<form>
  <div class="form-group" style="margin: 0 0 10px;">
    {{ localize 'CoC7.SanityLossTypeDialogBody' }}
  </div>
  <div class="form-group">
    <label>{{ localize 'CoC7.SanityLossType' }}</label>
    <select class="field_type">
      {{selectOptions encounterTypes selected=object.type localize=true valueAttr="key" nameAttr="key" labelAttr="label"}}
    </select>
  </div>
  <div class="form-group">
    <label>{{ localize 'CoC7.SanityLossTypeReason' }}</label>
    <input type="text" class="field_name" value="{{object.name}}" />
  </div>
  {{#unless isImmunity}}
    <div class="form-group">
      <label>{{ localize 'CoC7.SanityLossTypeValue' }}</label>
      <input type="text" class="field_value" value="{{object.value}}" data-dtype="Number">
    </div>
  {{/unless}}
  <div class="flexrow-coc7" style="margin: 10px 0 0;">
    <button class="dialog-button add" type="button" data-button="add">
      <i class="fas fa-check"></i>
      {{ localize 'CoC7.Add' }}
    </button>
    <button class="dialog-button close" type="button" data-button="close">
      <i class="fas fa-ban"></i>
      {{ localize 'CoC7.Cancel' }}
    </button>
  </div>
</form>