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@@ -13,7 +13,7 @@
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<tbody>
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<tr>
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<td>
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- <input type="text" class="form-control form-control-sm" icd-autocomplete-code data-target="input[name=rmReasonIcd1Description]" name="rmReasonIcd1" value="{{ $careMonth->rm_reason_icd1 }}" placeholder="ICD 1" />
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+ <input type="text" class="icd-input" icd-autocomplete-code data-target="input[name=rmReasonIcd1Description]" name="rmReasonIcd1" value="{{ $careMonth->rm_reason_icd1 }}" placeholder="ICD 1" />
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</td>
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<td>
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<input id="" type="text" class="form-control form-control-sm" icd-autocomplete-description name="rmReasonIcd1Description" value="{{ $careMonth->rm_reason_icd1description }}">
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@@ -21,7 +21,7 @@
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</tr>
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<tr>
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<td>
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- <input type="text" class="form-control form-control-sm" icd-autocomplete-code name="rmReasonIcd2" data-target="input[name=rmReasonIcd2Description]" value="{{ $careMonth->rm_reason_icd2 }}" placeholder="ICD 2" />
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+ <input type="text" class="icd-input" icd-autocomplete-code name="rmReasonIcd2" data-target="input[name=rmReasonIcd2Description]" value="{{ $careMonth->rm_reason_icd2 }}" placeholder="ICD 2" />
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</td>
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<td>
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<input type="text" class="form-control form-control-sm" icd-autocomplete-description name="rmReasonIcd2Description" value="{{ $careMonth->rm_reason_icd2description }}">
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@@ -29,15 +29,15 @@
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</tr>
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<tr>
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<td>
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- <input type="text" class="form-control form-control-sm" icd-autocomplete-code name="rmReasonIcd3" data-target="input[name=rmReasonIcd3Description]" value="{{ $careMonth->rm_reason_icd3 }}" placeholder="ICD 3" />
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+ <input type="text" class="icd-input" icd-autocomplete-code name="rmReasonIcd3" data-target="input[name=rmReasonIcd3Description]" value="{{ $careMonth->rm_reason_icd3 }}" placeholder="ICD 3" />
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</td>
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<td>
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- <input type="text" class="form-control form-control-sm" icd-autocomplete-description name="rmReasonIcd3Description" value="{{ $careMonth->rm_reason_icd3description }}">
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+ <input type="text" class="form-control form-control-sm" icd-autocomplete-description name="rmReasonIcd3Description" value="{{ $careMonth->rm_reason_icd3description }}" >
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</td>
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</tr>
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<tr>
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<td>
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- <input type="text" class="form-control form-control-sm" icd-autocomplete-code name="rmReasonIcd4" data-target="input[name=rmReasonIcd4Description]" value="{{ $careMonth->rm_reason_icd4 }}" />
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+ <input type="text" class="icd-input" icd-autocomplete-code name="rmReasonIcd4" data-target="input[name=rmReasonIcd4Description]" value="{{ $careMonth->rm_reason_icd4 }}" placeholder="ICD 4"/>
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</td>
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<td>
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<input type="text" class="form-control form-control-sm" icd-autocomplete-description name="rmReasonIcd4Description" value="{{ $careMonth->rm_reason_icd4description }}">
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