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fix template screening form a

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dpurbosakti
2025-12-02 16:12:13 +07:00
parent ef2189794f
commit 821c99833e
4 changed files with 214 additions and 40 deletions
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assets/docs/screening-form-a.html
+73 -37
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@@ -32,34 +32,43 @@
</head>
<body style="font-family: Arial, sans-serif; line-height: 1.4">
<table style="margin-top: 1rem;">
<!-- Tanggal Terbit (top-right) -->
<div style="
text-align: right;
margin-right: 2rem;
font-size: 0.95rem;
margin-top: 0.5rem;
">
Tanggal Terbit : {{ .IssuedDate }}
</div>
<!-- Patient Info Box -->
<table
style="
margin-top: 1rem;
margin-left: auto;
margin-right: 2rem; /* space from right like example */
border: 1px solid #000;
padding: 0.5rem 1rem;
border-collapse: separate;
border-spacing: 0.3rem 0.2rem;
width: auto;
"
>
<tr>
<td style="width: 9rem;">
Tanggal Terbit
</td>
<td class="data-colon">: </td>
<td>{{ .Repalcable }}</td>
<td style="width: 9rem;">No. RM</td>
<td class="data-colon">:</td>
<td>{{ .MedicalRecord }}</td>
</tr>
<tr>
<td>
No. RM
</td>
<td class="data-colon">: </td>
<td>{{ .Repalcable }}</td>
<td>Nama</td>
<td class="data-colon">:</td>
<td><b>{{ .Name }}</b></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>
<td>Tanggal Lahir</td>
<td class="data-colon">:</td>
<td>{{ .BirthDate }}</td>
</tr>
</table>
@@ -69,58 +78,85 @@
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;">
{{ if gt (len .EarlyMedic) 0 }}
{{ range .EarlyMedic }}
<tr>
<td>
&#9745; Kasus Dengan Penyakit Kronis, Katastropik (memerlukan Pembiayaan Tinggi), Terminal
&#9745; {{ . }}
</td>
</tr>
{{ end }}
{{ else }}
<tr>
<td>
&#9634; Status Fungsional Rendah, Kebutuhan Bantuan ADL(Activity Daily Living) Yang Tinggi
</td>
<td></td>
</tr>
</table>
{{ end }}
</table>
</section>
<section>
<h4 class="section-title">ASSESMEN:</h4>
<table style="margin-top: 0.3rem;">
<tr>
<td>
{{ .Assessment }}
</td>
</tr>
</table>
</section>
<section>
<h4 class="section-title">IDENTIFIKASI MASALAH:</h4>
<table style="margin-top: 0.3rem;">
</table>
{{ if gt (len .ProblemIdentification) 0 }}
{{ range .ProblemIdentification }}
<tr>
<td>
&#9745; {{ . }}
</td>
</tr>
{{ end }}
{{ else }}
<tr>
<td></td>
</tr>
{{ end }}
</table>
</section>
<section>
<h4 class="section-title">PERENCANAAN:</h4>
<table style="margin-top: 0.3rem;">
<tr>
<td>
{{ .Planning }}
</td>
</tr>
</table>
</section>
<table style="margin-top: 3rem;">
<tr>
<td></td>
<td style="text-align: center;width: 15rem;">
2025-10-08 16:06:22
<td style="text-align: center; width: 15rem;">
{{ .Date }}<br>
</td>
</tr>
<tr><td style="height: 7rem;"></td></tr>
<tr>
<td></td>
<td style="text-align: center;height: 10rem;width: 15rem;">
GATOT SUBROTO,AMd.Kep
<td style="text-align: center; width: 15rem;">
({{ .Employee_Name }})
</td>
</tr>
</table>