QtyReceived_4">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtyReceived_4_label}
                                      {END QtyReceived_4_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtyReceived_4_fieldblock}
                                {BEGIN Qty_Dispensed_4_fieldblock}
                                  <TR class="{$fielddispclass_Qty_Dispensed_4}" data-fieldname="Qty_Dispensed_4">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Qty_Dispensed_4_label}
                                      {END Qty_Dispensed_4_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Qty_Dispensed_4_fieldblock}
                                {BEGIN QtySOH_4_fieldblock}
                                  <TR class="{$fielddispclass_QtySOH_4}" data-fieldname="QtySOH_4">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtySOH_4_label}
                                      {END QtySOH_4_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtySOH_4_fieldblock}
                                {BEGIN Remark_4_fieldblock}
                                  <TR class="{$fielddispclass_Remark_4}" data-fieldname="Remark_4">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Remark_4_label}
                                      {END Remark_4_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Remark_4_fieldblock}
                                {BEGIN Drug_5_fieldblock}
                                  <TR class="{$fielddispclass_Drug_5}" data-fieldname="Drug_5">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Drug_5_label}
                                      {END Drug_5_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Drug_5_fieldblock}
                                {BEGIN QtyReceived_5_fieldblock}
                                  <TR class="{$fielddispclass_QtyReceived_5}" data-fieldname="QtyReceived_5">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtyReceived_5_label}
                                      {END QtyReceived_5_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtyReceived_5_fieldblock}
                                {BEGIN Qty_Dispensed_5_fieldblock}
                                  <TR class="{$fielddispclass_Qty_Dispensed_5}" data-fieldname="Qty_Dispensed_5">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Qty_Dispensed_5_label}
                                      {END Qty_Dispensed_5_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Qty_Dispensed_5_fieldblock}
                                {BEGIN QtySOH_5_fieldblock}
                                  <TR class="{$fielddispclass_QtySOH_5}" data-fieldname="QtySOH_5">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtySOH_5_label}
                                      {END QtySOH_5_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtySOH_5_fieldblock}
                                {BEGIN Remark_5_fieldblock}
                                  <TR class="{$fielddispclass_Remark_5}" data-fieldname="Remark_5">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Remark_5_label}
                                      {END Remark_5_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Remark_5_fieldblock}
                                {BEGIN Drug_6_fieldblock}
                                  <TR class="{$fielddispclass_Drug_6}" data-fieldname="Drug_6">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Drug_6_label}
                                      {END Drug_6_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Drug_6_fieldblock}
                                {BEGIN QtyReceived_6_fieldblock}
                                  <TR class="{$fielddispclass_QtyReceived_6}" data-fieldname="QtyReceived_6">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtyReceived_6_label}
                                      {END QtyReceived_6_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtyReceived_6_fieldblock}
                                {BEGIN Qty_Dispensed_6_fieldblock}
                                  <TR class="{$fielddispclass_Qty_Dispensed_6}" data-fieldname="Qty_Dispensed_6">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Qty_Dispensed_6_label}
                                      {END Qty_Dispensed_6_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Qty_Dispensed_6_fieldblock}
                                {BEGIN QtySOH_6_fieldblock}
                                  <TR class="{$fielddispclass_QtySOH_6}" data-fieldname="QtySOH_6">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtySOH_6_label}
                                      {END QtySOH_6_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtySOH_6_fieldblock}
                                {BEGIN Remark_6_fieldblock}
                                  <TR class="{$fielddispclass_Remark_6}" data-fieldname="Remark_6">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Remark_6_label}
                                      {END Remark_6_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Remark_6_fieldblock}
                                {BEGIN Drug_7_fieldblock}
                                  <TR class="{$fielddispclass_Drug_7}" data-fieldname="Drug_7">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Drug_7_label}
                                      {END Drug_7_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Drug_7_fieldblock}
                                {BEGIN QtyReceived_7_fieldblock}
                                  <TR class="{$fielddispclass_QtyReceived_7}" data-fieldname="QtyReceived_7">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtyReceived_7_label}
                                      {END QtyReceived_7_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtyReceived_7_fieldblock}
                                {BEGIN Qty_Dispensed_7_fieldblock}
                                  <TR class="{$fielddispclass_Qty_Dispensed_7}" data-fieldname="Qty_Dispensed_7">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Qty_Dispensed_7_label}
                                      {END Qty_Dispensed_7_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Qty_Dispensed_7_fieldblock}
                                {BEGIN QtySOH_7_fieldblock}
                                  <TR class="{$fielddispclass_QtySOH_7}" data-fieldname="QtySOH_7">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtySOH_7_label}
                                      {END QtySOH_7_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtySOH_7_fieldblock}
                                {BEGIN Remark_7_fieldblock}
                                  <TR class="{$fielddispclass_Remark_7}" data-fieldname="Remark_7">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Remark_7_label}
                                      {END Remark_7_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Remark_7_fieldblock}
                                {BEGIN Drug_8_fieldblock}
                                  <TR class="{$fielddispclass_Drug_8}" data-fieldname="Drug_8">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Drug_8_label}
                                      {END Drug_8_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Drug_8_fieldblock}
                                {BEGIN QtyReceived_8_fieldblock}
                                  <TR class="{$fielddispclass_QtyReceived_8}" data-fieldname="QtyReceived_8">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtyReceived_8_label}
                                      {END QtyReceived_8_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtyReceived_8_fieldblock}
                                {BEGIN Qty_Dispensed_8_fieldblock}
                                  <TR class="{$fielddispclass_Qty_Dispensed_8}" data-fieldname="Qty_Dispensed_8">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Qty_Dispensed_8_label}
                                      {END Qty_Dispensed_8_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Qty_Dispensed_8_fieldblock}
                                {BEGIN QtySOH_8_fieldblock}
                                  <TR class="{$fielddispclass_QtySOH_8}" data-fieldname="QtySOH_8">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtySOH_8_label}
                                      {END QtySOH_8_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtySOH_8_fieldblock}
                                {BEGIN Remark_8_fieldblock}
                                  <TR class="{$fielddispclass_Remark_8}" data-fieldname="Remark_8">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Remark_8_label}
                                      {END Remark_8_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Remark_8_fieldblock}
                                {BEGIN Drug_9_fieldblock}
                                  <TR class="{$fielddispclass_Drug_9}" data-fieldname="Drug_9">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Drug_9_label}
                                      {END Drug_9_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Drug_9_fieldblock}
                                {BEGIN QtyReceived_9_fieldblock}
                                  <TR class="{$fielddispclass_QtyReceived_9}" data-fieldname="QtyReceived_9">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtyReceived_9_label}
                                      {END QtyReceived_9_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtyReceived_9_fieldblock}
                                {BEGIN Qty_Dispensed_9_fieldblock}
                                  <TR class="{$fielddispclass_Qty_Dispensed_9}" data-fieldname="Qty_Dispensed_9">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Qty_Dispensed_9_label}
                                      {END Qty_Dispensed_9_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Qty_Dispensed_9_fieldblock}
                                {BEGIN QtySOH_9_fieldblock}
                                  <TR class="{$fielddispclass_QtySOH_9}" data-fieldname="QtySOH_9">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtySOH_9_label}
                                      {END QtySOH_9_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtySOH_9_fieldblock}
                                {BEGIN Remark_9_fieldblock}
                                  <TR class="{$fielddispclass_Remark_9}" data-fieldname="Remark_9">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Remark_9_label}
                                      {END Remark_9_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Remark_9_fieldblock}
                                {BEGIN Drug_10_fieldblock}
                                  <TR class="{$fielddispclass_Drug_10}" data-fieldname="Drug_10">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Drug_10_label}
                                      {END Drug_10_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Drug_10_fieldblock}
                                {BEGIN QtyReceived_10_fieldblock}
                                  <TR class="{$fielddispclass_QtyReceived_10}" data-fieldname="QtyReceived_10">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtyReceived_10_label}
                                      {END QtyReceived_10_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtyReceived_10_fieldblock}
                                {BEGIN Qty_Dispensed_10_fieldblock}
                                  <TR class="{$fielddispclass_Qty_Dispensed_10}" data-fieldname="Qty_Dispensed_10">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Qty_Dispensed_10_label}
                                      {END Qty_Dispensed_10_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Qty_Dispensed_10_fieldblock}
                                {BEGIN QtySOH_10_fieldblock}
                                  <TR class="{$fielddispclass_QtySOH_10}" data-fieldname="QtySOH_10">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtySOH_10_label}
                                      {END QtySOH_10_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtySOH_10_fieldblock}
                                {BEGIN Remark_10_fieldblock}
                                  <TR class="{$fielddispclass_Remark_10}" data-fieldname="Remark_10">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Remark_10_label}
                                      {END Remark_10_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Remark_10_fieldblock}
                                {BEGIN Drug_11_fieldblock}
                                  <TR class="{$fielddispclass_Drug_11}" data-fieldname="Drug_11">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Drug_11_label}
                                      {END Drug_11_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Drug_11_fieldblock}
                                {BEGIN QtyReceived_11_fieldblock}
                                  <TR class="{$fielddispclass_QtyReceived_11}" data-fieldname="QtyReceived_11">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtyReceived_11_label}
                                      {END QtyReceived_11_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtyReceived_11_fieldblock}
                                {BEGIN Qty_Dispensed_11_fieldblock}
                                  <TR style="height: 498px;" class="{$fielddispclass_Qty_Dispensed_11}" data-fieldname="Qty_Dispensed_11">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Qty_Dispensed_11_label}
                                      {END Qty_Dispensed_11_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Qty_Dispensed_11_fieldblock}
                                {BEGIN QtySOH_11_fieldblock}
                                  <TR class="{$fielddispclass_QtySOH_11}" data-fieldname="QtySOH_11">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtySOH_11_label}
                                      {END QtySOH_11_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtySOH_11_fieldblock}
                                {BEGIN Remark_11_fieldblock}
                                  <TR class="{$fielddispclass_Remark_11}" data-fieldname="Remark_11">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Remark_11_label}
                                      {END Remark_11_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Remark_11_fieldblock}
                                {BEGIN Drug_12_fieldblock}
                                  <TR class="{$fielddispclass_Drug_12}" data-fieldname="Drug_12">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Drug_12_label}
                                      {END Drug_12_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Drug_12_fieldblock}
                                {BEGIN QtyReceived_12_fieldblock}
                                  <TR class="{$fielddispclass_QtyReceived_12}" data-fieldname="QtyReceived_12">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtyReceived_12_label}
                                      {END QtyReceived_12_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END QtyReceived_12_fieldblock}
                                {BEGIN Qty_Dispensed_12_fieldblock}
                                  <TR class="{$fielddispclass_Qty_Dispensed_12}" data-fieldname="Qty_Dispensed_12">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Qty_Dispensed_12_label}
                                      {END Qty_Dispensed_12_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Qty_Dispensed_12_fieldblock}
                                {BEGIN QtySOH_12_fieldblock}
                                  <TR class="{$fielddispclass_QtySOH_12}" data-fieldname="QtySOH_12">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN QtySOH_12_label}
                                      {END Remark_15_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Remark_15_fieldblock}
                              </TBODY>
                            </TABLE>
                          </DIV>
                          {BEGIN editbuttons}
                            <DIV class="rnr-brickcontents style2 rnr-b-editbuttons {$brickclass_editbuttons}">
                              <DIV class="rnr-buttons-right">
                                {BEGIN prev_button}
                                  <A class="rnr-button {$prevbutton_class}" href="#" {$prevbutton_attrs}>
                                    <<<
                                  </A>
                                {END prev_button}
                                {BEGIN next_button}
                                  <A class="rnr-button  {$nextbutton_class}" href="#" {$nextbutton_attrs}>
                                    >>>
                                  </A>
                                {END next_button}
                              </DIV>
                              <DIV class="rnr-buttons-left">
                                {BEGIN save_button}
                                  <A class="rnr-button main" href="#" {$savebutton_attrs}>
                                    Save
                                  </A>
                                {END save_button}
                                {BEGIN reset_button}
                                  <A class="rnr-button" href="#" {$resetbutton_attrs}>
                                    Reset
                                  </A>
                                {END reset_button}
                                {BEGIN back_button}
                                  <A class="rnr-button" href="#" {$backbutton_attrs}>
                                    Back to list
                                  </A>
                                {END back_button}
                                {BEGIN close_button}
                                  <A class="rnr-button" href="#" {$closebutton_attrs}>
                                    Close window
                                  </A>
                                {END close_button}
                                {BEGIN view_page_button}
                                  <A class="rnr-button" href="#" {$view_page_button_attrs}>
                                    View
                                  </A>
                                {END view_page_button}
                              </DIV>
                            </DIV>
                          {END editbuttons}
                        </DIV>
                      {END container_fields}
                    </DIV>
                  </DIV>
                {END container_edit}
              </DIV>
            </DIV>
          {END container_all}
        </DIV>
        <DIV class="rnr-middle">
          <DIV class="rnr-left {$blockclass_left}">
          </DIV>
          <DIV class="rnr-center {$blockclass_center}">
          </DIV>
          <DIV class="rnr-right {$blockclass_right}">
          </DIV>
        </DIV>
        <DIV class="rnr-bottom {$blockclass_bottom}">
          <!--%%bottom%%-->
        </DIV>
      </DIV>
      {$footer}
    {END body}
  </BODY>
</HTML>

PARAMS:
{"action":"s","lyName":"edit2","lySource":"@version=2\r\nbeginblock top \r\n\tbegincontainer vertical style=empty align=center width=500 all\r\n\t\tbegincontainer vertical style=1 align=center width=500 edit\r\n\t\t\tbrick color2 editheader\r\n\t\t\tbrick color1 message\r\n\t\t\tbegincontainer vertical color=1 style=fields fields\r\n\t\t\t\tbrick editfields\r\n\t\t\t\tbrick color2 editbuttons\r\n\t\t\tendcontainer \r\n\t\tendcontainer \r\n\t\tbegincontainer vertical style=empty width=100% details\r\n\t\t\tbrick editdetails\r\n\t\tendcontainer\r\n\tendcontainer\r\nendblock\r\n"}


ACTIONTIME: 2015-02-12 15:28:49
SOURCE:
<!DOCTYPE html>
<HTML {$html_attrs}><HEAD>
<META content="IE=Edge" http-equiv="X-UA-Compatible"><TITLE>< DIV 
contentEditable=false id class='simple-xt-tag' style='background-image: ; 
display: inline-block;' ruleindex="182">pagetitle</DIV></TITLE>
<META content="text/html; charset=utf-8" http-equiv="Content-Type">
<LINK rel="stylesheet" type="text/css" href="styles/default.css">{BEGIN rtlCSS}<LINK rel="stylesheet" type="text/css" href="styles/defaultRTL.css">{END rtlCSS}{BEGIN styleCSSFiles}<LINK rel="stylesheet" type="text/css" href="{$stylepath}">{END styleCSSFiles}{BEGIN pageCSSFiles}<LINK rel="stylesheet" type="text/css" href="{$pagestylepath}">{END pageCSSFiles}
<META name="GENERATOR" content="MSHTML 9.00.8112.16599"></HEAD>
<BODY class="{$stylename} function-edit" {$bodyattrs}>{BEGIN body}
{$header}
<DIV class="rnr-page">
<DIV class="rnr-top {$blockclass_top}">
{BEGIN container_all}
<DIV class="rnr-c rnr-cv rnr-c-all">
<DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_edit} rnr-wrapper rnr-cbw-edit">
{BEGIN container_edit}
<DIV class="rnr-c rnr-cv rnr-c-edit">
{BEGIN editheader}<DIV class="rnr-brickcontents style2 rnr-b-editheader {$brickclass_editheader}"><SPAN>
<H1>
{$pagetitlelabel arv_pmtct edit}</H1>
</SPAN></DIV>
{END editheader}{BEGIN message_block}<DIV class="rnr-brickcontents style1 rnr-b-message {$brickclass_message}">
<DIV class="rnr-message">
{$message}</DIV></DIV>
{END message_block}<DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_fields} rnr-wrapper rnr-cbw-fields">
{BEGIN container_fields}
<DIV style="min-height: 3083px; min-width: 1327px;" class="rnr-c rnr-cv rnr-c-fields">
<DIV class="rnr-brickcontents style1 rnr-b-editfields {$brickclass_editfields}">
<TABLE style="width: auto;" class="fieldGrid">
  <TBODY>
  {BEGIN formid_fieldblock}<TR class="{$fielddispclass_formid}" data-fieldname="formid">
    <TD style="width: 100px;" class="rnr-label">{BEGIN formid_label}{END formid_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"></TD></TR>
  {END formid_fieldblock}{BEGIN SiteName_fieldblock}<TR class="{$fielddispclass_SiteName}" data-fieldname="SiteName">
    <TD style="width: auto;" class="rnr-label">
      {BEGIN SiteName_label}<TABLE style="width: 815px; height: 123px;" border="1" cellSpacing="1" cellPadding="1" width="708">
        <TBODY>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> SiteName</TD>
          <TD style="width: 227px;" rowSpan="1" colSpan="1">
            {$SiteName_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"></TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1"></TD>
          <TD style="width: 126px;" rowSpan="5" colSpan="1"><IMG style="width: 124px; height: 84px;" border="0" alt="coat of arms" src="images/coat.jpg" width="242" height="207"> &nbsp;&nbsp;&nbsp;</TD></TR>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> Facility Code</TD>
          <TD style="width: 227px;" rowSpan="1" colSpan="1">
            {$formid_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> Funding Source</TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1">
            {$Funding_Source_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> State</TD>
          <TD style="width: 227px;" rowSpan="1" colSpan="1">
            {$State_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> Service Type</TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1">
            {$Service_Type_editcontrol}
          </TD></TR>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"> Phase</TD>
          <TD style="width: 227px;" rowSpan="1" colSpan="1">
            {$Phase_editcontrol}</TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"> IPName</TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1">
            {$IPName_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 122px;" rowSpan="1" colSpan="1"></TD>
          <TD style="width: 227px;" rowSpan="1" colSpan="1"></TD>
          <TD style="width: 112px;" rowSpan="1" colSpan="1"></TD>
          <TD style="width: 231px;" rowSpan="1" colSpan="1"></TD></TR></TBODY>
      </TABLE>{END SiteName_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END SiteName_fieldblock}{BEGIN State_fieldblock}<TR class="{$fielddispclass_State}" data-fieldname="State">
    <TD style="width: auto;" class="rnr-label">
      {BEGIN State_label}<TABLE style="width: 1136px; height: 619px;" border="1" cellSpacing="1" cellPadding="1" width="985">
        <TBODY>
        <TR style="height: 42px;">
          <TD style="width: 33px;" rowSpan="1" colSpan="1"> &nbsp;S/No</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1"> &nbsp;Drugs</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1"> &nbsp;Basic Unit
          </TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">
            <P> &nbsp;Quantity Received During</P>
            <P> the Repoting Period</P></TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1"> &nbsp;Quantity 
            Received During the Repoting Period</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">
            <P> &nbsp;Endig Balance</P>
            <P> (Physical Count)</P></TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1"> &nbsp;Remarks</TD>
        </TR>
        <TR>
          <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" colSpan="7"></TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1"> &nbsp;1</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Drug_1_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1"> &nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtyReceived_1_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Qty_Dispensed_1_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtySOH_1_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Remark_1_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1"> &nbsp;2</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Drug_2_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1"> &nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtyReceived_2_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Qty_Dispensed_2_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtySOH_2_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Remark_2_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" colSpan="7"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
          </TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1"> &nbsp;3</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Drug_3_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1"> &nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtyReceived_3_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Qty_Dispensed_3_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtySOH_3_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Remark_3_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1"> &nbsp;4</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Drug_4_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1"> &nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtyReceived_4_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Qty_Dispensed_4_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtySOH_4_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Remark_4_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1"> &nbsp;5</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Drug_5_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1"> &nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtyReceived_5_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Qty_Dispensed_5_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtySOH_5_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Remark_5_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" colSpan="7"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
          </TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1"> &nbsp;6</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Drug_6_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1"> &nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtyReceived_6_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Qty_Dispensed_6_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtySOH_6_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Remark_6_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1"> &nbsp;7</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Drug_7_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1"> &nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtyReceived_7_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Qty_Dispensed_7_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtySOH_7_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Remark_7_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1"> &nbsp;8</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Drug_8_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1"> &nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtyReceived_8_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Qty_Dispensed_8_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtySOH_8_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Remark_8_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" colSpan="7"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
          </TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1"> &nbsp;9</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Drug_9_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1"> &nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtyReceived_9_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Qty_Dispensed_9_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtySOH_9_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Remark_9_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1"> &nbsp;10</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Drug_10_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1"> &nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtyReceived_10_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Qty_Dispensed_10_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtySOH_10_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Remark_10_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1"> &nbsp;11</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Drug_11_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1"> &nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtyReceived_11_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Qty_Dispensed_11_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtySOH_11_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Remark_11_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1"> &nbsp;12</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Drug_12_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1"> &nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtyReceived_12_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Qty_Dispensed_12_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtySOH_12_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Remark_12_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" colSpan="7"> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
          </TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1"> &nbsp;13</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Drug_13_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1"> &nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtyReceived_13_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Qty_Dispensed_14_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtySOH_13_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Remark_13_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1"> &nbsp;14</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Drug_14_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1"> &nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtyReceived_14_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Qty_Dispensed_14_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtySOH_14_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Remark_14_editcontrol}</TD></TR>
        <TR>
          <TD style="width: 33px;" rowSpan="1" colSpan="1"> &nbsp;15</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Drug_15_editcontrol}</TD>
          <TD style="width: 40px;" rowSpan="1" colSpan="1"> &nbsp;</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtyReceived_15_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Qty_Dispensed_15_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$QtySOH_15_editcontrol}</TD>
          <TD style="width: 213px;" rowSpan="1" colSpan="1">                   
                &nbsp;
            {$Remark_15_editcontrol}</TD></TR>
        </TBODY></TABLE>{END State_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END State_fieldblock}{BEGIN Funding_Source_fieldblock}<TR class="{$fielddispclass_Funding_Source}" data-fieldname="Funding_Source">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Funding_Source_label}{END Funding_Source_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Funding_Source_fieldblock}{BEGIN Service_Type_fieldblock}<TR style="height: 608px;" class="{$fielddispclass_Service_Type}" data-fieldname="Service_Type">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Service_Type_label}{END Service_Type_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Service_Type_fieldblock}{BEGIN Phase_fieldblock}<TR class="{$fielddispclass_Phase}" data-fieldname="Phase">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Phase_label}{END Phase_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Phase_fieldblock}{BEGIN IPName_fieldblock}<TR class="{$fielddispclass_IPName}" data-fieldname="IPName">
    <TD style="width: 100px;" class="rnr-label">{BEGIN IPName_label}{END IPName_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END IPName_fieldblock}{BEGIN Drug_1_fieldblock}<TR class="{$fielddispclass_Drug_1}" data-fieldname="Drug_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_1_label}{END Drug_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Drug_1_fieldblock}{BEGIN QtyReceived_1_fieldblock}<TR class="{$fielddispclass_QtyReceived_1}" data-fieldname="QtyReceived_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_1_label}{END QtyReceived_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtyReceived_1_fieldblock}{BEGIN Qty_Dispensed_1_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_1}" data-fieldname="Qty_Dispensed_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_1_label}{END Qty_Dispensed_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Qty_Dispensed_1_fieldblock}{BEGIN QtySOH_1_fieldblock}<TR class="{$fielddispclass_QtySOH_1}" data-fieldname="QtySOH_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_1_label}{END QtySOH_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtySOH_1_fieldblock}{BEGIN Remark_1_fieldblock}<TR class="{$fielddispclass_Remark_1}" data-fieldname="Remark_1">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_1_label}{END Remark_1_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Remark_1_fieldblock}{BEGIN Drug_2_fieldblock}<TR class="{$fielddispclass_Drug_2}" data-fieldname="Drug_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_2_label}{END Drug_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Drug_2_fieldblock}{BEGIN QtyReceived_2_fieldblock}<TR class="{$fielddispclass_QtyReceived_2}" data-fieldname="QtyReceived_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_2_label}{END QtyReceived_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtyReceived_2_fieldblock}{BEGIN Qty_Dispensed_2_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_2}" data-fieldname="Qty_Dispensed_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_2_label}{END Qty_Dispensed_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Qty_Dispensed_2_fieldblock}{BEGIN QtySOH_2_fieldblock}<TR class="{$fielddispclass_QtySOH_2}" data-fieldname="QtySOH_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_2_label}{END QtySOH_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtySOH_2_fieldblock}{BEGIN Remark_2_fieldblock}<TR class="{$fielddispclass_Remark_2}" data-fieldname="Remark_2">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_2_label}{END Remark_2_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Remark_2_fieldblock}{BEGIN Drug_3_fieldblock}<TR class="{$fielddispclass_Drug_3}" data-fieldname="Drug_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_3_label}{END Drug_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Drug_3_fieldblock}{BEGIN QtyReceived_3_fieldblock}<TR class="{$fielddispclass_QtyReceived_3}" data-fieldname="QtyReceived_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_3_label}{END QtyReceived_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtyReceived_3_fieldblock}{BEGIN Qty_Dispensed_3_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_3}" data-fieldname="Qty_Dispensed_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_3_label}{END Qty_Dispensed_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Qty_Dispensed_3_fieldblock}{BEGIN QtySOH_3_fieldblock}<TR class="{$fielddispclass_QtySOH_3}" data-fieldname="QtySOH_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_3_label}{END QtySOH_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtySOH_3_fieldblock}{BEGIN Remark_3_fieldblock}<TR class="{$fielddispclass_Remark_3}" data-fieldname="Remark_3">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_3_label}{END Remark_3_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Remark_3_fieldblock}{BEGIN Drug_4_fieldblock}<TR class="{$fielddispclass_Drug_4}" data-fieldname="Drug_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_4_label}{END Drug_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Drug_4_fieldblock}{BEGIN QtyReceived_4_fieldblock}<TR class="{$fielddispclass_QtyReceived_4}" data-fieldname="QtyReceived_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_4_label}{END QtyReceived_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtyReceived_4_fieldblock}{BEGIN Qty_Dispensed_4_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_4}" data-fieldname="Qty_Dispensed_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_4_label}{END Qty_Dispensed_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Qty_Dispensed_4_fieldblock}{BEGIN QtySOH_4_fieldblock}<TR class="{$fielddispclass_QtySOH_4}" data-fieldname="QtySOH_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_4_label}{END QtySOH_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtySOH_4_fieldblock}{BEGIN Remark_4_fieldblock}<TR class="{$fielddispclass_Remark_4}" data-fieldname="Remark_4">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_4_label}{END Remark_4_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Remark_4_fieldblock}{BEGIN Drug_5_fieldblock}<TR class="{$fielddispclass_Drug_5}" data-fieldname="Drug_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_5_label}{END Drug_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Drug_5_fieldblock}{BEGIN QtyReceived_5_fieldblock}<TR class="{$fielddispclass_QtyReceived_5}" data-fieldname="QtyReceived_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_5_label}{END QtyReceived_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtyReceived_5_fieldblock}{BEGIN Qty_Dispensed_5_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_5}" data-fieldname="Qty_Dispensed_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_5_label}{END Qty_Dispensed_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Qty_Dispensed_5_fieldblock}{BEGIN QtySOH_5_fieldblock}<TR class="{$fielddispclass_QtySOH_5}" data-fieldname="QtySOH_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_5_label}{END QtySOH_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtySOH_5_fieldblock}{BEGIN Remark_5_fieldblock}<TR class="{$fielddispclass_Remark_5}" data-fieldname="Remark_5">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_5_label}{END Remark_5_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Remark_5_fieldblock}{BEGIN Drug_6_fieldblock}<TR class="{$fielddispclass_Drug_6}" data-fieldname="Drug_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_6_label}{END Drug_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Drug_6_fieldblock}{BEGIN QtyReceived_6_fieldblock}<TR class="{$fielddispclass_QtyReceived_6}" data-fieldname="QtyReceived_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_6_label}{END QtyReceived_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtyReceived_6_fieldblock}{BEGIN Qty_Dispensed_6_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_6}" data-fieldname="Qty_Dispensed_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_6_label}{END Qty_Dispensed_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Qty_Dispensed_6_fieldblock}{BEGIN QtySOH_6_fieldblock}<TR class="{$fielddispclass_QtySOH_6}" data-fieldname="QtySOH_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_6_label}{END QtySOH_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtySOH_6_fieldblock}{BEGIN Remark_6_fieldblock}<TR class="{$fielddispclass_Remark_6}" data-fieldname="Remark_6">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_6_label}{END Remark_6_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Remark_6_fieldblock}{BEGIN Drug_7_fieldblock}<TR class="{$fielddispclass_Drug_7}" data-fieldname="Drug_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_7_label}{END Drug_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Drug_7_fieldblock}{BEGIN QtyReceived_7_fieldblock}<TR class="{$fielddispclass_QtyReceived_7}" data-fieldname="QtyReceived_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_7_label}{END QtyReceived_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtyReceived_7_fieldblock}{BEGIN Qty_Dispensed_7_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_7}" data-fieldname="Qty_Dispensed_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_7_label}{END Qty_Dispensed_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Qty_Dispensed_7_fieldblock}{BEGIN QtySOH_7_fieldblock}<TR class="{$fielddispclass_QtySOH_7}" data-fieldname="QtySOH_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_7_label}{END QtySOH_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtySOH_7_fieldblock}{BEGIN Remark_7_fieldblock}<TR class="{$fielddispclass_Remark_7}" data-fieldname="Remark_7">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_7_label}{END Remark_7_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Remark_7_fieldblock}{BEGIN Drug_8_fieldblock}<TR class="{$fielddispclass_Drug_8}" data-fieldname="Drug_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_8_label}{END Drug_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Drug_8_fieldblock}{BEGIN QtyReceived_8_fieldblock}<TR class="{$fielddispclass_QtyReceived_8}" data-fieldname="QtyReceived_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_8_label}{END QtyReceived_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtyReceived_8_fieldblock}{BEGIN Qty_Dispensed_8_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_8}" data-fieldname="Qty_Dispensed_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_8_label}{END Qty_Dispensed_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Qty_Dispensed_8_fieldblock}{BEGIN QtySOH_8_fieldblock}<TR class="{$fielddispclass_QtySOH_8}" data-fieldname="QtySOH_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_8_label}{END QtySOH_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtySOH_8_fieldblock}{BEGIN Remark_8_fieldblock}<TR class="{$fielddispclass_Remark_8}" data-fieldname="Remark_8">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_8_label}{END Remark_8_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Remark_8_fieldblock}{BEGIN Drug_9_fieldblock}<TR class="{$fielddispclass_Drug_9}" data-fieldname="Drug_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_9_label}{END Drug_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Drug_9_fieldblock}{BEGIN QtyReceived_9_fieldblock}<TR class="{$fielddispclass_QtyReceived_9}" data-fieldname="QtyReceived_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_9_label}{END QtyReceived_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtyReceived_9_fieldblock}{BEGIN Qty_Dispensed_9_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_9}" data-fieldname="Qty_Dispensed_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_9_label}{END Qty_Dispensed_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Qty_Dispensed_9_fieldblock}{BEGIN QtySOH_9_fieldblock}<TR class="{$fielddispclass_QtySOH_9}" data-fieldname="QtySOH_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_9_label}{END QtySOH_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtySOH_9_fieldblock}{BEGIN Remark_9_fieldblock}<TR class="{$fielddispclass_Remark_9}" data-fieldname="Remark_9">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_9_label}{END Remark_9_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Remark_9_fieldblock}{BEGIN Drug_10_fieldblock}<TR class="{$fielddispclass_Drug_10}" data-fieldname="Drug_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_10_label}{END Drug_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Drug_10_fieldblock}{BEGIN QtyReceived_10_fieldblock}<TR class="{$fielddispclass_QtyReceived_10}" data-fieldname="QtyReceived_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_10_label}{END QtyReceived_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtyReceived_10_fieldblock}{BEGIN Qty_Dispensed_10_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_10}" data-fieldname="Qty_Dispensed_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_10_label}{END Qty_Dispensed_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Qty_Dispensed_10_fieldblock}{BEGIN QtySOH_10_fieldblock}<TR class="{$fielddispclass_QtySOH_10}" data-fieldname="QtySOH_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_10_label}{END QtySOH_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtySOH_10_fieldblock}{BEGIN Remark_10_fieldblock}<TR class="{$fielddispclass_Remark_10}" data-fieldname="Remark_10">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_10_label}{END Remark_10_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Remark_10_fieldblock}{BEGIN Drug_11_fieldblock}<TR class="{$fielddispclass_Drug_11}" data-fieldname="Drug_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_11_label}{END Drug_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Drug_11_fieldblock}{BEGIN QtyReceived_11_fieldblock}<TR class="{$fielddispclass_QtyReceived_11}" data-fieldname="QtyReceived_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_11_label}{END QtyReceived_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtyReceived_11_fieldblock}{BEGIN Qty_Dispensed_11_fieldblock}<TR style="height: 498px;" class="{$fielddispclass_Qty_Dispensed_11}" data-fieldname="Qty_Dispensed_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_11_label}{END Qty_Dispensed_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Qty_Dispensed_11_fieldblock}{BEGIN QtySOH_11_fieldblock}<TR class="{$fielddispclass_QtySOH_11}" data-fieldname="QtySOH_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtySOH_11_label}{END QtySOH_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtySOH_11_fieldblock}{BEGIN Remark_11_fieldblock}<TR class="{$fielddispclass_Remark_11}" data-fieldname="Remark_11">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Remark_11_label}{END Remark_11_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Remark_11_fieldblock}{BEGIN Drug_12_fieldblock}<TR class="{$fielddispclass_Drug_12}" data-fieldname="Drug_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Drug_12_label}{END Drug_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Drug_12_fieldblock}{BEGIN QtyReceived_12_fieldblock}<TR class="{$fielddispclass_QtyReceived_12}" data-fieldname="QtyReceived_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN QtyReceived_12_label}{END QtyReceived_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END QtyReceived_12_fieldblock}{BEGIN Qty_Dispensed_12_fieldblock}<TR class="{$fielddispclass_Qty_Dispensed_12}" data-fieldname="Qty_Dispensed_12">
    <TD style="width: 100px;" class="rnr-label">{BEGIN Qty_Dispensed_12_label}{END Qty_Dispensed_12_label}</TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR>
  {END Qty_Dispensed_12_fieldblock}<TR class="{$fielddispclass_QtySOH_12}" data-fieldname="QtySOH_12">
    <TD style="width: 100px;" class="rnr-label"></TD>
    <TD style="width: 427px;" class="rnr-control style3"> &nbsp;</TD></TR></TBODY>
</TABLE></DIV>
{BEGIN editbuttons}<DIV class="rnr-brickcontents style2 rnr-b-editbuttons {$brickclass_editbuttons}">
<DIV class="rnr-buttons-right">{BEGIN prev_button}<A class="rnr-button {$prevbutton_class}" href="#" {$prevbutton_attrs}>
&lt;&lt;&lt;</A>{END prev_button}{BEGIN next_button}<A class="rnr-button  {$nextbutton_class}" href="#" {$nextbutton_attrs}> &gt;&gt;&gt;
</A>{END next_button}</DIV>
<DIV class="rnr-buttons-left">{BEGIN save_button}<A class="rnr-button main" href="#" {$savebutton_attrs}> Save</A>{END save_button}{BEGIN reset_button}<A class="rnr-button" href="#" {$resetbutton_attrs}> 
Reset</A>{END reset_button}{BEGIN back_button}<A class="rnr-button" href="#" {$backbutton_attrs}> Back to list</A>{END back_button}{BEGIN close_button}<A class="rnr-button" href="#" {$closebutton_attrs}> 
Close window</A>{END close_button}{BEGIN view_page_button}<A class="rnr-button" href="#" {$view_page_button_attrs}> View</A>{END view_page_button}</DIV></DIV>{END editbuttons}</DIV>{END container_fields}</DIV>
</DIV>{END container_edit}</DIV></DIV>{END container_all}</DIV>
<DIV class="rnr-middle">
<DIV class="rnr-left {$blockclass_left}"></DIV>
<DIV class="rnr-center {$blockclass_center}"></DIV>
<DIV class="rnr-right {$blockclass_right}"></DIV></DIV>
<DIV class="rnr-bottom {$blockclass_bottom}"><!--%%bottom%%--></DIV></DIV>
{$footer}{END body}</BODY></HTML>


ACTIONTIME: 2015-02-12 15:29:50
SOURCE:
<!DOCTYPE html>
<HTML {$html_attrs}>
  <HEAD>
    <META content="IE=Edge" http-equiv="X-UA-Compatible">
    <TITLE>
      < DIV contentEditable=false id class='simple-xt-tag' style='background-image: ; display: inline-block;' ruleindex="182">pagetitle</DIV>
    </TITLE>
    <META content="text/html; charset=utf-8" http-equiv="Content-Type">
    <LINK rel="stylesheet" type="text/css" href="styles/default.css">
    {BEGIN rtlCSS}
      <LINK rel="stylesheet" type="text/css" href="styles/defaultRTL.css">
    {END rtlCSS}
    {BEGIN styleCSSFiles}
      <LINK rel="stylesheet" type="text/css" href="{$stylepath}">
    {END styleCSSFiles}
    {BEGIN pageCSSFiles}
      <LINK rel="stylesheet" type="text/css" href="{$pagestylepath}">
    {END pageCSSFiles}
    <META name="GENERATOR" content="MSHTML 9.00.8112.16599">
  </HEAD>
  <BODY class="{$stylename} function-edit" {$bodyattrs}>
    {BEGIN body}
      {$header}
      <DIV class="rnr-page">
        <DIV class="rnr-top {$blockclass_top}">
          {BEGIN container_all}
            <DIV class="rnr-c rnr-cv rnr-c-all">
              <DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_edit} rnr-wrapper rnr-cbw-edit">
                {BEGIN container_edit}
                  <DIV class="rnr-c rnr-cv rnr-c-edit">
                    {BEGIN editheader}
                      <DIV class="rnr-brickcontents style2 rnr-b-editheader {$brickclass_editheader}">
                        <SPAN>
                          <H1>
                            {$pagetitlelabel arv_pmtct edit}
                          </H1>
                        </SPAN>
                      </DIV>
                    {END editheader}
                    {BEGIN message_block}
                      <DIV class="rnr-brickcontents style1 rnr-b-message {$brickclass_message}">
                        <DIV class="rnr-message">
                          {$message}
                        </DIV>
                      </DIV>
                    {END message_block}
                    <DIV class="rnr-brickcontents style1 rnr-b-wrapper {$wrapperclass_fields} rnr-wrapper rnr-cbw-fields">
                      {BEGIN container_fields}
                        <DIV style="min-height: 3083px; min-width: 1327px;" class="rnr-c rnr-cv rnr-c-fields">
                          <DIV class="rnr-brickcontents style1 rnr-b-editfields {$brickclass_editfields}">
                            <TABLE style="width: auto;" class="fieldGrid">
                              <TBODY>
                                {BEGIN formid_fieldblock}
                                  <TR class="{$fielddispclass_formid}" data-fieldname="formid">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN formid_label}
                                      {END formid_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                    </TD>
                                  </TR>
                                {END formid_fieldblock}
                                {BEGIN SiteName_fieldblock}
                                  <TR class="{$fielddispclass_SiteName}" data-fieldname="SiteName">
                                    <TD style="width: auto;" class="rnr-label">
                                      {BEGIN SiteName_label}
                                        <TABLE style="width: 815px; height: 123px;" border="1" cellSpacing="1" cellPadding="1" width="708">
                                          <TBODY>
                                            <TR>
                                              <TD style="width: 122px;" rowSpan="1" colSpan="1">
                                                SiteName
                                              </TD>
                                              <TD style="width: 227px;" rowSpan="1" colSpan="1">
                                                {$SiteName_editcontrol}
                                              </TD>
                                              <TD style="width: 112px;" rowSpan="1" colSpan="1">
                                              </TD>
                                              <TD style="width: 231px;" rowSpan="1" colSpan="1">
                                              </TD>
                                              <TD style="width: 126px;" rowSpan="5" colSpan="1">
                                                <IMG style="width: 124px; height: 84px;" border="0" alt="coat of arms" src="images/coat.jpg" width="242" height="207">
                                                &nbsp;&nbsp;&nbsp;
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 122px;" rowSpan="1" colSpan="1">
                                                Facility Code
                                              </TD>
                                              <TD style="width: 227px;" rowSpan="1" colSpan="1">
                                                {$formid_editcontrol}
                                              </TD>
                                              <TD style="width: 112px;" rowSpan="1" colSpan="1">
                                                Funding Source
                                              </TD>
                                              <TD style="width: 231px;" rowSpan="1" colSpan="1">
                                                {$Funding_Source_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 122px;" rowSpan="1" colSpan="1">
                                                State
                                              </TD>
                                              <TD style="width: 227px;" rowSpan="1" colSpan="1">
                                                {$State_editcontrol}
                                              </TD>
                                              <TD style="width: 112px;" rowSpan="1" colSpan="1">
                                                Service Type
                                              </TD>
                                              <TD style="width: 231px;" rowSpan="1" colSpan="1">
                                                {$Service_Type_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 122px;" rowSpan="1" colSpan="1">
                                                Phase
                                              </TD>
                                              <TD style="width: 227px;" rowSpan="1" colSpan="1">
                                                {$Phase_editcontrol}
                                              </TD>
                                              <TD style="width: 112px;" rowSpan="1" colSpan="1">
                                                IPName
                                              </TD>
                                              <TD style="width: 231px;" rowSpan="1" colSpan="1">
                                                {$IPName_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 122px;" rowSpan="1" colSpan="1">
                                              </TD>
                                              <TD style="width: 227px;" rowSpan="1" colSpan="1">
                                              </TD>
                                              <TD style="width: 112px;" rowSpan="1" colSpan="1">
                                              </TD>
                                              <TD style="width: 231px;" rowSpan="1" colSpan="1">
                                              </TD>
                                            </TR>
                                          </TBODY>
                                        </TABLE>
                                      {END SiteName_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END SiteName_fieldblock}
                                {BEGIN State_fieldblock}
                                  <TR class="{$fielddispclass_State}" data-fieldname="State">
                                    <TD style="width: auto;" class="rnr-label">
                                      {BEGIN State_label}
                                        <TABLE style="width: 1136px; height: 619px;" border="1" cellSpacing="1" cellPadding="1" width="985">
                                          <TBODY>
                                            <TR style="height: 42px;">
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;S/No
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;Drugs
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;Basic Unit
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                <P>
                                                  &nbsp;Quantity Received During
                                                </P>
                                                <P>
                                                  the Repoting Period
                                                </P>
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;Quantity Received During the Repoting Period
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                <P>
                                                  &nbsp;Endig Balance
                                                </P>
                                                <P>
                                                  (Physical Count)
                                                </P>
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;Remarks
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" colSpan="7">
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;1
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_1_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_1_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_1_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_1_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_1_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;2
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_2_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_2_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_2_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_2_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_2_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" colSpan="7">
                                                &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;3
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_3_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_3_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_3_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_3_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_3_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;4
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_4_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_4_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_4_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_4_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_4_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;5
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_5_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_5_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_5_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_5_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_5_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" colSpan="7">
                                                &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;6
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_6_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_6_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_6_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_6_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_6_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;7
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_7_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_7_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_7_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_7_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_7_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;8
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_8_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_8_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_8_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_8_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_8_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" colSpan="7">
                                                &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;9
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_9_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_9_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_9_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_9_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_9_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;10
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_10_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_10_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_10_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_10_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_10_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;11
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_11_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_11_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_11_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_11_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_11_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;12
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_12_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_12_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_12_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_12_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_12_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 1140px; white-space: normal; background-image: none; background-color: rgb(0, 0, 139);" 
          rowSpan="1" colSpan="7">
                                                &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;13
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_13_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_13_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_14_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_13_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_13_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;14
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_14_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_14_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_14_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_14_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_14_editcontrol}
                                              </TD>
                                            </TR>
                                            <TR>
                                              <TD style="width: 33px;" rowSpan="1" colSpan="1">
                                                &nbsp;15
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Drug_15_editcontrol}
                                              </TD>
                                              <TD style="width: 40px;" rowSpan="1" colSpan="1">
                                                &nbsp;
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtyReceived_15_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Qty_Dispensed_15_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$QtySOH_15_editcontrol}
                                              </TD>
                                              <TD style="width: 213px;" rowSpan="1" colSpan="1">
                                                &nbsp;{$Remark_15_editcontrol}
                                              </TD>
                                            </TR>
                                          </TBODY>
                                        </TABLE>
                                      {END State_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END State_fieldblock}
                                {BEGIN Funding_Source_fieldblock}
                                  <TR class="{$fielddispclass_Funding_Source}" data-fieldname="Funding_Source">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Funding_Source_label}
                                      {END Funding_Source_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Funding_Source_fieldblock}
                                {BEGIN Service_Type_fieldblock}
                                  <TR style="height: 608px;" class="{$fielddispclass_Service_Type}" data-fieldname="Service_Type">
                                    <TD style="width: 100px;" class="rnr-label">
                                      {BEGIN Service_Type_label}
                                      {END Qty_Dispensed_12_label}
                                    </TD>
                                    <TD style="width: 427px;" class="rnr-control style3">
                                      &nbsp;
                                    </TD>
                                  </TR>
                                {END Qty_Dispensed_12_fieldblock}
                                <TR class="{$fielddispclass_QtySOH_12}" data-fieldname="QtySOH_12">
                                  <TD style="width: 100px;" class="rnr-label">
                                  </TD>
                                  <TD style="width: 427px;" class="rnr-control style3">
                                    &nbsp;
                                  </TD>
                                </TR>
                              </TBODY>
                            </TABLE>
                          </DIV>
                          {BEGIN editbuttons}
                            <DIV class="rnr-brickcontents style2 rnr-b-editbuttons {$brickclass_editbuttons}">
                              <DIV class="rnr-buttons-right">
                                {BEGIN prev_button}
                                  <A class="rnr-button {$prevbutton_class}" href="#" {$prevbutton_attrs}>
                                    <<<
                                  </A>
                                {END prev_button}
                                {BEGIN next_button}
                                  <A class="rnr-button  {$nextbutton_class}" href="#" {$nextbutton_attrs}>
                                    >>>
                                  </A>
                                {END next_button}
                              </DIV>
                              <DIV class="rnr-buttons-left">
                                {BEGIN save_button}
                                  <A class="rnr-button main" href="#" {$savebutton_attrs}>
                                    Save
                                  </A>
                                {END save_button}
                                {BEGIN reset_button}
                                  <A class="rnr-button" href="#" {$resetbutton_attrs}>
                                    Reset
                                  </A>
                                {END reset_button}
                                {BEGIN back_button}
                                  <A class="rnr-button" href="#" {$backbutton_attrs}>
                                    Back to list
                                  </A>
                                {END back_button}
                                {BEGIN close_button}
                                  <A class="rnr-button" href="#" {$closebutton_attrs}>
                                    Close window
                                  </A>
                                {END close_button}
                                {BEGIN view_page_button}
                                  <A class="rnr-button" href="#" {$view_page_button_attrs}>
                                    View
                                  </A>
                                {END view_page_button}
                              </DIV>
                            </DIV>
                          {END editbuttons}
                        </DIV>
                      {END container_fields}
                    </DIV>
                  </DIV>
                {END container_edit}
              </DIV>
            </DIV>
          {END container_all}
        </DIV>
        <DIV class="rnr-middle">
          <DIV class="rnr-left {$blockclass_left}">
          </DIV>
          <DIV class="rnr-center {$blockclass_center}">
          </DIV>
          <DIV class="rnr-right {$blockclass_right}">
          </DIV>
        </DIV>
        <DIV class="rnr-bottom {$blockclass_bottom}">
          <!--%%bottom%%-->
        </DIV>
      </DIV>
      {$footer}
    {END body}
  </BODY>
</HTML>

PARAMS:
{"action":"s","lyName":"edit2","lySource":"@version=2\r\nbeginblock top \r\n\tbegincontainer vertical style=empty align=center width=500 all\r\n\t\tbegincontainer vertical style=1 align=center width=500 edit\r\n\t\t\tbrick color2 editheader\r\n\t\t\tbrick color1 message\r\n\t\t\tbegincontainer vertical color=1 style=fields fields\r\n\t\t\t\tbrick editfields\r\n\t\t\t\tbrick color2 editbuttons\r\n\t\t\tendcontainer \r\n\t\tendcontainer \r\n\t\tbegincontainer vertical style=empty width=100% details\r\n\t\t\tbrick editdetails\r\n\t\tendcontainer\r\n\tendcontainer\r\nendblock\r\n"}


