<center>
<form action="{actionurl}" method="POST">
<input type=hidden name=interviewer value={interviewer}>
- <input type=hidden name=elder value={elder}>
- <input type=hidden name=aaronic value={aaronic}>
+ <input type=hidden name=individual value={individual}>
<input type=hidden name=companionship value={companionship}>
- <input type=hidden name=eqpresppi value={eqpresppi}>
+ <input type=hidden name=interview_type value={interview_type}>
<table border="0" width="60%" cellspacing="2" cellpadding="2">
<tr>
<td align="center" bgcolor="#c9c9c9"><font face="{font}"><b>{lang_action}: {name}</b></font></td>
<option value={interviewer}>{interviewer_name}</option>
<!-- END interviewer_list -->
</select>
+ <input type="checkbox" name="eqpresppi" value="1" {eqpresppi_checked} DISABLED {disabled}>
+ Yearly PPI
</tr>
<tr>
<td align="left"><font face="{font}"><b>Date:</b>
</tr>
<tr>
<td align="left"><font face="{font}" size="{font_size}">
- <textarea cols="60" rows="10" name="notes" wrap="virtual" {readonly}>{notes}</textarea></font></td>
+ <textarea cols="100" rows="10" name="notes" wrap="virtual" {readonly}>{notes}</textarea></font></td>
</tr>
</table>