65 lines
2.0 KiB
PHP
65 lines
2.0 KiB
PHP
<?php
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$sql_rsm_pulang = "SELECT * FROM t_kajianawalmedis WHERE IDXRANAP = '".$id_admission."'";
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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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<h3 class="text-center">DAFTAR PENGGUNAAN DOKUMEN REKAM MEDIS <br> UNTUK PENDIDIK DAN PENELITIAN <br> DI SEKSI REKAM MEDIK</h3>
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<form method="post" id="dokumen_form" enctype="multipart/form-data">
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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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<div class="row text-left">
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<div class="col-md-9 col-lg-9 mt-5">
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<div class="form-group">
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<label >Stempel</label>
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<div class="control">
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<input type="text" name="input[stempel]" class="form-control">
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</div>
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</div>
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<div class="form-group">
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<label >Keperluan</label>
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<div class="control">
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<input type="text" name="input[keperluan]" class="form-control">
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</div>
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</div>
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<div class="form-group">
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<label >Instalasi</label>
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<div class="control">
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<input type="text" name="input[instalasi]" class="form-control">
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</div>
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</div>
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<div class="form-group">
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<label >Pengguna</label>
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<div class="control">
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<input type="text" name="input[pengguna]" class="form-control">
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</div>
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</div>
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<div class="form-group">
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<div class="control">
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<button class="btn btn-primary mt-5">S I M P A N</button>
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</div>
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</div>
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</div>
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</div>
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</form>
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<table class="table table-bordered table-striped table-sm mt-3" style="width:100% !important;">
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<tr class="bg-green">
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<th>NO</th>
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<th>STEMPEL</th>
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<th>KEPERLUAN</th>
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<th>INSTALASI</th>
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<th>PENGGUNA</th>
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</tr>
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</table>
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<script type="text/javascript">
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</script>
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