View source for Form:ICD10 dx

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This is the "ICD10 dx" form.
To create a page with this form, enter the page name below;
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{{#forminput:form=ICD10 dx}}

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<div id="wikiPreview" style="display: none; padding-bottom: 25px; margin-bottom: 25px; border-bottom: 1px solid #AAAAAA;"></div>
{{{for template|ICD10 dx}}}
{| class="formtable"
! ICD10 Code: 
| {{{field|ICD10 Code}}}
|-
! StartDate: 
| {{{field|StartDate|input type=datepicker}}}
|-
! StopDate: 
| {{{field|StopDate|input type=datepicker}}}
|}
{{{end template}}}

{{{for template|ICD10 category|multiple|label=ICD10 category}}}
Copy-paste the category you need from another dx or from the subcategories list in [[:Category:ICD10_Diagnosis]].
{| class="formtable"
! ICD10 category: 
| {{{field|1}}} 
|}
{{{end template}}}

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{{{standard input|free text|rows=10}}}

{{{standard input|summary}}}

{{{standard input|minor edit}}} {{{standard input|watch}}}

{{{standard input|save}}} {{{standard input|preview}}} {{{standard input|changes}}} {{{standard input|cancel}}}
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