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| style="background:silver; color:arsenic" align="right"| '''Diagnosis Code: ''' | | style="background:silver; color:arsenic" align="right"| '''Diagnosis Code: ''' | ||
|[[DxCode::{{{5}}}]] | ||[[DxCode::{{{5}}}]] | ||
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| style="background:silver; color:arsenic" align="right"| '''[[:Category:Comorbid Diagnosis | Comorbid Code]]: ''' | | style="background:silver; color:arsenic" align="right"| '''[[:Category:Comorbid Diagnosis | Comorbid Code]]: ''' | ||