<table>
  <thead>
    <tr>
      <th> <img src="{$path}/_assets/custom/images/nas_head.jpg" alt="Header image"></th>
    </tr>
    <tr>
      <th>
        {if $source != 5 }
        <hr style="border: 1px solid black;     margin: 5px 0; ">
        <div class="col-md-12">

                    <table style="width: 98%;margin: 5px auto;" cellpadding="2" class="noborder">
                        <tr>
                            <td style="width: 18%;font-weight: bold;"> Patient Name </td>
                            <td > {$name} </td>
                            <td style="width: 18%;font-weight: bold;"> Patient ID </td>
                            <td style="width: 22%;">{$patientId}</td>
                        </tr>
                        <tr>
                            <td style="font-weight: bold;"> Age / Sex </td>
                            <td> {$age} / {$sex} </td>
                            <td style="font-weight: bold;"> Requested Date </td>
                            <td> {$req_date} {$req_time} </td>
                        </tr>
                        <tr>
                            <td style="font-weight: bold;"> Referred Dr. </td>
                            <td>{$doctor_name} </td>
                            <td style="font-weight: bold;"> Printed In </td>
                            <td> {$dateTime} </td>
                        </tr>
                                  <tr>
                            <td style="font-weight: bold;"> Printed By </td>
                            <td>{$printedBy} </td>
                            <td style="font-weight: bold;"> </td>
                            <td> </td>
                        </tr>
                    </table>
        </div>

        <hr style="border: 1px solid black;  margin: 5px 0;">
        {/if}
      </th>
    </tr>
  </thead>
  <tbody>
    <tr>
      <td>

        <main class="print-main">

          <div class="position: relative;">


            <div class="row">

              <div class="col-md-12">