{% set userData = app.session.get('userData') %}
<form method="POST" id="form-transfer" style="height: 30%;">
    <h5>{{ title }}</h5>
    <div class="large-12 columns">
        <div class="row">
            <div class="large-3 large-text-right columns">
                <label for="referring-provider-name">Referring Physician</label>
            </div>
            <div class="large-9 columns">
                <input type="text" id="referring-provider-name">
                <input type="hidden" id="referring-provider-id">
            </div>
        </div>
    </div>
    <hr>
    <div class="row-max-width-initial">
        <div class="small-12 columns no-padding-right">
            <div class="button-container text-right">
                <a href="javascript:void(0)" class="button just-continue href-transfer-action"
                   data-message="Are you sure you want to transfer encounter to this patient?"
                   style="margin-left: 10px; margin-right: 0;"
                >Save</a>
                <a href="javascript:void(0)" class="button secondary" data-close style="margin-left: 10px; margin-right: 0;">Close</a>
            </div>
        </div>
    </div>
    <script>
        let autoCompleteUrl = '{{ path('referring_provider_autocomplete') }}' ;
        global.autocomplete.bind(autoCompleteUrl, '#referring-provider-name', '#referring-provider-id');
    </script>
</form>