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26. It is not feasible in most administrative or statistical data collection settings to clinically determine a person's sex. In many cases 'sex' will therefore be as reported by a respondent or as observed by the person collecting the data on the basis of observable characteristics. These include external appearance and attire, name and relationships to other persons. In a very small number of cases this will lead to a discrepancy between the sex recorded and the biological sex of the person.

27. A person’s sex may change during their lifetime as a result of procedures known alternatively as Sex change, Gender reassignment, Transsexual surgery, Transgender reassignment or Sexual reassignment. Throughout this process, which may be over a considerable period of time, sex could be recorded as either Male or Female. In clinical settings, diagnosis codes should include the appropriate ICD 10 AM code(s) that clearly identify that the person is undergoing or has completed such a process.