<div data-role="header" class="ui-header ui-bar-c">
    <h1 class="ui-title" role="heading">Select a desired date</h1>
    <a href="#" id="close-btn" data-rel="back" data-role="button" data-theme="c" data-icon="delete" data-iconpos="notext" class="ui-btn-left ui-btn ui-shadow ui-btn-corner-all ui-btn-icon-notext ui-btn-up-c" data-corners="true" data-shadow="true" data-iconshadow="true" data-wrapperels="span" title="Close"><span class="ui-btn-inner"><span class="ui-btn-text">Close</span><span class="ui-icon ui-icon-delete ui-icon-shadow">&nbsp;</span></span></a>
</div>
<div class="desired-date">
    <p class="error-message date-error hidden"><span class="alert-icon"></span>
        <span>The date cannot be in the past and must no more than 90 days in the future</span>
    </p>
    <div>
        <label for="correcting-desired-date" class="ui-input-text">Desired Date of Appointment</label>
    </div>
    <div class="ui-input-text ui-shadow-inset ui-corner-all ui-btn-shadow ui-body-c">
        <input type="text" name="correcting-desired-date" id="correcting-desired-date" placeholder="MM/DD/YYYY" autocomplete="off" class="ui-input-text ui-body-c">
    </div>
    <button id="correcting-date-picker-btn" class="date-picker-btn" data-role="none"><span class="icon-calendar"></span><span class="hide-text">Select Date</span></button>
</div>
<div id="desired-date-ok-button">
    <button class="ok-button ui-btn ui-shadow ui-btn-corner-all ui-btn-up-b" data-role="none" disabled><span class="ui-btn-inner"><span class="ui-btn-text">SET DESIRED DATE</span></span></button>
</div>