<div class="questionrow">
	<div class="question">Lab Department</div>
	<div class="answer">
		<?php $common->dropdown('lab_dept_code', 'lab_dept_name', 'custom_lab_dept_master', 'status = "Y"', 'lab_dept_name', 'dept_id', $dept_id, 'class="required"'); ?>
	</div>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
	<div class="question">Test Code</div>
	<div class="answer">
		<input type="text" name="test_code" id="test_code" value="<?php echo $test_code; ?>" readonly />
		<input type="hidden" name="id" id="id" value="<?php echo $id; ?>"/>
	</div>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
	<div class="question">Test Name</div>
	<div class="answer">
		<input type="text" name="test_name" id="test_name" value="<?php echo $test_name; ?>" />
	</div>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
	<div class="question">Spot Test</div>
	<div class="answer">
		<input type="checkbox" name="spot_test" id="spot_test" value="Y" <?php echo $spot_test_chk; ?> />
	</div>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
	<div class="question">Status</div>
	<div class="answer">
		<input type="checkbox" name="status" id="status" value="Y" <?php echo $status_chk; ?> />
	</div>
</div>
<div class="clear_form">
</div>
<div class="questionrow">
	<div style="padding: 5px;" align="center">
		<input type="submit" name="Submit" value="Submit" />
	</div>
</div>