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% Author: Karsten Hilbert
% License: GPL v2 or later
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\documentclass[english]{article}
\usepackage[T1]{fontenc}
\usepackage[utf8x]{inputenc}
\usepackage{hyperref}
\usepackage{ucs}
\usepackage{graphicx}
\usepackage[space]{grffile}
%\usepackage{lmodern}
%\usepackage{times}
%\usepackage{amsmath}
\usepackage[a4paper]{geometry}
%\usepackage[a5paper]{geometry}
%\geometry{verbose,lmargin=2.54cm}
\geometry{verbose,lmargin=1cm}
\pagestyle{empty}
\setlength{\parskip}{\medskipamount}
\setlength{\parindent}{0pt}

\makeatletter

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% LyX specific LaTeX commands.
%% Because html converters don't know tabularnewline
\providecommand{\tabularnewline}{\\}

\makeatother

\usepackage{babel}

\begin{document}

\footnotetext {\tiny \href{http://www.gnumed.org}{GNUmed} $<client_version>$ -- \href{http://www.gnumed.org}{www.gnumed.org}}
\footnotetext {\tiny Template: $<form_name_long::::60>$ v$<form_version::::20>$}

\noindent \begin{center}
{\large Vaccination history (printed $<today::%Y %B %d>$)}
\par\end{center}

%\noindent \begin{center}
%{\large By $<current_provider>$}
%\par\end{center}{\large \par}

\noindent Patient: $<lastname>$, $<firstname>$ ($<date_of_birth::%Y %B %d>$)

{\footnotesize
	$<adr_street::home>$ $<adr_number::home>$ \\
	$<adr_postcode::home>$ $<adr_location::home>$
}

\includegraphics[width=30mm]{$<patient_image::%s::250>$}

%\vspace*{\medskipamount}


\begin{tabular}{|l|l|l|}
\hline 
Given & Vaccine (batch) & Indications\tabularnewline
\hline
\hline 
$<vaccination_history::%(date_given)s & %(vaccine)s {\footnotesize (%(batch_no)s) } & {\footnotesize %(l10n_indications)s \tabularnewline \hline }//%Y %b %d::250>$
\end{tabular}


\vfill{}

\noindent Known allergies:

\begin{tabular}{|l|l|l|}
\hline 
Agent & Type & Reaction\tabularnewline
\hline
\hline 
$<allergies::%(descriptor)s & %(l10n_type)s & {\footnotesize %(reaction)s} \tabularnewline \hline >$
\end{tabular}

\medskip{}


\noindent \begin{flushright}
\texttt{\textsl{\footnotesize Practice Stamp / Physician Signature}}
\par\end{flushright}
\end{document}

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