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dpurbosakti
2025-12-02 13:37:26 +07:00
parent 7e454b0a2d
commit 5adb4e5666
8 changed files with 361 additions and 43 deletions
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assets/docs/screening-form-a.html
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<html>
<head>
<meta charset="UTF-8" />
<style>
body {
padding: 2rem 3rem;
}
table {
width: 100%;
border-collapse: collapse
}
td {
vertical-align: top;
}
.border-table,
.border-table td,
.border-table th {
border: 1px solid black;
}
.section-title {
margin-top: 1rem;
margin-bottom: 0rem;
}
.data-label {
width: 9rem;
}
.data-colon {
width: 0.1234rem;
}
</style>
</head>
<body style="font-family: Arial, sans-serif; line-height: 1.4">
<table style="margin-top: 1rem;">
<tr>
<td style="width: 9rem;">
Tanggal Terbit
</td>
<td class="data-colon">: </td>
<td>{{ .Repalcable }}</td>
</tr>
<tr>
<td>
No. RM
</td>
<td class="data-colon">: </td>
<td>{{ .Repalcable }}</td>
</tr>
<tr>
<td>
Nama
</td>
<td class="data-colon">: </td>
<td>{{ .Repalcable }}</td>
</tr>
<tr>
<td>
Tanggal Lahir
</td>
<td class="data-colon">: </td>
<td>{{ .Repalcable }}</td>
</tr>
</table>
<hr style="margin: 20px 0" />
<h1 style="
text-align: center;
font-weight: bold;
font-size: 1rem;
margin: 0;
">
FORM A
</h1>
<section>
<h4 class="section-title">Kajian Awal Medis:</i></h4>
<table style="margin-top: 0.3rem;">
<tr>
<td>
&#9745; Kasus Dengan Penyakit Kronis, Katastropik (memerlukan Pembiayaan Tinggi), Terminal
</td>
</tr>
<tr>
<td>
&#9634; Status Fungsional Rendah, Kebutuhan Bantuan ADL(Activity Daily Living) Yang Tinggi
</td>
</tr>
</table>
</section>
<section>
<h4 class="section-title">ASSESMEN:</h4>
<table style="margin-top: 0.3rem;">
</table>
</section>
<section>
<h4 class="section-title">IDENTIFIKASI MASALAH:</h4>
<table style="margin-top: 0.3rem;">
</table>
</section>
<section>
<h4 class="section-title">PERENCANAAN:</h4>
<table style="margin-top: 0.3rem;">
</table>
</section>
<table style="margin-top: 3rem;">
<tr>
<td></td>
<td style="text-align: center;width: 15rem;">
2025-10-08 16:06:22
</td>
</tr>
<tr>
<td></td>
<td style="text-align: center;height: 10rem;width: 15rem;">
GATOT SUBROTO,AMd.Kep
</td>
</tr>
</table>
<div style="height: 3rem;"></div>
</body>
</html>