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  <input type="hidden" name="step" id="step" value="1" autocomplete="off">
  <label class="visually-hidden" for="drug-lookup-input">Prescription Lookup</label>
  <div class="field-button-group drug-lookup">
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      <input type="text" name="" id="drug-lookup-input" value="" class="combobox-text" data-autocomplete-target="input" data-lookup-target="input" data-action="blur->lookup#useHighlightedItem" placeholder="Search prescription" autocomplete="off"
        spellcheck="false">
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      <ul class="list-group" data-autocomplete-target="results" data-lookup-target="results" role="listbox" hidden=""></ul>
      <div class="no-results" data-lookup-target="noResults" hidden="">
        <p class="error-message">No results matching search</p>
      </div>
      <button class="btn-icon clear" type="reset">
        <svg aria-label="Clear" class="icon feather-icon" fill="none" height="24" role="img" stroke="currentColor" stroke-linecap="round" stroke-linejoin="round" stroke-width="2" width="24">
          <title>Clear</title>
          <use xlink:href="https://rx.id.me/assets/icons/feather-sprite-cc766207bb20e0ccb16f4c4ed14424e265aa37f4d311dc368c5774c6412d9665.svg#x"></use>
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    </div>
    <button class="btn btn-primary" type="submit">
      <svg aria-label="Search" class="icon feather-icon" fill="none" height="24" role="img" stroke="currentColor" stroke-linecap="round" stroke-linejoin="round" stroke-width="2" width="24">
        <title>Search</title>
        <use xlink:href="https://rx.id.me/assets/icons/feather-sprite-cc766207bb20e0ccb16f4c4ed14424e265aa37f4d311dc368c5774c6412d9665.svg#search"></use>
      </svg>
    </button>
  </div>
</form>

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