94 lines
5.2 KiB
PHP
94 lines
5.2 KiB
PHP
@extends('layouts.app')
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@section('title', 'Tambah Billing Baru')
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@section('content')
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<div class="container px-6 mx-auto">
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<h2 class="my-6 text-2xl font-semibold text-gray-700 dark:text-gray-200">
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Tambah Billing Baru
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</h2>
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<div class="px-4 py-3 mb-8 bg-white rounded-lg shadow-md dark:bg-gray-800">
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<form action="{{ route('billing.store') }}" method="POST">
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@csrf
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<!-- ID Registrasi -->
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<label class="block text-sm mb-4">
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<span class="text-gray-700 dark:text-gray-400">ID Registrasi</span>
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<select name="IdRegistrasi" id="IdRegistrasi"
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class="block w-full mt-1 text-sm dark:border-gray-600 dark:bg-gray-700
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focus:border-purple-400 focus:outline-none focus:shadow-outline-purple
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dark:text-gray-300 dark:focus:shadow-outline-gray form-input @error('IdRegistrasi') border-red-500 @enderror"
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required>
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<option value="">Pilih ID Registrasi</option>
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@foreach ($registrasis as $registrasi)
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<option value="{{ $registrasi->IdRegistrasi }}"
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{{ old('IdRegistrasi') == $registrasi->IdRegistrasi ? 'selected' : '' }}>
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{{ $registrasi->IdRegistrasi }} - {{ $registrasi->pasien->NamaPasien ?? 'Unknown' }}
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</option>
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@endforeach
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</select>
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@error('IdRegistrasi')
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<span class="text-xs text-red-600 dark:text-red-400">{{ $message }}</span>
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@enderror
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</label>
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<!-- Tanggal Billing -->
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<label class="block text-sm mb-4">
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<span class="text-gray-700 dark:text-gray-400">Tanggal Billing</span>
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<input type="date" name="TanggalBilling" id="TanggalBilling"
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value="{{ old('TanggalBilling', date('Y-m-d')) }}"
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class="block w-full mt-1 text-sm dark:border-gray-600 dark:bg-gray-700
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focus:border-purple-400 focus:outline-none focus:shadow-outline-purple
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dark:text-gray-300 dark:focus:shadow-outline-gray form-input @error('TanggalBilling') border-red-500 @enderror"
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required>
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@error('TanggalBilling')
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<span class="text-xs text-red-600 dark:text-red-400">{{ $message }}</span>
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@enderror
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</label>
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<!-- Pembayaran Awal -->
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<label class="block text-sm mb-4">
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<span class="text-gray-700 dark:text-gray-400">Pembayaran Awal (Rp)</span>
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<input type="number" name="Dibayar" id="Dibayar" min="0" value="{{ old('Dibayar', 0) }}"
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class="block w-full mt-1 text-sm dark:border-gray-600 dark:bg-gray-700
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focus:border-purple-400 focus:outline-none focus:shadow-outline-purple
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dark:text-gray-300 dark:focus:shadow-outline-gray form-input @error('Dibayar') border-red-500 @enderror"
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required>
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@error('Dibayar')
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<span class="text-xs text-red-600 dark:text-red-400">{{ $message }}</span>
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@enderror
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</label>
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<!-- Keterangan -->
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<label class="block text-sm mb-4">
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<span class="text-gray-700 dark:text-gray-400">Keterangan</span>
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<textarea name="Keterangan" id="Keterangan" rows="3"
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class="block w-full mt-1 text-sm dark:border-gray-600 dark:bg-gray-700
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focus:border-purple-400 focus:outline-none focus:shadow-outline-purple
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dark:text-gray-300 dark:focus:shadow-outline-gray form-input @error('Keterangan') border-red-500 @enderror">{{ old('Keterangan') }}</textarea>
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@error('Keterangan')
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<span class="text-xs text-red-600 dark:text-red-400">{{ $message }}</span>
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@enderror
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</label>
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<!-- Buttons -->
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<div class="flex justify-start mt-6 space-x-4">
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<a href="{{ route('billing.index') }}"
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class="px-6 py-2 text-sm font-medium leading-5 text-gray-700 transition-colors duration-150
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bg-white border border-gray-300 rounded-md dark:text-gray-400 dark:bg-gray-800 dark:border-gray-600
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hover:border-gray-500 focus:outline-none focus:shadow-outline-gray">
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Batal
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</a>
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<button type="submit"
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class="px-6 py-2 text-sm font-medium leading-5 text-white transition-colors duration-150
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bg-purple-600 border border-transparent rounded-md active:bg-purple-600 hover:bg-purple-700
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focus:outline-none focus:shadow-outline-purple">
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Simpan Billing
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</button>
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</div>
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</form>
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</div>
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</div>
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@endsection
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