286 lines
15 KiB
PHP
286 lines
15 KiB
PHP
<?php
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$m_ppa = $db->query("SELECT * from m_ppa");
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if($m_ppa->numRows() > 0)
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{
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$arr_ppa = array();
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foreach($m_ppa->fetchAll() as $ds) {
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$arr_ppa[$ds['id_ppa']] = $ds['nama_ppa'];
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}
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}
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?>
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<form action="ranap/save_formulis_khusus.php" name="formulir_khusus" method="post" id="formulir_khusus">
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<input type="hidden" name="id_admission" value="<?php echo $id_admission;?>" />
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<input type="hidden" name="nomr" value="<?php echo $nomr;?>" />
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<input type="hidden" name="noruang" value="<?php echo $noruang;?>" />
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<fieldset class="fieldset">
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<label class="col-form-label col-sm-12 pt-0" style="text-align:center"><h5>ASSESSMEN KEBUTUHAN EDUKASI</h5></label>
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<div class="row">
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<fieldset class="form-group">
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<div class="row">
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<div class="col-sm-6">
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:left"> KEBUTUHAN EDUKASI </label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Informasi Umum</label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<select name="informasi_umum" id="informasi_umum" class="form-control text" style="width: 100%">
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<option value=""> -- </option>
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<?php
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$qryiu = $db->query("SELECT * FROM t_kebutuhan_edukasi where jenis_kebutuhan = 'UMUM' ORDER BY id_kebutuhan ASC");
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foreach($qryiu->fetchAll() as $listiu) {
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?>
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<option value="<?php echo $listiu['nama_kebutuhan'];?>"><?php echo $listiu['nama_kebutuhan'];?></option>
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<?php } ?>
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</select>
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-12 pt-0" style="text-align:left">ASSASMENT KEMAMPUAN DAN KEMAUAN BELAJAR</label>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Kemampuan Belajar</label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<select name="kemampuan_belajar" id="kemampuan_belajar" class="form-control text" style="width: 100%">
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<option value=""> -- </option>
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<?php
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$qryiu = $db->query("SELECT * FROM t_kemampuan_belajar where jenis_kemampuan = 'KEMAMPUAN' ORDER BY id_kemampuan_belajar ASC");
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foreach($qryiu->fetchAll() as $listiu) {
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?>
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<option value="<?php echo $listiu['nama_kemampuan'];?>"><?php echo $listiu['nama_kemampuan'];?></option>
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<?php } ?>
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</select>
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Hambatan</label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<select name="hambatan" id="hambatan" class="form-control text" style="width: 100%">
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<option value=""> -- </option>
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<?php
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$qryiu = $db->query("SELECT * FROM t_kemampuan_belajar where jenis_kemampuan = 'HAMBATAN' ORDER BY id_kemampuan_belajar ASC");
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foreach($qryiu->fetchAll() as $listiu) {
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?>
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<option value="<?php echo $listiu['nama_kemampuan'];?>"><?php echo $listiu['nama_kemampuan'];?></option>
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<?php } ?>
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</select>
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Bahasa yang digunakan</label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<input type="text" name="bahasa" id="bahasa" class="form-control text">
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Membutuhkan Penterjemah</label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<select name="hambatan_penterjemah" id="hambatan_penterjemah" class="form-control text" style="width: 100%">
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<option value=""> -- </option>
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<option value="Ya">Ya</option>
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<option value="Tidak">Tidak</option>
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</select>
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Keyakinan dan Nilai-nilai yang dianut</label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<select name="keyakinan" id="keyakinan" class="form-control text" style="width: 100%">
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<option value=""> -- </option>
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<option value="Ya">Ya</option>
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<option value="Tidak">Tidak</option>
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</select>
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">PPA</label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<?php echo form_dropdown('kategori_ppa',$arr_ppa,'','class="form-control" id="kategori_ppa" style="width:100%"'); ?>
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Rencana Edukasi</label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<textarea name="rencana_edukasi" cols="60" rows="5" class="form-control text" placeholder="Sesuaikan dengan hasil assessment edukasi"></textarea>
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-12 pt-0" style="text-align:left"> PELAKSANAAN EDUKASI DAN VERIFIKASI TERINTEGRASI</label>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Tanggal</label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<input type="text" name="tanggal" class="form-control text" readonly value="<?php echo date('Y-m-d') ?>">
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Materi Edukasi</label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<textarea name="materi_edukasi" cols="60" rows="5" class="form-control text"></textarea>
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Hasil Verifikasi</label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<textarea name="hasil_verifikasi" cols="60" rows="5" class="form-control text"></textarea>
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</div>
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</div>
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</div>
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<div class="col-sm-6">
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right"> </label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Edukasi Khusus</label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<select name="edukasi_khusus" id="edukasi_khusus" class="form-control text" style="width: 100%">
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<option value=""> -- </option>
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<?php
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$qryiu = $db->query("SELECT * FROM t_kebutuhan_edukasi where jenis_kebutuhan = 'KHUSUS' ORDER BY id_kebutuhan ASC");
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foreach($qryiu->fetchAll() as $listiu) {
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?>
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<option value="<?php echo $listiu['nama_kebutuhan'];?>"><?php echo $listiu['nama_kebutuhan'];?></option>
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<?php } ?>
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</select>
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right"> </label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Kemauan Belajar</label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<select name="kemauan_belajar" id="kemauan_belajar" class="form-control text" style="width: 100%">
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<option value=""> -- </option>
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<?php
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$qryiu = $db->query("SELECT * FROM t_kemampuan_belajar where jenis_kemampuan = 'KEMAUAN' ORDER BY id_kemampuan_belajar ASC");
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foreach($qryiu->fetchAll() as $listiu) {
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?>
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<option value="<?php echo $listiu['nama_kemampuan'];?>"><?php echo $listiu['nama_kemampuan'];?></option>
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<?php } ?>
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</select>
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Metode Pembelajaran</label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<select name="metode_pembelajaran" id="metode_pembelajaran" class="form-control text" style="width: 100%">
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<option value=""> -- </option>
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<?php
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$qryiu = $db->query("SELECT * FROM t_kemampuan_belajar where jenis_kemampuan = 'METODE' ORDER BY id_kemampuan_belajar ASC");
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foreach($qryiu->fetchAll() as $listiu) {
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?>
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<option value="<?php echo $listiu['nama_kemampuan'];?>"><?php echo $listiu['nama_kemampuan'];?></option>
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<?php } ?>
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</select>
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Hambatan Bahasa</label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<select name="hambatan_bahasa" id="hambatan_bahasa" class="form-control text" style="width: 100%">
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<option value=""> -- </option>
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<option value="Ya">Ya</option>
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<option value="Tidak">Tidak</option>
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</select>
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Penterjemah<br> </label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<select name="penterjemah" id="penterjemah" class="form-control text" style="width: 100%">
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<option value=""> -- </option>
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<option value="Tim Penterjemah">Tim Penterjemah</option>
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<option value="Keluarga">Keluarga</option>
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</select>
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Sebutkan<br> </label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<input type="text" id="sebutkan" name="sebutkan" class="form-control text">
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Nama PPA</label>
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<div class="col-sm-8 pt-0" style="text-align:left" id="temp_ppa_f9">
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<?php echo form_dropdown('perawat',array(),'','class="form-control" id="perawat"'); ?>
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right"> </label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right"> </label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right"> </label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right"> </label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<br>
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right"> </label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right">Kebutuhan Edukasi</label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<textarea name="kebutuhan_edukasi" cols="60" rows="5" class="form-control text" ></textarea>
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</div>
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</div>
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<div class="form-group row">
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<label class="col-form-label col-sm-4 pt-0" style="text-align:right"></label>
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<div class="col-sm-8 pt-0" style="text-align:left">
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<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;"/>
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</div>
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</div>
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</div>
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</div>
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</fieldset>
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</div>
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</fieldset>
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<div id="valid_formulir_khusus" >
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<?php include("save_formulir_khusus.php"); ?>
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</div>
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</form>
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<script>
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$(document).ready(function(){
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$("#kategori_ppa").on("change",function()
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{
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$jenis = $(this).find(":selected").val();
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$.post("<?php echo _BASE_.'include/master.php'; ?>",{ppa:true,jenis_ppa:$jenis},function(d)
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{
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$("#temp_ppa_f9").html(d);
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$("select").select2();
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});
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});
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$("#kategori_ppa").trigger("change");
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});
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</script>
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