anchor.diff:  
   <h1><%= t('patient.data_entry.patient_entry') %></h1>
   
  -<%= bootstrap_form_for @patient, url: data_entry_create_path, html: { class: 'mass_entry_form' } do |f| %>
  +<%= bootstrap_form_with model: @patient,
  +                        url: data_entry_create_path,
  +                        html: { class: 'mass_entry_form' } do |f| %>
     <%= f.select :line, options_for_select(lines, current_line) %>
   
  -  <%= f.date_field :initial_call_date, label: t('patient.new.initial_call_date') %>
  +  <%= f.date_field :initial_call_date,
  +                   label: t('patient.new.initial_call_date') %>
   
  -  <%= f.text_field :name, label: t('common.name'), autocomplete: 'off' %>
  +  <%= f.text_field :name,
  +                   label: t('common.name'), autocomplete: 'off' %>
   
  -  <%= f.text_field :primary_phone, label: t('common.phone'), autocomplete: 'off' %>
  +  <%= f.text_field :primary_phone,
  +                   label: t('common.phone'),
  +                   autocomplete: 'off' %>
   
  -  <%= f.text_field :other_contact, label: t('patient.information.other_contact.name'), autocomplete: 'off' %>
  -  <%= f.text_field :other_phone, label: t('patient.information.other_contact.phone'), autocomplete: 'off' %>
  -  <%= f.text_field :other_contact_relationship, label: t('patient.information.other_contact.relationship'), autocomplete: 'off'%>
  +  <%= f.text_field :other_contact,
  +                   label: t('patient.information.other_contact.name'),
  +                   autocomplete: 'off' %>
  +  <%= f.text_field :other_phone,
  +                   label: t('patient.information.other_contact.phone'),
  +                   autocomplete: 'off' %>
  +  <%= f.text_field :other_contact_relationship,
  +                   label: t('patient.information.other_contact.relationship'),
  +                   autocomplete: 'off'%>
   
     <div class="row">
  -    <div class="col-sm-6">
  -      <%= f.select :last_menstrual_period_weeks, options_for_select(weeks_options), label: t('patient.dashboard.weeks_along'), autocomplete: 'off' %>
  +    <div class="col">
  +      <%= f.select :last_menstrual_period_weeks,
  +                   options_for_select(weeks_options),
  +                   label: t('patient.dashboard.weeks_along'),
  +                   autocomplete: 'off' %>
       </div>
  -    <div class="col-sm-6 hide-label">
  -      <%= f.select :last_menstrual_period_days, options_for_select(days_options, @patient.last_menstrual_period_days ), autocomplete: 'off', skip_label: true %>
  -      <%= f.label :last_menstrual_period_days, t('common.days_along'), class: "sr-only" %>
  +    <div class="col">
  +      <%= f.select :last_menstrual_period_days,
  +                   options_for_select(days_options, @patient.last_menstrual_period_days),
  +                   autocomplete: 'off',
  +                   label: t('common.days_along') %>
       </div>
     </div>
   
  
positive.code:                label: t('patient.helper.referred_by.title'),
                 autocomplete: 'off' %>
  
      <%= f.number_field :procedure_cost, label: t('patient.pledge_fulfillment.form.procedure_cost') %>
      <%= f.number_field :patient_contribution, label: t('patient.abortion_information.cost_section.patient_contribution'), autocomplete: 'off', prepend: '$' %>
      <%= f.number_field :naf_pledge, label: t('patient.abortion_information.cost_section.naf_pledge'), autocomplete: 'off', prepend: '$' %>
  
      <%= f.check_box :pledge_sent, label: t('patient.status.key.pledge_sent') %>
  
    <p style="font-weight:bold"><%= t('patient.information.special_circumstances.title')%></p>
    <%= f.form_group :special_circumstances do %>
      <div class="col-sm-6">
        <%= f.check_box :special_circumstances, { label: t('patient.information.special_circumstances.fetal_diagnosis'), name: 'patient[special_circumstances][]', namespace: 'Fetal' }, 'Fetal diagnosis', '' %>
        <%= f.check_box :special_circumstances, { label: t('patient.information.special_circumstances.homelessness'), name: 'patient[special_circumstances][]', namespace: 'Home' }, 'Homelessness', '' %>
        <%= f.check_box :special_circumstances, { label: t('patient.information.special_circumstances.domestic_violence'), name: 'patient[special_circumstances][]', namespace: 'Domestic' }, 'Domestic violence', '' %>
      </div>
      <div class="col-sm-6">
      <%= f.check_box :special_circumstances, { label: t('patient.information.special_circumstances.rape'), name: 'patient[special_circumstances][]', namespace: 'Rape' }, 'Rape', '' %>
      <%= f.check_box :special_circumstances, { label: t('patient.information.special_circumstances.incest'), name: 'patient[special_circumstances][]', namespace: 'Incest' }, 'Incest', '' %>
      <%= f.check_box :special_circumstances, { label: t('patient.information.special_circumstances.prison'), name: 'patient[special_circumstances][]', namespace: 'Prison' }, 'Prison', '' %>
      </div>
    <% end %>
  
    <%= f.submit class: 'btn-lg btn-primary' %>
  <% end %>
  
negative.code:     <%#= notes.text_area :full_text, size: '20x5', placeholder: 'Enter notes here' %>
    <%# end %>
  
    <%= f.number_field :fund_pledge,
                       label: t('patient.abortion_information.cost_section.fund_pledge',
                       fund: "#{FUND}"),
                       autocomplete: 'off' %>
  
    <%= f.number_field :age, autocomplete: 'off' %>
    <%= f.select :race_ethnicity,
                 options_for_select(race_ethnicity_options),
                 autocomplete: 'off' %>
    <%= f.select :clinic_id,
                 options_for_select(clinic_options),
                 label: t('patient.pledge_fulfillment.confirmation.clinic') %>
  
    <%= f.date_field :appointment_date,
                     label: t('patient.shared.appt_date'),
                     autocomplete: 'off' %>
  
    <%= f.select :insurance,
                 options_for_select(insurance_options),
                 label: t('patient.information.insurance') %>
  
    <div class="row">
      <div class="col">
        <%= f.select :household_size_adults,
                      options_for_select(household_size_options),
                      help: t('patient.information.household_help') %>
      </div>
      <div class="col">
        <%= f.select :household_size_children,
                      options_for_select(household_size_options) %>
      </div>
  