34 lines
2.1 KiB
PHP
34 lines
2.1 KiB
PHP
<x-app-layout>
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<div class="py-12">
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<div class="max-w-3xl mx-auto sm:px-6 lg:px-8">
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<div class="bg-white overflow-hidden shadow-sm sm:rounded-lg">
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<div class="p-6 bg-white border-b border-gray-200">
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<h1 class="text-xl mb-4 font-bold">Edit Data Pasien #{{$pasien->mr_pasien}}</h1>
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<hr class="opacity-10 mb-4"></hr>
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<form method="POST" action="{{ route('admin.ms_pasien.update', $pasien->mr_pasien) }}">
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@csrf
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<x-input id="mr_pasien" label="No RM" name="mr_pasien" required :value="$pasien->mr_pasien" disabled/>
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<x-input id="nama_pasien" label="Nama Pasien" name="nama_pasien" required :value="$pasien->nama_pasien"/>
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<x-input id="tanggal_lahir" label="Tanggal Lahir" name="tanggal_lahir" type="date" required :value="$pasien->tanggal_lahir"/>
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<div>
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<label class="block font-medium text-sm mb-2">Jenis Kelamin <span class="text-red-600">*</span></label>
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<select name="jenis_kelamin" required class="text-sm block mt-1 w-full p-2 bg-gray-50 border border-gray-300 focus:ring-gray-500 focus:border-gray-500 rounded-md shadow-sm placeholder-gray-300">
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<option value="">-- Pilih --</option>
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<option value="L" {{$pasien->jenis_kelamin == 'L' ? 'selected' : ''}}>Laki-laki</option>
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<option value="P" {{$pasien->jenis_kelamin == 'P' ? 'selected' : ''}}>Perempuan</option>
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</select>
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</div>
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<div class="flex justify-end mt-4 gap-2">
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<a href="{{ route('admin.ms_pasien.index') }}" class="bg-gray-300 text-gray-700 px-4 py-2 rounded-md mr-2">Batal</a>
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<button type="submit" class="bg-blue-500 text-white px-4 py-2 rounded-md">Simpan Perubahan</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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</div>
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</div>
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</x-app-layout>
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