139 lines
8.6 KiB
PHP
139 lines
8.6 KiB
PHP
<!DOCTYPE html>
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<html lang="en">
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<head>
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<head>
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<meta charset="utf-8">
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<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
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<meta name="description" content="">
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<meta name="author" content="">
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<link rel="icon" href="/docs/4.0/assets/img/favicons/favicon.ico">
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<title>Dashboard Template for Bootstrap</title>
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<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/4.4.1/css/bootstrap.min.css" integrity="sha384-Vkoo8x4CGsO3+Hhxv8T/Q5PaXtkKtu6ug5TOeNV6gBiFeWPGFN9MuhOf23Q9Ifjh" crossorigin="anonymous">
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<!-- Custom styles for this template -->
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<link href="dashboard.css" rel="stylesheet">
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<style type="text/css">/* Chart.js */
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@-webkit-keyframes chartjs-render-animation{from{opacity:0.99}to{opacity:1}}@keyframes chartjs-render-animation{from{opacity:0.99}to{opacity:1}}.chartjs-render-monitor{-webkit-animation:chartjs-render-animation 0.001s;animation:chartjs-render-animation 0.001s;}</style></head>
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</head>
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<body>
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<nav class="navbar navbar-dark sticky-top bg-dark flex-md-nowrap p-0">
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<a class="navbar-brand col-sm-3 col-md-2 mr-0" href="#">RS Saiful Anwar</a>
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</nav>
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<div class="container-fluid">
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<div class="row">
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<nav class="col-md-2 d-none d-md-block bg-light sidebar">
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<div class="sidebar-sticky">
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<ul class="nav flex-column">
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<li class="nav-item">
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<a class="nav-link active" href="{{ route('index') }}">
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<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="feather feather-home"><path d="M3 9l9-7 9 7v11a2 2 0 0 1-2 2H5a2 2 0 0 1-2-2z"></path><polyline points="9 22 9 12 15 12 15 22"></polyline></svg>
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Dashboard <span class="sr-only">(current)</span>
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</a>
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</li>
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<li class="nav-item">
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<a class="nav-link" href="{{ route('daftar') }}">
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<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="feather feather-users"><path d="M17 21v-2a4 4 0 0 0-4-4H5a4 4 0 0 0-4 4v2"></path><circle cx="9" cy="7" r="4"></circle><path d="M23 21v-2a4 4 0 0 0-3-3.87"></path><path d="M16 3.13a4 4 0 0 1 0 7.75"></path></svg>
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Pendaftaran Pasien
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</a>
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</li>
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<li class="nav-item">
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<a class="nav-link" href="#">
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<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="feather feather-bar-chart-2"><line x1="18" y1="20" x2="18" y2="10"></line><line x1="12" y1="20" x2="12" y2="4"></line><line x1="6" y1="20" x2="6" y2="14"></line></svg>
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List Kunjungan Pasien
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</a>
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</li>
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</ul>
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</nav>
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<main role="main" class="col-md-9 ml-sm-auto col-lg-10 pt-3 px-4"><div class="chartjs-size-monitor" style="position: absolute; inset: 0px; overflow: hidden; pointer-events: none; visibility: hidden; z-index: -1;"><div class="chartjs-size-monitor-expand" style="position:absolute;left:0;top:0;right:0;bottom:0;overflow:hidden;pointer-events:none;visibility:hidden;z-index:-1;"><div style="position:absolute;width:1000000px;height:1000000px;left:0;top:0"></div></div><div class="chartjs-size-monitor-shrink" style="position:absolute;left:0;top:0;right:0;bottom:0;overflow:hidden;pointer-events:none;visibility:hidden;z-index:-1;"><div style="position:absolute;width:200%;height:200%;left:0; top:0"></div></div></div>
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<div class="d-flex justify-content-between flex-wrap flex-md-nowrap align-items-center pb-2 mb-3 border-bottom">
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<h1 class="h2">Pendaftaran Pasien</h1>
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</div>
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<form action="">
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<h5>Tipe Pasien</h5>
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<div class="form-check form-check-inline">
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<input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio1" value="option1" checked>
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<label class="form-check-label" for="inlineRadio1">Pasien Lama</label>
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</div>
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<div class="form-check form-check-inline">
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<input class="form-check-input" type="radio" name="inlineRadioOptions" id="inlineRadio2" value="option2">
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<label class="form-check-label" for="inlineRadio2">Pasien Baru</label>
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</div>
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<h5 class="mt-2">Pencarian Nomor Rekam Medis</h5>
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<div class="form-group">
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<input type="number" class="form-control" id="formGroupExampleInput" placeholder="Nomor Rekam Medis">
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</div>
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<h5 class="mt-2">Nama Pasien</h5>
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<div class="form-group">
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<input type="text" class="form-control" id="formGroupExampleInput" placeholder="Nama Pasien">
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</div>
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<h5 class="mt-2">Alamat Pasien</h5>
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<div class="form-group">
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<input type="text" class="form-control" id="formGroupExampleInput" placeholder="Alamat Pasien">
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</div>
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<h5 class="mt-2">Nomor Telepon</h5>
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<div class="form-group">
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<input type="number" class="form-control" id="formGroupExampleInput" placeholder="Nama Pasien">
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</div>
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<h5 class="mt-2">Penjamin</h5>
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<div class="dropdown">
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<button class="btn btn-secondary dropdown-toggle" type="button" id="dropdownMenuButton" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">
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Penjamin
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</button>
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<div class="dropdown-menu" aria-labelledby="dropdownMenuButton">
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<a class="dropdown-item" href="#">BPJS</a>
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</div>
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</div>
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<h5 class="mt-2">Nomor Kartu BPJS</h5>
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<div class="form-group">
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<input type="number" class="form-control" id="formGroupExampleInput" placeholder="Nomor BPJS">
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</div>
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<h5 class="mt-2">Poliklinik</h5>
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<div class="dropdown">
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<button class="btn btn-secondary dropdown-toggle" type="button" id="dropdownMenuButton" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">
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Poliklinik
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</button>
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<div class="dropdown-menu" aria-labelledby="dropdownMenuButton">
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<a class="dropdown-item" href="#">Mata</a>
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</div>
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</div>
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<h5 class="mt-2">Nama Dokter</h5>
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<div class="dropdown">
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<button class="btn btn-secondary dropdown-toggle" type="button" id="dropdownMenuButton" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">
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Nama Dokter
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</button>
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<div class="dropdown-menu" aria-labelledby="dropdownMenuButton">
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<a class="dropdown-item" href="#">Heri</a>
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</div>
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</div>
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<button type="submit" class="mt-3 btn btn-primary">Submit</button>
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</form>
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</main>
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</div>
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</div>
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<!-- Bootstrap core JavaScript
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================================================== -->
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<script src="https://code.jquery.com/jquery-3.4.1.slim.min.js" integrity="sha384-J6qa4849blE2+poT4WnyKhv5vZF5SrPo0iEjwBvKU7imGFAV0wwj1yYfoRSJoZ+n" crossorigin="anonymous"></script>
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<script src="https://cdn.jsdelivr.net/npm/popper.js@1.16.0/dist/umd/popper.min.js" integrity="sha384-Q6E9RHvbIyZFJoft+2mJbHaEWldlvI9IOYy5n3zV9zzTtmI3UksdQRVvoxMfooAo" crossorigin="anonymous"></script>
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<script src="https://stackpath.bootstrapcdn.com/bootstrap/4.4.1/js/bootstrap.min.js" integrity="sha384-wfSDF2E50Y2D1uUdj0O3uMBJnjuUD4Ih7YwaYd1iqfktj0Uod8GCExl3Og8ifwB6" crossorigin="anonymous"></script>
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<!-- Placed at the end of the document so the pages load faster -->
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<script src="https://code.jquery.com/jquery-3.2.1.slim.min.js" integrity="sha384-KJ3o2DKtIkvYIK3UENzmM7KCkRr/rE9/Qpg6aAZGJwFDMVNA/GpGFF93hXpG5KkN" crossorigin="anonymous"></script>
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<script>window.jQuery || document.write('<script src="../../assets/js/vendor/jquery-slim.min.js"><\/script>')</script>
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<script src="../../assets/js/vendor/popper.min.js"></script>
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<script src="../../dist/js/bootstrap.min.js"></script>
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<!-- Icons -->
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<script src="https://unpkg.com/feather-icons/dist/feather.min.js"></script>
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<script>
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feather.replace()
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</script>
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</body>
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</html>
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