+<input type="hidden" name="prescription" value="${mpx[prescription]}">
+
+<label class=presctype>$(l10n doctor):</label>
+<input type=radio name=presctype id=doctor_selfpaid value=doctor_selfpaid $(check "$mpx[presctype]" doctor_selfpaid)>
+<label for=doctor_selfpaid>$(l10n selfpaid)</label>
+<input type=radio name=presctype id=doctor_private value=doctor_private $(check "$mpx[presctype]" doctor_private)>
+<label for=doctor_private>$(l10n private)</label>
+<input type=radio name=presctype id=doctor_compulsory value=doctor_compulsory $(check "$mpx[presctype]" doctor_compulsory)>
+<label for=doctor_compulsory>$(l10n compulsory)</label>
+<br>
+
+<label class=presctype>$(l10n dentist):</label>
+<input type=radio name=presctype id=dentist_selfpaid value=dentist_selfpaid $(check "$mpx[presctype]" dentist_selfpaid)>
+<label for=dentist_selfpaid>$(l10n selfpaid)</label>
+<input type=radio name=presctype id=dentist_private value=dentist_private $(check "$mpx[presctype]" dentist_private)>
+<label for=dentist_private>$(l10n private)</label>
+<input type=radio name=presctype id=dentist_compulsory value=dentist_compulsory $(check "$mpx[presctype]" dentist_compulsory)>
+<label for=dentist_compulsory>$(l10n compulsory)</label>
+<br>