{% extends 'modal_base.html' %}
{% load forms %}
{% block icon %}<i class="fa fa-flask"></i>{% endblock %}
{% block modal_body %}
  <form class="form-horizontal">
   {% input  label="Drug" model="editing.drug" lookuplist="antimicrobial_list" %}
   {% input  label="Dose" model="editing.dose"  %}
   {% input  label="Route" model="editing.route"  %}
   {% input  label="Frequency" model="editing.frequency"  %}
   {% datepicker  label="Start Date" model="editing.start_date" %}
   {% datepicker  label="End Date" model="editing.end_date"  %}
  </form>
{% endblock %}
