	<!DOCTYPE html>
		<html class="no-js" lang="en" dir="ltr">
			<head>
				<meta charset="utf-8">
				<meta http-equiv="x-ua-compatible" content="ie=edge">
				<meta name="viewport" content="width=device-width, initial-scale=1.0">
				<title>DSRC Letter</title>
			</head>
			<body style="font-family:'Arial'; font-size:15px;">
				<div style="width:766px; height: 1056px; padding:50px; margin: 0 auto; box-shadow:3px 1px 10px 1px;">
					<img src="{{ app.request.getSchemeAndHttpHost() ~ '/bundles/rxconnexion/images/patientLetterLogo.jpg' }}" style="width: 40%;"/>
					<div style="width: 100%; height: auto; text-align:left;margin-top: 70px;">
						{% if patientLetter.patientReferringProvider %}
							{% set receiverFullName = patientLetter.patientReferringProvider.referringProvider.fullName %}
							{% set receiverPhone = patientLetter.patientReferringProvider.referringProvider.phoneNo is null ? patientLetter.patientReferringProvider.referringProvider.phoneNoTwo : patientLetter.patientReferringProvider.referringProvider.phoneNo %}
							{% set receiverFax = patientLetter.patientReferringProvider.referringProvider.faxNo is null ? patientLetter.patientReferringProvider.referringProvider.faxNoTwo : patientLetter.patientReferringProvider.referringProvider.faxNo %}
							<p style="margin:2px">{{ receiverFullName }} </p>
							<p style="margin:2px">Mental Institution</p>
							<p style="margin:2px">{{ patientLetter.patientReferringProvider.referringProvider.address }}</p>
						{% endif %}
						{% if patientLetter.patientReferringHealthFacility %}
							{% set receiverFullName = patientLetter.patientReferringHealthFacility.referringHealthFacility.description %}
							{% set receiverPhone = patientLetter.patientReferringHealthFacility.referringHealthFacility.phoneNo is null ? patientLetter.patientReferringHealthFacility.referringHealthFacility.phoneNoTwo : patientLetter.patientReferringHealthFacility.referringHealthFacility.phoneNo %}
							{% set receiverFax = patientLetter.patientReferringHealthFacility.referringHealthFacility.faxNo is null ? patientLetter.patientReferringHealthFacility.referringHealthFacility.faxNoTwo : patientLetter.patientReferringHealthFacility.referringHealthFacility.faxNo %}
							<p style="margin:2px">{{ receiverFullName }} </p>
							<p style="margin:2px">Mental Institution</p>
							<p style="margin:2px">{{ patientLetter.patientReferringHealthFacility.referringHealthFacility.address }}</p>
						{% endif %}
						{% if patientLetter.patientInsurance %}
							{% set receiverFullName = patientLetter.patientInsurance.insurance.description %}
							{% set receiverPhone = patientLetter.patientInsurance.insurance.phoneNo is null ? patientLetter.patientInsurance.insurance.phoneNoTwo : patientLetter.patientInsurance.insurance.phoneNo %}
							{% set receiverFax = patientLetter.patientInsurance.insurance.faxNo is null ? patientLetter.patientInsurance.insurance.faxNoTwo : patientLetter.patientInsurance.insurance.faxNo %}
							<p style="margin:2px">{{ receiverFullName }} </p>
							<p style="margin:2px">Mental Institution</p>
							{#<p style="margin:2px">{{ patientLetter.patientInsurance.insurance.address }}</p>#}
						{% endif %}
					</div>
					<div style="width: 100%; height: auto; text-align:left;margin-top: 30px;">
						<p style="margin:2px">{{ 'now'|date('F j, Y') }}</p>
					</div>
					<div style="width: 100%; height: auto; text-align:left;margin-top: 30px;">
						{% set patientFullName = patientLetter.patient.fullName %}
						{% set patientFirstName = patientLetter.patient.firstName %}
						{% set patientLastName = patientLetter.patient.lastName %}
						<p style="margin:2px">Patient Name: {{ patientLastName ~','~ patientLastName }}</p>
						<p style="margin:2px">Date of Birth: {{ patientLetter.patient.birthdate|date('F j, Y') }}</p>
						<p style="margin:2px">PHN: 000000</p>
					</div>
					<div style="width: 100%; height: auto; text-align:left;margin-top: 30px;">
						<p style="margin:2px">Dear {{ receiverFullName }},</p>
					</div>
					<div style="width: 100%; height: auto; text-align:left;margin-top: 20px;">
						<p style="margin:2px">Thank you for your referral. We would like to inform you that we weren’t able to book {{ patientFullName }} for the Home Sleep Apnea Test (HSAT) at this time as he is under ALBERTA WORKS. If {{ patientFullName }}’s results come back positive, he would need funding in order to purchase his own CPAP machine. In order for him to be funded by the government, he would require a Level 1 Sleep Study. We have advised {{ patientFullName }} to contact his case worker regarding this matter. </p>
					</div>					
					<div style="width: 100%; height: auto; text-align:left;margin-top: 20px;">
						<p style="margin:2px">In the past, to have the Level 1 PSG performed, you could contact the Sleep Disorders Lab at the Edmonton General Hospital Department 8C, 11111 Jasper Ave at 780-342-8310 or Fax 780-342- 8323 for a Consult Request. </p>
					</div>					
					<div style="width: 100%; height: auto; text-align:left;margin-top: 20px;">
						<p style="margin:2px">While we work towards offering Level 1 PSG Studies, an alternative may be a private sleep facility, such as Advanced Respiratory Care in Sherwood Park, 780-449-1434 or the Northern Alberta Sleep Clinic,780-756-5350.</p>
					</div>
					<div style="width: 100%; height: auto; text-align:left;margin-top: 20px;">
						<p style="margin:2px">Thank you for your continued support.</p>
					</div>
					<div style="width: 100%; height: auto; text-align:left;margin-top: 20px;">
						<p style="margin:2px">Sincerely,</p>
					</div>
					<div style="width: 100%; height: auto; text-align:left;margin-top: 50px;">
						<p style="margin:2px">{{ userData.fullName }}</p>
						<p style="margin:2px">Dynamic Sleep & Respiratory Care</p>
					</div>
				</div>
				<!------ 2ND PAGE --------->
				<div style="width:766px; height: 1056px; padding:50px; margin: 0 auto; margin-top: 20px; box-shadow:3px 1px 10px 1px;">
					<img src="{{ app.request.getSchemeAndHttpHost() ~ '/bundles/rxconnexion/images/patientLetterLogo.jpg' }}" style="width: 40%;"/>
					<div style="width: 100%; height: auto; text-align:left;margin-top: 70px;">
						<h2 style="text-align: center;">Fax Cover Sheet</h2>
						<div style="margin-top:60px; height: 150px; width:100%; padding: 5px;">
							<div style="width: 50%; height: 150px; float: left; box-sizing: border-box; padding: 10px;">
								<p>TO:</p>
								<div style="width: 100%; /**height: 100%**/; border:1px solid #000; box-sizing: border-box; padding:10px;">
									<table>
										<tr>
											<td style="width: 40%;">ATTN</td>
											<td>: {{ receiverFullName }}</td>
										</tr>
										<tr>
											<td style="width: 40%;">RE</td>
											<td>: {{ patientFullName }}</td>
										</tr>
										<tr>
											<td style="width: 40%;">Date</td>
											<td>: {{ 'now'|date('F j, Y') }}</td>
										</tr>
										<tr>
											<td style="width: 40%;">Phone</td>
											<td>: {{ receiverPhone }}</td>
										</tr>
										<tr>
											<td style="width: 40%;">Fax</td>
											<td>: {{ receiverFax }}</td>
										</tr>
									</table>
								</div>
							</div>
							<div style="width: 50%; height: 150px; float: right; box-sizing: border-box; padding: 10px;">
								<p>FROM:</p>
								<div style="width: 100%; height: 100%; border:1px solid #000; box-sizing: border-box; padding:10px;">
									<table>
										<tr>
											<td style="width: 60%;">Name</td>
											<td>: {{ userData.fullName }}</td>
										</tr>
										<tr>
											<td style="width: 60%;">No. of Pages (inc. cover)</td>
											<td>: 2</td>
										</tr>
										<tr>
											<td style="width: 60%;">CC</td>
											<td>: Mr. Tom Smith</td>
										</tr>
									</table>
								</div>
							</div>
						</div>
						<div style="width:100%; height: 70px; margin-top: 80px; box-sizing: border-box; padding:20px; border:1px solid #000;">
							<div style="width: 100%; height: 100%;">
								<input type="checkbox" id="urgent" style="height: 18px; width:18px;"><label style="font-size: 18px; margin-right:40px;"><strong>Urgent</strong></label>
								<input type="checkbox" id="urgent" style="height: 18px; width:18px;"><label style="font-size: 18px; margin-right:40px;"><strong>For Review</strong></label>
								<input type="checkbox" id="urgent" style="height: 18px; width:18px;"><label style="font-size: 18px; margin-right:40px;"><strong>Please Comment</strong></label>
								<input type="checkbox" id="urgent" style="height: 18px; width:18px;"><label style="font-size: 18px; margin-right:40px;"><strong>Please Reply</strong></label>
							</div>
						</div>
						<div style="width: 100%; height: auto; margin-top:25px; border: 1px solid #000; box-sizing: border-box; padding:20px;">
							<p><strong>Notes:</strong></p>
							<p style="margin:0;">Good day {{ receiverFullName }}</p>
							<p>Thank you for your referral.</p>
							<p>Please find attached letter regarding your patient {{ patientFullName }}</p>
							<p>Kind regards,</p>
							<br>
							<p style="margin:0;">{{ userData.fullName }}</p>
							<p style="margin:0;">Dynamic Sleep Respiratory Care</p>
						</div>
						<p style="font-size: 10px;">"This Facsimile transmission contains information which is confidential and/or privileged. This information is intended for use only by the addressee indicated above. If you are not the intended recipient, please be advised that any disclosure, copying, distribution or use of the contents of this information is stricly prohibited, and that any misdirected or improperly received information must be returned to this company immediately. Your cooperation in phoning us of erroneous receipt is requested."</p>
					</div>
				</div>
			</body>
		</html>