77 lines
2.7 KiB
PHP
77 lines
2.7 KiB
PHP
<form action="save_dpmp.php" name="dpmp" method="post" id="dpmp">
|
|
<input type="hidden" name="IDXDAFTAR" value="<?php echo $id_admission;?>" />
|
|
<input type="hidden" name="NOMR" value="<?php echo $nomr;?>" />
|
|
<input type="hidden" name="RUANG" value="<?php echo $noruang;?>" />
|
|
<table width="95%" class="tb" border="0">
|
|
<tr valign="top">
|
|
<td width="17%">DIIT :</td>
|
|
<td colspan="2">
|
|
Shift :
|
|
<input type="radio" name="SHIFT" value="1"/> Pagi
|
|
<input type="radio" name="SHIFT" value="2"/> Siang
|
|
<input type="radio" name="SHIFT" value="3"/> Sore
|
|
<span style="padding-left:100px;">Snack :
|
|
<input type="radio" name="SNACK" value="1"/> Pagi
|
|
<input type="radio" name="SNACK" value="2"/> Sore</span> </td>
|
|
</tr>
|
|
<tr>
|
|
<td>TYPE MAKANAN</td>
|
|
<td width="30%">
|
|
<select name="TYPEMAKANAN" class="text">
|
|
<option selected="selected"> -Pilih- </option>
|
|
<option value="1">PASIEN YANG MENDAPAT MAKANAN BIASA</option>
|
|
<option value="2">PASIEN YANG MENDAPAT MAKANAN KHUSUS</option>
|
|
</select>
|
|
</td>
|
|
<td width="53%">KETERANGAN TAMBAHAN</td>
|
|
</tr>
|
|
<tr>
|
|
<td>KETERANGAN</td>
|
|
<td>
|
|
<select name="KETERANGAN" class="text">
|
|
<option selected="selected"> -Pilih- </option>
|
|
<option value="1">TKTP</option>
|
|
<option value="2">RG</option>
|
|
<option value="3">DL</option>
|
|
<option value="4">DH</option>
|
|
<option value="5">DM</option>
|
|
<option value="6">DJ</option>
|
|
<option value="7">TP</option>
|
|
<option value="8">RP.r</option>
|
|
<option value="9">RP</option>
|
|
<option value="10">LAIN-LAIN</option>
|
|
</select>
|
|
</td>
|
|
<td rowspan="5" valign="top"><textarea name="KETERANGANTAMBAHAN" class="text" cols="50" rows="6"></textarea></td>
|
|
</tr>
|
|
<tr>
|
|
<td>JENIS MAKANAN</td>
|
|
<td>
|
|
<select name="JENISMAKANAN" class="text">
|
|
<option selected="selected"> -Pilih- </option>
|
|
<option value="1">Nasi</option>
|
|
<option value="6">Nasi TIM (TIM)</option>
|
|
<option value="2">Lunak / BUBUR</option>
|
|
<option value="3">Bubur Saring</option>
|
|
<option value="4">Cair</option>
|
|
<option value="5">Sonde</option>
|
|
</select>
|
|
</td>
|
|
</tr>
|
|
<tr>
|
|
<td> </td>
|
|
<td><input type="submit" name="Submit" value="Simpan" class="text" onclick="newsubmitform (document.getElementById('dpmp'),'ranap/save_dpmp.php','valid_save_dpmp',validatetask); return false;"/></td>
|
|
</tr>
|
|
<tr>
|
|
<td> </td>
|
|
<td> </td>
|
|
</tr>
|
|
<tr>
|
|
<td> </td>
|
|
<td> </td>
|
|
</tr>
|
|
</table>
|
|
</form>
|
|
<div id="valid_save_dpmp">
|
|
<?php include("save_update_dpmp.php"); ?>
|
|
</div>
|