{% extends "global/Page.html" %} {% block title %}Prescribe{% endblock %} {% block content %}

Please enter your prescribed treatment level. The amount can be between 0 and 10, inclusive. You may refer to the table below for the equivalent patient benefits and payment.

{% formfields %}
Treatment Level Equivalent Patient Benefit Payment You Get Without Penalty(Experimental Dollars) Payment You Get With Penalty (Experimental Dollars)
0 50 0 -
1 60 19 -
2 70 36 -
3 80 51 -
4 90 64 -
5 100 75 -
6 100 84 66
7 100 91 59
8 100 96 54
9 100 99 51
10 100 100 50
{% endblock %}