<div data-role="fieldcontain">
    <label for="appt-purpose">Status</label>
    <select name="appt-purpose" id="appt-purpose" data-transition="none" data-native-menu="false">
        <option>Select Status</option>
        <option value="N">No-Show</option>
        <option value="C">Cancelled by Clinic</option>
        <option value="I">Inpatient Appointment</option>
        <option value="PC">Cancelled by Patient</option>
        <option value="NT">No Action Taken</option>
    </select>
</div>
<div class="rebook-warning hidden">
    <p>*NOTE: If you cancel with this status, attempting to rebook the exact same appointment will cause data errors.</p>
</div>
<div data-role="fieldcontain">
    <label for="appt-type">Reason</label>
    <select name="appt-type" id="appt-type" data-transition="none" data-native-menu="false">
        <option>Select Reason</option>
    </select>
</div>

