simrs-jatim/ranap/form_f9.php

<?php
$m_ppa = $db->query("SELECT * from m_ppa");
if($m_ppa->numRows() > 0)
{
  $arr_ppa = array();
  foreach($m_ppa->fetchAll() as $ds) {
    $arr_ppa[$ds['id_ppa']] = $ds['nama_ppa'];
  }
}
?>
<form action="ranap/save_formulis_khusus.php" name="formulir_khusus" method="post" id="formulir_khusus">
<input type="hidden" name="id_admission" value="<?php echo $id_admission;?>" />
<input type="hidden" name="nomr" value="<?php echo $nomr;?>" />
<input type="hidden" name="noruang" value="<?php echo $noruang;?>" />

 <fieldset class="fieldset">
    <label class="col-form-label col-sm-12 pt-0" style="text-align:center"><h5>ASSESSMEN KEBUTUHAN EDUKASI</h5></label>
    <div class="row">
      <fieldset class="form-group">
        <div class="row">
          <div class="col-sm-6">
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:left">&nbsp;&nbsp;KEBUTUHAN EDUKASI </label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                &nbsp;
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Informasi Umum</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <select name="informasi_umum" id="informasi_umum" class="form-control text"  style="width: 100%">
                    <option value=""> -- </option>
                    <?php
                    $qryiu = $db->query("SELECT * FROM t_kebutuhan_edukasi where jenis_kebutuhan = 'UMUM' ORDER BY id_kebutuhan ASC");
                    foreach($qryiu->fetchAll() as $listiu) {
                    ?>
                    <option value="<?php echo $listiu['nama_kebutuhan'];?>"><?php echo $listiu['nama_kebutuhan'];?></option>
                    <?php } ?>
                </select>
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-12 pt-0" style="text-align:left">ASSASMENT KEMAMPUAN DAN KEMAUAN BELAJAR</label>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Kemampuan Belajar</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <select name="kemampuan_belajar" id="kemampuan_belajar" class="form-control text"  style="width: 100%">
                    <option value=""> -- </option>
                    <?php
                    $qryiu = $db->query("SELECT * FROM t_kemampuan_belajar where jenis_kemampuan = 'KEMAMPUAN' ORDER BY id_kemampuan_belajar ASC");
                    foreach($qryiu->fetchAll() as $listiu) {
                    ?>
                    <option value="<?php echo $listiu['nama_kemampuan'];?>"><?php echo $listiu['nama_kemampuan'];?></option>
                    <?php } ?>
                </select>
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Hambatan</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <select name="hambatan" id="hambatan" class="form-control text"  style="width: 100%">
                    <option value=""> -- </option>
                    <?php
                    $qryiu = $db->query("SELECT * FROM t_kemampuan_belajar where jenis_kemampuan = 'HAMBATAN' ORDER BY id_kemampuan_belajar ASC");
                    foreach($qryiu->fetchAll() as $listiu) {
                    ?>
                    <option value="<?php echo $listiu['nama_kemampuan'];?>"><?php echo $listiu['nama_kemampuan'];?></option>
                    <?php } ?>
                </select>
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Bahasa yang digunakan</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <input type="text" name="bahasa" id="bahasa" class="form-control text">
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Membutuhkan Penterjemah</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <select name="hambatan_penterjemah" id="hambatan_penterjemah" class="form-control text"  style="width: 100%">
                    <option value=""> -- </option>
                    <option value="Ya">Ya</option>
                    <option value="Tidak">Tidak</option>
                </select>
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Keyakinan dan Nilai-nilai yang dianut</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <select name="keyakinan" id="keyakinan" class="form-control text"  style="width: 100%">
                    <option value=""> -- </option>
                    <option value="Ya">Ya</option>
                    <option value="Tidak">Tidak</option>
                </select>
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">PPA</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <?php echo form_dropdown('kategori_ppa',$arr_ppa,'','class="form-control" id="kategori_ppa" style="width:100%"'); ?>
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Rencana Edukasi</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <textarea  name="rencana_edukasi" cols="60" rows="5" class="form-control text" placeholder="Sesuaikan dengan hasil assessment edukasi"></textarea>
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-12 pt-0" style="text-align:left">&nbsp;&nbsp;PELAKSANAAN EDUKASI DAN VERIFIKASI TERINTEGRASI</label>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Tanggal</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <input type="text"  name="tanggal" class="form-control text" readonly value="<?php echo date('Y-m-d') ?>">
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Materi Edukasi</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <textarea name="materi_edukasi" cols="60" rows="5"  class="form-control text"></textarea>
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Hasil Verifikasi</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <textarea name="hasil_verifikasi" cols="60" rows="5"  class="form-control text"></textarea>
              </div>
            </div>
          </div>
          <div class="col-sm-6">
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">&nbsp;</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                &nbsp;
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Edukasi Khusus</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <select name="edukasi_khusus" id="edukasi_khusus" class="form-control text"  style="width: 100%">
                    <option value=""> -- </option>
                    <?php
                    $qryiu = $db->query("SELECT * FROM t_kebutuhan_edukasi where jenis_kebutuhan = 'KHUSUS' ORDER BY id_kebutuhan ASC");
                    foreach($qryiu->fetchAll() as $listiu) {
                    ?>
                    <option value="<?php echo $listiu['nama_kebutuhan'];?>"><?php echo $listiu['nama_kebutuhan'];?></option>
                    <?php } ?>
                </select>
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">&nbsp;</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                &nbsp;
              </div>
            </div>
            <div class="form-group row">
                <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Kemauan Belajar</label>
                <div class="col-sm-8 pt-0" style="text-align:left">
                <select name="kemauan_belajar" id="kemauan_belajar" class="form-control text"  style="width: 100%">
                    <option value=""> -- </option>
                    <?php
                    $qryiu = $db->query("SELECT * FROM t_kemampuan_belajar where jenis_kemampuan = 'KEMAUAN' ORDER BY id_kemampuan_belajar ASC");
                    foreach($qryiu->fetchAll() as $listiu) {
                    ?>
                    <option value="<?php echo $listiu['nama_kemampuan'];?>"><?php echo $listiu['nama_kemampuan'];?></option>
                    <?php } ?>
                </select>
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Metode Pembelajaran</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <select name="metode_pembelajaran" id="metode_pembelajaran" class="form-control text"  style="width: 100%">
                    <option value=""> -- </option>
                    <?php
                    $qryiu = $db->query("SELECT * FROM t_kemampuan_belajar where jenis_kemampuan = 'METODE' ORDER BY id_kemampuan_belajar ASC");
                    foreach($qryiu->fetchAll() as $listiu) {
                    ?>
                    <option value="<?php echo $listiu['nama_kemampuan'];?>"><?php echo $listiu['nama_kemampuan'];?></option>
                    <?php } ?>
                </select>
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Hambatan Bahasa</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <select name="hambatan_bahasa" id="hambatan_bahasa" class="form-control text"  style="width: 100%">
                    <option value=""> -- </option>
                    <option value="Ya">Ya</option>
                    <option value="Tidak">Tidak</option>
                </select>
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Penterjemah<br>&nbsp;</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <select name="penterjemah" id="penterjemah" class="form-control text"  style="width: 100%">
                    <option value=""> -- </option>
                    <option value="Tim Penterjemah">Tim Penterjemah</option>
                    <option value="Keluarga">Keluarga</option>
                </select>
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Sebutkan<br>&nbsp;</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <input type="text" id="sebutkan" name="sebutkan" class="form-control text">
              </div>
            </div>
             <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Nama PPA</label>
              <div class="col-sm-8 pt-0" style="text-align:left" id="temp_ppa_f9">
                <?php echo form_dropdown('perawat',array(),'','class="form-control" id="perawat"'); ?>
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">&nbsp;</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                &nbsp;
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">&nbsp;</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                &nbsp;
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">&nbsp;</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                &nbsp;
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">&nbsp;</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <br>&nbsp;
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">&nbsp;</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                &nbsp;
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right">Kebutuhan Edukasi</label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <textarea  name="kebutuhan_edukasi" cols="60" rows="5" class="form-control text" ></textarea>
              </div>
            </div>
            <div class="form-group row">
              <label class="col-form-label col-sm-4 pt-0" style="text-align:right"></label>
              <div class="col-sm-8 pt-0" style="text-align:left">
                <input type="submit" name="Submit" value="Simpan" class="btn btn-primary text" onclick="newsubmitform (document.getElementById('formulir_khusus'),'ranap/save_formulir_khusus.php','valid_formulir_khusus',validatetask); return false;"/>  
              </div>
            </div>
          </div>
        </div>
      </fieldset>
    </div>
</fieldset>

<div id="valid_formulir_khusus" >
<?php include("save_formulir_khusus.php"); ?>
</div>
</form>
<script>
$(document).ready(function(){
    $("#kategori_ppa").on("change",function()
    {
      $jenis = $(this).find(":selected").val();
      $.post("<?php echo _BASE_.'include/master.php'; ?>",{ppa:true,jenis_ppa:$jenis},function(d)
      {
        $("#temp_ppa_f9").html(d);
        $("select").select2();
      });
    });

    $("#kategori_ppa").trigger("change");
});
</script>