+<br>
+<p class="issuer">
+ <label>$(l10n issuer)</label>
+ <input type="radio" name="issuer_select" value="list" id="issuer_select_list" checked /><label for="issuer_select_list">$(l10n issuer_from_list)</label><!--
+ --><input type="radio" name="issuer_select" value="other" id="issuer_other"><label for="issuer_other">$(l10n issuer_other)</label>
+ <select class="item" name="issuer">
+ <option value="" disabled="disabled" $([ -z "${mpx[issuer]}" ] && printf 'selected' )>$(l10n issuer)...</option>
+ $(list_prescription_issuers |while read f; do
+ [ "$f" = "$mpx[issuer]" ] \
+ && printf '<option value="%s" selected>%s</option>' "$f" "$f" \
+ || printf '<option value="%s">%s</option>' "$f" "$f"
+ done)
+ </select>
+ <input type="text" name="issuer_other" value="" placeholder="$(l10n issuer)..." />
+</p>