<htmlform>
  <section headerLabel="1. Encounter Details">
    Date: <encounterDate default="today"/> <br/>
    Location: <encounterLocation/> <br/>
    Physician: <encounterProvider role="Provider"/> <br/>
    <br/>
  </section>

  <section headerLabel="2. Demographic Info">
    <span>Nom du patient: <lookup expression="patient.personName"/></span>
    <span>No. Dossier: <lookup complexExpression="#foreach( $patId in $patientIdentifiers.get("PIH ID") ) $\!patId #end"/></span><br/>
    <span>Sexe: <lookup expression="patient.gender" codePrefix="gender_"/></span>
    <span>(a) Date de naissance: <lookup expression="patient.birthdate"/></span>
    <span>(b) Age: <lookup expression="patient.age"/></span>
  </section>

  <section headerLabel="3.  Vital Signs">
    <obs conceptId="5089" labelText="Weight" /> (kg)
    <obs conceptId="5090" labelText="Height" /> (cm)
  </section>
<br/><br/>

<submit/>
</htmlform>