30 lines
2.2 KiB
PHP
30 lines
2.2 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 Registrasi #{{$registrasi->id_registrasi}}</h1>
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<hr class="opacity-10 mb-4"></hr>
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<form method="POST" action="{{ route('admin.tr_registrasi.update', $registrasi->id_registrasi) }}">
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@csrf
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<x-input id="id_registrasi" label="ID Registrasi" name="id_registrasi" placeholder="misal: Budi" required :value="$registrasi->id_registrasi"/>
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<x-input id="mr_pasien" label="MR Pasien" name="mr_pasien" required placeholder="misal:150000" :value="$registrasi->mr_pasien"/>
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<x-input id="id_asuransi" label="Asuransi" name="id_asuransi" required placeholder="misal: 2" :value="$registrasi->id_asuransi"/>
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<x-input id="no_asuransi" label="No. Asuransi" name="no_asuransi" placeholder="misal: Budi" required :value="$registrasi->no_asuransi"/>
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<x-input id="id_ruang_pelayanan" label="Ruang Pelayanan" name="id_ruang_pelayanan" required placeholder="misal:150000" :value="$registrasi->id_ruang_pelayanan"/>
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<x-input id="id_pegawai" label="Pelaksana" name="id_pegawai" required placeholder="misal: 1" :value="$registrasi->id_pegawai"/>
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<x-input id="tanggal_registrasi" label="Tanggal Registrasi" name="tanggal_registrasi" type="date" required placeholder="misal: 2" :value="$registrasi->tanggal_registrasi"/>
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<div class="flex justify-end mt-4 gap-2">
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<a href="{{ route('admin.tr_registrasi.index') }}" class="bg-gray-300 text-gray-700 px-4 py-2 rounded-md id-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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