448 lines
32 KiB
PHP
448 lines
32 KiB
PHP
<?php
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$sql_rsm_pulang = "SELECT * FROM t_kajianawalmedis WHERE IDXRANAP = '".$id_admission."' and status_aktif = 1";
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$get_rsm_pulang = $db->query($sql_rsm_pulang);
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$found = $get_rsm_pulang->numRows();
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$dat_rp = $get_rsm_pulang->fetchAll()[0];
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$IDXF2 = ($found > 0) ? $dat_rp['IDXF2'] : null;
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?>
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<form name="kajian_awal_medis" method="post" id="kajian_awal_medis">
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<input type="hidden" name="input[IDXF2]" value="<?php echo $IDXF2;?>" />
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<input type="hidden" name="input[IDXRANAP]" id="idx_kajian" value="<?php echo $id_admission;?>" />
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<input type="hidden" name="input[NOMR]" id="nomr_kajian" value="<?php echo $nomr;?>" />
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<input type="hidden" name="input[TANGGALMASUK]" value="<?php echo $masukrs;?>" />
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<fieldset class="fieldset">
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<label class="col-form-label col-sm-12 pt-0" style="text-align:center"><h5>DAFTAR MASALAH FARMASI</h5></label>
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<div class="row">
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<fieldset class="form-group">
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<div class="row">
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<div class="col-sm-12">
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<div class="form-group row">
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<table class="table table-sm table-bordered table-striped" id="table_obat">
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<tr align="center" class="bg-success text-white">
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<th width="5%" rowspan="2">No</th>
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<th width="10%" rowspan="2">Tanggal Ditemukan</th>
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<th width="45%" rowspan="2">Masalah Awal <br> (Beri Tanda Centang Pada Kotak Dibawah Ini) </th>
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<th width="30%" colspan="3">Masalah</th>
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</tr>
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<tr>
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<th width="10%"><center>Selesai/Tanggal</center></th>
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<th width="10%"><center>Terkontrol/Tanggal</center></th>
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<th width="10%"><center>Tetap</center></th>
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</tr>
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<tr>
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<td>1</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGL1]" id="TGL1" size="30" value="<?php if( ($dat_rp['TGL1'] == '') or ($dat_rp['TGL1'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGL1']; endif;?>"/>
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</td>
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<td>
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<div class="form-check form-check-inline">
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<label class="form-check-label">
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<input class="form-check-input" id="" type="checkbox" value="1" name="input[URAIAN1]">
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Tidak Ada Masalah Obat
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</label>
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</div>
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<input type="text" class="form-control text" name="input[ISI1]" tabindex="8" placeholder="">
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTSELESAI1]" id="TGLTSELESAI1" size="30" value="<?php if( ($dat_rp['TGLTSELESAI1'] == '') or ($dat_rp['TGLTSELESAI1'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTSELESAI1']; endif;?>"/>
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTERKONTROL1]" id="TGLTERKONTROL1" size="30" value="<?php if( ($dat_rp['TGLTERKONTROL1'] == '') or ($dat_rp['TGLTERKONTROL1'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTERKONTROL1']; endif;?>"/>
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</td>
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<td><center><input class="form-check-input" id="" type="checkbox" value="1" name="input[TETAP1]"></center></td>
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</tr>
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<tr>
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<td>2</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGL2]" id="TGL2" size="30" value="<?php if( ($dat_rp['TGL2'] == '') or ($dat_rp['TGL2'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGL2']; endif;?>"/>
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</td>
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<td>
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<div class="form-check form-check-inline">
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<label class="form-check-label">
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<input class="form-check-input" id="" type="checkbox" value="1" name="input[URAIAN2]">
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Ada Indikasi Tapi tidak Diterapi Obat
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</label>
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</div>
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<input type="text" class="form-control text" name="input[ISI2]" tabindex="8" placeholder="">
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTSELESAI2]" id="TGLTSELESAI2" size="30" value="<?php if( ($dat_rp['TGLTSELESAI2'] == '') or ($dat_rp['TGLTSELESAI2'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTSELESAI2']; endif;?>"/>
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTERKONTROL2]" id="TGLTERKONTROL2" size="30" value="<?php if( ($dat_rp['TGLTERKONTROL2'] == '') or ($dat_rp['TGLTERKONTROL2'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTERKONTROL2']; endif;?>"/>
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</td>
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<td><center><input class="form-check-input" id="" type="checkbox" value="1" name="input[TETAP2]"></center></td>
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</tr>
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<tr>
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<td>3</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGL3]" id="TGL3" size="30" value="<?php if( ($dat_rp['TGL3'] == '') or ($dat_rp['TGL3'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGL3']; endif;?>"/>
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</td>
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<td>
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<div class="form-check form-check-inline">
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<label class="form-check-label">
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<input class="form-check-input" id="" type="checkbox" value="1" name="input[URAIAN3]">
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Tidak ada Indikasi Tapi diterapi Obat
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</label>
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</div>
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<input type="text" class="form-control text" name="input[ISI3]" tabindex="8" placeholder="">
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTSELESAI3]" id="TGLTSELESAI3" size="30" value="<?php if( ($dat_rp['TGLTSELESAI3'] == '') or ($dat_rp['TGLTSELESAI3'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTSELESAI3']; endif;?>"/>
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTERKONTROL3]" id="TGLTERKONTROL3" size="30" value="<?php if( ($dat_rp['TGLTERKONTROL3'] == '') or ($dat_rp['TGLTERKONTROL3'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTERKONTROL3']; endif;?>"/>
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</td>
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<td><center><input class="form-check-input" id="" type="checkbox" value="1" name="input[TETAP3]"></center></td>
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</tr>
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<tr>
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<td>4</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGL4]" id="TGL4" size="30" value="<?php if( ($dat_rp['TGL4'] == '') or ($dat_rp['TGL4'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGL4']; endif;?>"/>
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</td>
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<td>
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<div class="form-check form-check-inline">
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<label class="form-check-label">
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<input class="form-check-input" id="" type="checkbox" value="1" name="input[URAIAN4]">
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Pemilihan Obat tidak Tepat
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</label>
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</div>
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<input type="text" class="form-control text" name="input[ISI4]" tabindex="8" placeholder="">
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTSELESAI4]" id="TGLTSELESAI4" size="30" value="<?php if( ($dat_rp['TGLTSELESAI4'] == '') or ($dat_rp['TGLTSELESAI4'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTSELESAI4']; endif;?>"/>
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTERKONTROL4]" id="TGLTERKONTROL4" size="30" value="<?php if( ($dat_rp['TGLTERKONTROL4'] == '') or ($dat_rp['TGLTERKONTROL4'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTERKONTROL4']; endif;?>"/>
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</td>
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<td><center><input class="form-check-input" id="" type="checkbox" value="1" name="input[TETAP4]"></center></td>
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</tr>
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<tr>
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<td>5</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGL5]" id="TGL5" size="30" value="<?php if( ($dat_rp['TGL5'] == '') or ($dat_rp['TGL5'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGL5']; endif;?>"/>
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</td>
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<td>
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<div class="form-check form-check-inline">
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<label class="form-check-label">
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<input class="form-check-input" id="" type="checkbox" value="1" name="input[URAIAN5]">
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Dosis Obat Terlalu Rendah
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</label>
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</div>
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<input type="text" class="form-control text" name="input[ISI5]" tabindex="8" placeholder="">
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTSELESAI5]" id="TGLTSELESAI5" size="30" value="<?php if( ($dat_rp['TGLTSELESAI5'] == '') or ($dat_rp['TGLTSELESAI5'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTSELESAI5']; endif;?>"/>
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTERKONTROL5]" id="TGLTERKONTROL5" size="30" value="<?php if( ($dat_rp['TGLTERKONTROL5'] == '') or ($dat_rp['TGLTERKONTROL5'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTERKONTROL5']; endif;?>"/>
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</td>
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<td><center><input class="form-check-input" id="" type="checkbox" value="1" name="input[TETAP5]"></center></td>
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</tr>
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<tr>
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<td>6</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGL6]" id="TGL6" size="30" value="<?php if( ($dat_rp['TGL6'] == '') or ($dat_rp['TGL6'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGL6']; endif;?>"/>
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</td>
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<td>
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<div class="form-check form-check-inline">
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<label class="form-check-label">
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<input class="form-check-input" id="" type="checkbox" value="1" name="input[URAIAN6]">
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Dosis Obat Terlalu Tinggi
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</label>
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</div>
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<input type="text" class="form-control text" name="input[ISI6]" tabindex="8" placeholder="">
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTSELESAI6]" id="TGLTSELESAI6" size="30" value="<?php if( ($dat_rp['TGLTSELESAI6'] == '') or ($dat_rp['TGLTSELESAI6'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTSELESAI6']; endif;?>"/>
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTERKONTROL6]" id="TGLTERKONTROL6" size="30" value="<?php if( ($dat_rp['TGLTERKONTROL6'] == '') or ($dat_rp['TGLTERKONTROL6'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTERKONTROL6']; endif;?>"/>
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</td>
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<td><center><input class="form-check-input" id="" type="checkbox" value="1" name="input[TETAP6]"></center></td>
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</tr>
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<tr>
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<td>7</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGL7]" id="TGL7" size="30" value="<?php if( ($dat_rp['TGL7'] == '') or ($dat_rp['TGL7'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGL7']; endif;?>"/>
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</td>
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<td>
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<div class="form-check form-check-inline">
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<label class="form-check-label">
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<input class="form-check-input" id="" type="checkbox" value="1" name="input[URAIAN7]">
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Efek Samping Obat (Alergi, Non Alergi)
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</label>
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</div>
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<input type="text" class="form-control text" name="input[ISI7]" tabindex="8" placeholder="">
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTSELESAI7]" id="TGLTSELESAI7" size="30" value="<?php if( ($dat_rp['TGLTSELESAI7'] == '') or ($dat_rp['TGLTSELESAI7'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTSELESAI7']; endif;?>"/>
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTERKONTROL7]" id="TGLTERKONTROL7" size="30" value="<?php if( ($dat_rp['TGLTERKONTROL7'] == '') or ($dat_rp['TGLTERKONTROL7'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTERKONTROL7']; endif;?>"/>
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</td>
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<td><center><input class="form-check-input" id="" type="checkbox" value="1" name="input[TETAP7]"></center></td>
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</tr>
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<tr>
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<td>8</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGL8]" id="TGL8" size="30" value="<?php if( ($dat_rp['TGL8'] == '') or ($dat_rp['TGL8'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGL8']; endif;?>"/>
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</td>
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<td>
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<div class="form-check form-check-inline">
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<label class="form-check-label">
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<input class="form-check-input" id="" type="checkbox" value="1" name="input[URAIAN8]">
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Interaksi Obat (Obat-Obatan, Obat Makanan)
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</label>
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</div>
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<input type="text" class="form-control text" name="input[ISI8]" tabindex="8" placeholder="">
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTSELESAI8]" id="TGLTSELESAI8" size="30" value="<?php if( ($dat_rp['TGLTSELESAI8'] == '') or ($dat_rp['TGLTSELESAI8'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTSELESAI8']; endif;?>"/>
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTERKONTROL8]" id="TGLTERKONTROL8" size="30" value="<?php if( ($dat_rp['TGLTERKONTROL8'] == '') or ($dat_rp['TGLTERKONTROL8'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTERKONTROL8']; endif;?>"/>
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</td>
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<td><center><input class="form-check-input" id="" type="checkbox" value="1" name="input[TETAP8]"></center></td>
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</tr>
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<tr>
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<td>9</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGL9]" id="TGL9" size="30" value="<?php if( ($dat_rp['TGL9'] == '') or ($dat_rp['TGL9'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGL9']; endif;?>"/>
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</td>
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<td>
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<div class="form-check form-check-inline">
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<label class="form-check-label">
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<input class="form-check-input" id="" type="checkbox" value="1" name="input[URAIAN9]">
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Pasien Tidak Menggunakan Obat
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<input type="text" class="form-control text" name="input[ISI9]" tabindex="8" placeholder="">
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</label>
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</div>
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTSELESAI9]" id="TGLTSELESAI9" size="30" value="<?php if( ($dat_rp['TGLTSELESAI9'] == '') or ($dat_rp['TGLTSELESAI9'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTSELESAI9']; endif;?>"/>
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTERKONTROL9]" id="TGLTERKONTROL9" size="30" value="<?php if( ($dat_rp['TGLTERKONTROL9'] == '') or ($dat_rp['TGLTERKONTROL9'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTERKONTROL9']; endif;?>"/>
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</td>
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<td><center><input class="form-check-input" id="" type="checkbox" value="1" name="input[TETAP9]"></center></td>
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</tr>
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<tr>
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<td></td>
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<td></td>
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<td>Ada Faktor Penghambat Kepatuhan Minum Obat</td>
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<td></td>
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<td></td>
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<td></td>
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</tr>
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<tr>
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<td>10</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGL10]" id="TGL10" size="30" value="<?php if( ($dat_rp['TGL10'] == '') or ($dat_rp['TGL10'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGL10']; endif;?>"/>
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</td>
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<td>
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<div class="form-check form-check-inline">
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<label class="form-check-label">
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<input class="form-check-input" id="" type="checkbox" value="1" name="input[URAIAN10]">
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a. Pemahaman Tentang Obat
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</label>
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</div>
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<input type="text" class="form-control text" name="input[ISI10]" tabindex="8" placeholder="">
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTSELESAI10]" id="TGLTSELESAI10" size="30" value="<?php if( ($dat_rp['TGLTSELESAI10'] == '') or ($dat_rp['TGLTSELESAI10'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTSELESAI10']; endif;?>"/>
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</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTERKONTROL10]" id="TGLTERKONTROL10" size="30" value="<?php if( ($dat_rp['TGLTERKONTROL10'] == '') or ($dat_rp['TGLTERKONTROL10'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTERKONTROL10']; endif;?>"/>
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</td>
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<td><center><input class="form-check-input" id="" type="checkbox" value="1" name="input[TETAP10]"></center></td>
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</tr>
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<tr>
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<td>11</td>
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<td>
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<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGL11]" id="TGL11" size="30" value="<?php if( ($dat_rp['TGL11'] == '') or ($dat_rp['TGL11'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGL11']; endif;?>"/>
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</td>
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<td>
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<div class="form-check form-check-inline">
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<label class="form-check-label">
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<input class="form-check-input" id="" type="checkbox" value="1" name="input[URAIAN11]">
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b. Bahasa (Komunikasi)
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</label>
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</div>
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|
<input type="text" class="form-control text" name="input[ISI11]" tabindex="8" placeholder="">
|
|
</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTSELESAI11]" id="TGLTSELESAI11" size="30" value="<?php if( ($dat_rp['TGLTSELESAI11'] == '') or ($dat_rp['TGLTSELESAI11'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTSELESAI11']; endif;?>"/>
|
|
</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTERKONTROL11]" id="TGLTERKONTROL11" size="30" value="<?php if( ($dat_rp['TGLTERKONTROL11'] == '') or ($dat_rp['TGLTERKONTROL11'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTERKONTROL11']; endif;?>"/>
|
|
</td>
|
|
<td><center><input class="form-check-input" id="" type="checkbox" value="1" name="input[TETAP11]"></center></td>
|
|
</tr>
|
|
<tr>
|
|
<td>12</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGL12]" id="TGL12" size="30" value="<?php if( ($dat_rp['TGL12'] == '') or ($dat_rp['TGL12'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGL12']; endif;?>"/>
|
|
</td>
|
|
<td>
|
|
<div class="form-check form-check-inline">
|
|
<label class="form-check-label">
|
|
<input class="form-check-input" id="" type="checkbox" value="1" name="input[URAIAN12]">
|
|
c. Ingatan
|
|
</label>
|
|
</div>
|
|
<input type="text" class="form-control text" name="input[ISI12]" tabindex="8" placeholder="">
|
|
</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTSELESAI12]" id="TGLTSELESAI12" size="30" value="<?php if( ($dat_rp['TGLTSELESAI12'] == '') or ($dat_rp['TGLTSELESAI12'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTSELESAI12']; endif;?>"/>
|
|
</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTERKONTROL12]" id="TGLTERKONTROL12" size="30" value="<?php if( ($dat_rp['TGLTERKONTROL12'] == '') or ($dat_rp['TGLTERKONTROL12'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTERKONTROL12']; endif;?>"/>
|
|
</td>
|
|
<td><center><input class="form-check-input" id="" type="checkbox" value="1" name="input[TETAP12]"></center></td>
|
|
</tr>
|
|
<tr>
|
|
<td>13</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGL13]" id="TGL13" size="30" value="<?php if( ($dat_rp['TGL13'] == '') or ($dat_rp['TGL13'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGL13']; endif;?>"/>
|
|
</td>
|
|
<td>
|
|
<div class="form-check form-check-inline">
|
|
<label class="form-check-label">
|
|
<input class="form-check-input" id="" type="checkbox" value="1" name="input[URAIAN13]">
|
|
d. Tingkat Pendidikan
|
|
</label>
|
|
</div>
|
|
<input type="text" class="form-control text" name="input[ISI13]" tabindex="8" placeholder="">
|
|
</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTSELESAI13]" id="TGLTSELESAI13" size="30" value="<?php if( ($dat_rp['TGLTSELESAI13'] == '') or ($dat_rp['TGLTSELESAI13'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTSELESAI13']; endif;?>"/>
|
|
</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTERKONTROL13]" id="TGLTERKONTROL13" size="30" value="<?php if( ($dat_rp['TGLTERKONTROL13'] == '') or ($dat_rp['TGLTERKONTROL13'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTERKONTROL13']; endif;?>"/>
|
|
</td>
|
|
<td><center><input class="form-check-input" id="" type="checkbox" value="1" name="input[TETAP13]"></center></td>
|
|
</tr>
|
|
<tr>
|
|
<td>14</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGL14]" id="TGL14" size="30" value="<?php if( ($dat_rp['TGL14'] == '') or ($dat_rp['TGL14'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGL14']; endif;?>"/>
|
|
</td>
|
|
<td>
|
|
<div class="form-check form-check-inline">
|
|
<label class="form-check-label">
|
|
<input class="form-check-input" id="" type="checkbox" value="1" name="input[URAIAN14]">
|
|
e. Kemampuan Penggunaan Obat Secara Mandiri
|
|
</label>
|
|
</div>
|
|
<input type="text" class="form-control text" name="input[ISI14]" tabindex="8" placeholder="">
|
|
</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTSELESAI14]" id="TGLTSELESAI14" size="30" value="<?php if( ($dat_rp['TGLTSELESAI14'] == '') or ($dat_rp['TGLTSELESAI14'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTSELESAI14']; endif;?>"/>
|
|
</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTERKONTROL14]" id="TGLTERKONTROL14" size="30" value="<?php if( ($dat_rp['TGLTERKONTROL14'] == '') or ($dat_rp['TGLTERKONTROL14'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTERKONTROL14']; endif;?>"/>
|
|
</td>
|
|
<td><center><input class="form-check-input" id="" type="checkbox" value="1" name="input[TETAP14]"></center></td>
|
|
</tr>
|
|
<tr>
|
|
<td>15</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGL15]" id="TGL15" size="30" value="<?php if( ($dat_rp['TGL15'] == '') or ($dat_rp['TGL15'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGL15']; endif;?>"/>
|
|
</td>
|
|
<td>
|
|
<div class="form-check form-check-inline">
|
|
<label class="form-check-label">
|
|
<input class="form-check-input" id="" type="checkbox" value="1" name="input[URAIAN15]">
|
|
f. Kebosanan
|
|
</label>
|
|
</div>
|
|
<input type="text" class="form-control text" name="input[ISI15]" tabindex="8" placeholder="">
|
|
</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTSELESAI15]" id="TGLTSELESAI15" size="30" value="<?php if( ($dat_rp['TGLTSELESAI15'] == '') or ($dat_rp['TGLTSELESAI15'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTSELESAI15']; endif;?>"/>
|
|
</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTERKONTROL15]" id="TGLTERKONTROL15" size="30" value="<?php if( ($dat_rp['TGLTERKONTROL15'] == '') or ($dat_rp['TGLTERKONTROL15'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTERKONTROL15']; endif;?>"/>
|
|
</td>
|
|
<td><center><input class="form-check-input" id="" type="checkbox" value="1" name="input[TETAP15]"></center></td>
|
|
</tr>
|
|
<tr>
|
|
<td>16</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGL16]" id="TGL16" size="30" value="<?php if( ($dat_rp['TGL16'] == '') or ($dat_rp['TGL16'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGL16']; endif;?>"/>
|
|
</td>
|
|
<td>
|
|
<div class="form-check form-check-inline">
|
|
<label class="form-check-label">
|
|
<input class="form-check-input" id="" type="checkbox" value="1" name="input[URAIAN16]">
|
|
g. Polifarmasi
|
|
</label>
|
|
</div>
|
|
<input type="text" class="form-control text" name="input[ISI16]" tabindex="8" placeholder="">
|
|
</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTSELESAI16]" id="TGLTSELESAI16" size="30" value="<?php if( ($dat_rp['TGLTSELESAI16'] == '') or ($dat_rp['TGLTSELESAI16'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTSELESAI16']; endif;?>"/>
|
|
</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTERKONTROL16]" id="TGLTERKONTROL16" size="30" value="<?php if( ($dat_rp['TGLTERKONTROL16'] == '') or ($dat_rp['TGLTERKONTROL16'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTERKONTROL16']; endif;?>"/>
|
|
</td>
|
|
<td><center><input class="form-check-input" id="" type="checkbox" value="1" name="input[TETAP16]"></center></td>
|
|
</tr>
|
|
<tr>
|
|
<td>17</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGL17]" id="TGL17" size="30" value="<?php if( ($dat_rp['TGL17'] == '') or ($dat_rp['TGL17'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGL17']; endif;?>"/>
|
|
</td>
|
|
<td>
|
|
<div class="form-check form-check-inline">
|
|
<label class="form-check-label">
|
|
<input class="form-check-input" id="" type="checkbox" value="1" name="input[URAIAN17]">
|
|
Lain-lain
|
|
</label>
|
|
</div>
|
|
<input type="text" class="form-control text" name="input[ISI17]" tabindex="8" placeholder="">
|
|
</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTSELESAI17]" id="TGLTSELESAI17" size="30" value="<?php if( ($dat_rp['TGLTSELESAI17'] == '') or ($dat_rp['TGLTSELESAI17'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTSELESAI17']; endif;?>"/>
|
|
</td>
|
|
<td>
|
|
<input type="text" class="datepicker-default mask-date-default form-control" name="input[TGLTERKONTROL17]" id="TGLTERKONTROL17" size="30" value="<?php if( ($dat_rp['TGLTERKONTROL17'] == '') or ($dat_rp['TGLTERKONTROL17'] == '0000-00-00')): echo date('Y-m-d'); else: echo $dat_rp['TGLTERKONTROL17']; endif;?>"/>
|
|
</td>
|
|
<td><center><input class="form-check-input" id="" type="checkbox" value="1" name="input[TETAP17]"></center></td>
|
|
</tr>
|
|
</table>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
|
|
<hr>
|
|
<div class="form-group row">
|
|
<div class="col-sm-12 pt-0" style="text-align:center;">
|
|
<input type="button" name="Submit" id="simpankajianmedis" value="Simpan" class="btn btn-primary" tabindex="41"/>
|
|
</div>
|
|
</div>
|
|
</fieldset>
|
|
</div>
|
|
</fieldset>
|
|
</form>
|
|
<!-- <div id="valid_kajian_awal"></div> -->
|
|
<script>
|
|
$(document).ready(function(){
|
|
$.get("<?php echo _BASE_;?>ranap/save_kajian_awal.php",{get_data:true,NOMR:$("#nomr_kajian").val(),IDXRANAP:$("#idx_kajian").val()},function(data)
|
|
{
|
|
$("#valid_kajian_awal").html(data.html);
|
|
},"json");
|
|
|
|
$('#simpankajianmedis').click(function(){
|
|
$.post('<?php echo _BASE_;?>ranap/save_kajian_awal.php',$('#kajian_awal_medis').serialize()+"&save=1",function(data){
|
|
Toast.fire({title:data.message,type:data.type,onClose : function(){
|
|
window.location.reload();
|
|
}});
|
|
},"json");
|
|
});
|
|
|
|
});
|
|
</script>
|