This links to POLI to pay an amount that we can choose (we can let the user change this if we want), and ask the user for other information. We can include this information in the Particulars and Code reference on our Bank Statement.
In practice, I think we would use a Google Form to collect information, combined with the Simple Button.
This will take take your outdoor First Aid skills to a new level, enabling you to carry out useful procedures such as open heart surgery.