<label for="addcontrib">$(l10n addcontrib)</label>
<input id="addcontrib" name="addcontrib" value="${mpx[addcontrib]}" placeholder="$(l10n addcontrib)">
-<input type="checkbox" id="contribconfirm" name="contribconfirm" value="true" ${mpx[contribconfirm]:+checked}>
<label for="contribconfirm">$(l10n contribconfirm)</label>
+<input id="contribconfirm" name="contribconfirm" value="${mpx[contribconfirm]}" placeholder="$(l10n contribconfirm)">
+<input type="checkbox" id="contribreceipt" name="contribreceipt" value="true" ${mpx[contribreceipt]:+checked}>
+<label for="contribreceipt">$(l10n contribreceipt)</label>
</fieldset>
+<input type="checkbox" id="prescreviewed" name="prescreviewed" value="true" ${mpx[prescreviewed]:+checked}>
+<label for="prescreviewed">$(l10n prescreviewed)</label>
+
<fieldset class="catalogue">
<h2>$(l10n prescription_by_catalogue)</h2>
<input type="radio" id="prescfirst" name="prescno" value="first" $(check "$mpx[prescno]" first)>
<input type="radio" id="prescfollow2" name="prescno" value="follow2" $(check "$mpx[prescno]" follow2)>
<label for="prescfollow2">$(l10n prescfollow2)</label>
<br>
-<input type="radio" id="presccontinual" name="prescno" value="continual" $(check "$mpx[prescno]" continual)>
-<label for="presccontinual">$(l10n presccontinual)</label>
-<br>
<input type="radio" id="prescother" name="prescno" value="other" $(check "$mpx[prescno]" other)>
<label for="prescother">$(l10n prescother)</label>
+<br>
+<input type="radio" id="presccontinual" name="prescno" value="continual" $(check "$mpx[prescno]" continual)>
+<label for="presccontinual">$(l10n presccontinual)</label>
<br>
<input type="checkbox" id="grouptherapy" name="grouptherapy" value="true" ${mpx[grouptherapy]:+checked}>
<input id="icd10" name="icd10" value="${mpx[icd10]}" placeholder="$(l10n icd10)">
</fieldset>
-<input type="checkbox" id="prescreviewed" name="prescreviewed" value="true" ${mpx[prescreviewed]:+checked}>
-<label for="prescreviewed">$(l10n prescreviewed)</label>
-
<fieldset class="controls">
<button type="submit" name="action" value="save">$(l10n save)</button>
<button type="submit" name="action" value="cancel">$(l10n cancel)</button>