65 lines
2.3 KiB
PHP
65 lines
2.3 KiB
PHP
@extends('layouts.app')
|
|
|
|
@section('title', 'Tambah Registrasi')
|
|
@section('content')
|
|
<div class="container">
|
|
<h1>Tambah Registrasi</h1>
|
|
|
|
<form action="{{ route('tr_registrasi.store') }}" method="POST">
|
|
@csrf
|
|
<div class="mb-3">
|
|
<label>Tanggal Registrasi</label>
|
|
<input type="date" name="TanggalRegistrasi" class="form-control" required>
|
|
</div>
|
|
|
|
<div class="mb-3">
|
|
<label>Pasien</label>
|
|
<select name="MRPasien" class="form-control" required>
|
|
<option value="">-- Pilih Pasien --</option>
|
|
@foreach($pasiens as $pasien)
|
|
<option value="{{ $pasien->id }}">{{ $pasien->NamaPasien }}</option>
|
|
@endforeach
|
|
</select>
|
|
</div>
|
|
|
|
<div class="mb-3">
|
|
<label>Nomor Kartu Asuransi</label>
|
|
<input type="text" name="NomorKartuAsuransi" class="form-control" required>
|
|
</div>
|
|
|
|
<div class="mb-3">
|
|
<label>Asuransi</label>
|
|
<select name="IdAsuransi" class="form-control" required>
|
|
<option value="">-- Pilih Asuransi --</option>
|
|
@foreach($asuransis as $asuransi)
|
|
<option value="{{ $asuransi->id }}">{{ $asuransi->NamaAsuransi }}</option>
|
|
@endforeach
|
|
</select>
|
|
</div>
|
|
|
|
<div class="mb-3">
|
|
<label>Pegawai</label>
|
|
<select name="IdPegawai" class="form-control" required>
|
|
<option value="">-- Pilih Pegawai --</option>
|
|
@foreach($pegawais as $pegawai)
|
|
<option value="{{ $pegawai->id }}">{{ $pegawai->NamaPegawai }}</option>
|
|
@endforeach
|
|
</select>
|
|
</div>
|
|
|
|
<div class="mb-3">
|
|
<label>Ruang Pelayanan</label>
|
|
<select name="IdRuangPelayanan" class="form-control" required>
|
|
<option value="">-- Pilih Ruang Pelayanan --</option>
|
|
@foreach($ruangpelayanans as $ruang)
|
|
<option value="{{ $ruang->id }}">{{ $ruang->NamaRuangPelayanan }}</option>
|
|
@endforeach
|
|
</select>
|
|
</div>
|
|
|
|
<button type="submit" class="btn btn-success">Simpan</button>
|
|
<a href="{{ route('tr_registrasi.index') }}" class="btn btn-secondary">Kembali</a>
|
|
</form>
|
|
</div>
|
|
@endsection
|