351 lines
18 KiB
TypeScript
351 lines
18 KiB
TypeScript
import { Button } from '@/components/ui/button';
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import { Calendar } from '@/components/ui/calendar';
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import { Input } from '@/components/ui/input';
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import { Label } from '@/components/ui/label';
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import { RadioGroup, RadioGroupItem } from '@/components/ui/radio-group';
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import { Select, SelectContent, SelectItem, SelectTrigger, SelectValue } from '@/components/ui/select';
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import { useForm } from '@inertiajs/react';
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import AppLayout from '@/layouts/app-layout';
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import { Head } from '@inertiajs/react';
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import { type BreadcrumbItem } from '@/types';
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import InputError from '@/components/input-error';
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import { format } from 'date-fns';
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import { CalendarIcon } from 'lucide-react';
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import { Popover, PopoverContent, PopoverTrigger } from '@/components/ui/popover';
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import { cn } from '@/lib/utils';
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import { Textarea } from '@/components/ui/textarea';
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interface PatientFormProps {
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mode: 'create' | 'edit';
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patient?: {
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id?: string;
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medical_record_number: string;
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name: string;
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gender: string;
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nik?: string;
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birth_date: string;
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birth_place?: string;
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address?: string;
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phone_number?: string;
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email?: string;
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blood_type?: string;
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religion?: string;
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marital_status?: string;
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emergency_contact_name?: string;
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emergency_contact_phone?: string;
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emergency_contact_relation?: string;
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is_active: boolean;
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};
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}
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const breadcrumbs: BreadcrumbItem[] = [
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{ title: 'Dashboard', href: '/dashboard' },
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{ title: 'Patients', href: '/patients' },
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{ title: 'Form', href: '#' },
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];
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const toLocalISOString = (date: Date) => {
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const offset = date.getTimezoneOffset();
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const localDate = new Date(date.getTime() - (offset * 60 * 1000));
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return localDate.toISOString().split('T')[0];
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};
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export default function PatientForm({ mode, patient }: PatientFormProps) {
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const { data, setData, post, put, processing, errors, reset } = useForm({
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// Patient fields
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medical_record_number: patient?.medical_record_number || '',
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name: patient?.name || '',
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gender: patient?.gender || 'laki-laki',
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nik: patient?.nik || '',
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birth_date: patient?.birth_date || '',
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birth_place: patient?.birth_place || '',
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address: patient?.address || '',
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phone_number: patient?.phone_number || '',
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email: patient?.email || '',
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blood_type: patient?.blood_type || 'unknown',
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religion: patient?.religion || '',
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marital_status: patient?.marital_status || '',
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emergency_contact_name: patient?.emergency_contact_name || '',
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emergency_contact_phone: patient?.emergency_contact_phone || '',
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emergency_contact_relation: patient?.emergency_contact_relation || '',
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is_active: patient?.is_active ?? true,
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});
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const onSubmit = (e: React.FormEvent) => {
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e.preventDefault();
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if (mode === 'create') {
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post(route('patients.store'), {
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onSuccess: () => reset(),
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});
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} else {
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put(route('patients.update', patient?.id), {
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preserveScroll: true,
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});
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}
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};
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return (
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<AppLayout breadcrumbs={breadcrumbs}>
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<Head title={`${mode === 'create' ? 'Tambah' : 'Edit'} Pasien`} />
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<div className="flex h-full flex-1 flex-col gap-4 rounded-xl p-4">
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<div className="flex items-center justify-between">
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<h1 className="text-2xl font-bold">
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{mode === 'create' ? 'Tambah Pasien Baru' : 'Edit Data Pasien'}
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</h1>
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{mode === 'edit' && (
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<span className="text-xl">
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No. Pasien {data.medical_record_number}
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</span>
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)}
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</div>
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<div>
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<form onSubmit={onSubmit} className="space-y-6">
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<div className="grid grid-cols-1 gap-6 md:grid-cols-2">
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{/* Informasi Utama */}
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<div className="space-y-2">
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<Label htmlFor="name">Nama Lengkap *</Label>
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<Input
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id="name"
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value={data.name}
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onChange={(e) => setData('name', e.target.value)}
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placeholder="Nama pasien"
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/>
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<InputError message={errors.name} />
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</div>
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<div className="space-y-2">
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<Label>Jenis Kelamin *</Label>
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<RadioGroup
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value={data.gender}
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onValueChange={(value) => setData('gender', value)}
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className="flex gap-4 mt-4"
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>
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<div className="flex items-center space-x-2">
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<RadioGroupItem value="laki-laki" id="male" />
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<Label htmlFor="male">Laki-laki</Label>
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</div>
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<div className="flex items-center space-x-2">
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<RadioGroupItem value="perempuan" id="female" />
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<Label htmlFor="female">Perempuan</Label>
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</div>
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</RadioGroup>
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<InputError message={errors.gender} />
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</div>
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<div className="space-y-2">
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<Label htmlFor="nik">NIK</Label>
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<Input
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id="nik"
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value={data.nik}
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onChange={(e) => setData('nik', e.target.value)}
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placeholder="16-digit NIK"
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maxLength={16}
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/>
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<InputError message={errors.nik} />
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</div>
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<div className="space-y-2">
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<Label htmlFor="birth_date">Tanggal Lahir *</Label>
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<Popover>
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<PopoverTrigger asChild>
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<Button
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variant={"outline"}
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className={cn(
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"w-full justify-start text-left font-normal",
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!data.birth_date && "text-muted-foreground"
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)}
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>
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<CalendarIcon className="mr-2 h-4 w-4" />
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{data.birth_date ? (
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format(new Date(data.birth_date), "dd/MM/yyyy")
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) : (
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<span>Pilih tanggal</span>
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)}
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</Button>
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</PopoverTrigger>
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<PopoverContent className="w-auto p-0">
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<Calendar
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mode="single"
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selected={data.birth_date ? new Date(data.birth_date) : undefined}
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onSelect={(date) => date && setData('birth_date', toLocalISOString(date))}
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initialFocus
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/>
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</PopoverContent>
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</Popover>
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<InputError message={errors.birth_date} />
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</div>
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<div className="space-y-2">
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<Label htmlFor="birth_place">Tempat Lahir</Label>
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<Input
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id="birth_place"
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value={data.birth_place}
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onChange={(e) => setData('birth_place', e.target.value)}
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placeholder="Kota kelahiran"
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/>
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<InputError message={errors.birth_place} />
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</div>
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{/* Kontak & Informasi Tambahan */}
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<div className="space-y-2">
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<Label htmlFor="phone_number">Nomor Telepon</Label>
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<Input
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id="phone_number"
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value={data.phone_number}
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onChange={(e) => setData('phone_number', e.target.value)}
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placeholder="08123456789"
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/>
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<InputError message={errors.phone_number} />
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</div>
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<div className="space-y-2">
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<Label htmlFor="email">Email</Label>
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<Input
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id="email"
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type="email"
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value={data.email}
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onChange={(e) => setData('email', e.target.value)}
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placeholder="joko_susanto@example.com"
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/>
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<InputError message={errors.email} />
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</div>
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<div className="space-y-2">
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<Label htmlFor="blood_type">Golongan Darah</Label>
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<Select
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value={data.blood_type}
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onValueChange={(value) => setData('blood_type', value)}
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>
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<SelectTrigger>
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<SelectValue placeholder="Pilih golongan darah" />
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</SelectTrigger>
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<SelectContent>
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<SelectItem value="unknown">Tidak Tahu</SelectItem>
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<SelectItem value="A">A</SelectItem>
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<SelectItem value="B">B</SelectItem>
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<SelectItem value="AB">AB</SelectItem>
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<SelectItem value="O">O</SelectItem>
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</SelectContent>
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</Select>
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<InputError message={errors.blood_type} />
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</div>
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<div className="space-y-2">
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<Label htmlFor="religion">Agama</Label>
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<Select
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value={data.religion}
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onValueChange={(value) => setData('religion', value)}
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>
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<SelectTrigger>
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<SelectValue placeholder="Pilih agama" />
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</SelectTrigger>
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<SelectContent>
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<SelectItem value="islam">Islam</SelectItem>
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<SelectItem value="kristen">Kristen</SelectItem>
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<SelectItem value="katolik">Katolik</SelectItem>
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<SelectItem value="hindu">Hindu</SelectItem>
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<SelectItem value="budha">Budha</SelectItem>
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<SelectItem value="konghucu">Konghucu</SelectItem>
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<SelectItem value="other">Lainnya</SelectItem>
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</SelectContent>
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</Select>
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<InputError message={errors.religion} />
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</div>
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<div className="space-y-2">
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<Label htmlFor="marital_status">Status Pernikahan</Label>
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<Select
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value={data.marital_status}
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onValueChange={(value) => setData('marital_status', value)}
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>
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<SelectTrigger>
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<SelectValue placeholder="Pilih status" />
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</SelectTrigger>
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<SelectContent>
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<SelectItem value="lajang">Lajang</SelectItem>
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<SelectItem value="menikah">Menikah</SelectItem>
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<SelectItem value="cerai">Cerai</SelectItem>
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<SelectItem value="duda/janda">Duda/Janda</SelectItem>
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</SelectContent>
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</Select>
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<InputError message={errors.marital_status} />
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</div>
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<div className="space-y-2 col-span-full">
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<Label htmlFor="address">Alamat</Label>
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<Textarea
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id="address"
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value={data.address}
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onChange={(e) => setData('address', e.target.value)}
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placeholder="Alamat lengkap"
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/>
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<InputError message={errors.address} />
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</div>
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{/* Kontak Darurat */}
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<div className="space-y-2">
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<Label htmlFor="emergency_contact_name">Nama Kontak Darurat</Label>
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<Input
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id="emergency_contact_name"
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value={data.emergency_contact_name}
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onChange={(e) => setData('emergency_contact_name', e.target.value)}
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placeholder="Nama kontak darurat"
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/>
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<InputError message={errors.emergency_contact_name} />
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</div>
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<div className="space-y-2">
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<Label htmlFor="emergency_contact_phone">Telepon Darurat</Label>
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<Input
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id="emergency_contact_phone"
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value={data.emergency_contact_phone}
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onChange={(e) => setData('emergency_contact_phone', e.target.value)}
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placeholder="Nomor telepon darurat"
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/>
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<InputError message={errors.emergency_contact_phone} />
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</div>
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<div className="space-y-2">
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<Label htmlFor="emergency_contact_relation">Hubungan</Label>
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<Input
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id="emergency_contact_relation"
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value={data.emergency_contact_relation}
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onChange={(e) => setData('emergency_contact_relation', e.target.value)}
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placeholder="Hubungan dengan pasien"
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/>
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<InputError message={errors.emergency_contact_relation} />
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</div>
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{mode === 'edit' && (
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<div className="flex items-center space-x-2">
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<input
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type="checkbox"
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id="is_active"
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checked={data.is_active}
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onChange={(e) => setData('is_active', e.target.checked)}
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className="h-4 w-4 rounded border-gray-300 text-indigo-600 focus:ring-indigo-500"
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/>
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<Label htmlFor="is_active">Pasien Aktif</Label>
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</div>
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)}
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</div>
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<div className="flex justify-end gap-2">
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<Button variant="outline" type="button" onClick={() => window.history.back()}>
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Batal
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</Button>
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<Button type="submit" disabled={processing}>
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{mode === 'create' ? 'Simpan' : 'Perbarui'} Pasien
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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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</AppLayout>
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);
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}
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