167 lines
3.8 KiB
HTML
167 lines
3.8 KiB
HTML
<html>
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<head>
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<meta charset="UTF-8" />
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<style>
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body {
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padding: 2rem 3rem;
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}
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table {
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width: 100%;
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border-collapse: collapse
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}
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td {
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vertical-align: top;
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}
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.border-table,
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.border-table td,
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.border-table th {
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border: 1px solid black;
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}
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.section-title {
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margin-top: 1rem;
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margin-bottom: 0rem;
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}
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.data-label {
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width: 9rem;
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}
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.data-colon {
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width: 0.1234rem;
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}
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</style>
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</head>
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<body style="font-family: Arial, sans-serif; line-height: 1.4">
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<!-- Tanggal Terbit (top-right) -->
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<div style="
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text-align: right;
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margin-right: 2rem;
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font-size: 0.95rem;
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margin-top: 0.5rem;
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">
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Tanggal Terbit : {{ .IssuedDate }}
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</div>
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<!-- Patient Info Box -->
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<table
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style="
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margin-top: 1rem;
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margin-left: auto;
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margin-right: 2rem; /* space from right like example */
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border: 1px solid #000;
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padding: 0.5rem 1rem;
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border-collapse: separate;
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border-spacing: 0.3rem 0.2rem;
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width: auto;
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"
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>
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<tr>
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<td style="width: 9rem;"><b>No. RM</b></td>
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<td class="data-colon">:</td>
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<td><b>{{ .MedicalRecord }}</b></td>
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</tr>
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<tr>
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<td><b>Nama</b></td>
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<td class="data-colon">:</td>
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<td><b>{{ .Name }}</b></td>
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</tr>
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<tr>
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<td><b>Tanggal Lahir</b></td>
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<td class="data-colon">:</td>
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<td>{{ .BirthDate }}</td>
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</tr>
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</table>
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<hr style="margin: 20px 0" />
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<h1 style="
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text-align: center;
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font-weight: bold;
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font-size: 1rem;
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margin: 0;
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">
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FORM A
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</h1>
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<section>
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<h4 class="section-title">Kajian Awal Medis:</i></h4>
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<table style="margin-top: 0.3rem;">
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{{ if gt (len .EarlyMedic) 0 }}
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{{ range .EarlyMedic }}
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<tr>
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<td>
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☑ {{ . }}
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</td>
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</tr>
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{{ end }}
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{{ else }}
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<tr>
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<td></td>
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</tr>
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{{ end }}
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</table>
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</section>
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<section>
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<h4 class="section-title">ASSESMEN:</h4>
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<table style="margin-top: 0.3rem;">
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<tr>
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<td>
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{{ .Assessment }}
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</td>
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</tr>
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</table>
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</section>
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<section>
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<h4 class="section-title">IDENTIFIKASI MASALAH:</h4>
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<table style="margin-top: 0.3rem;">
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{{ if gt (len .ProblemIdentification) 0 }}
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{{ range .ProblemIdentification }}
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<tr>
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<td>
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☑ {{ . }}
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</td>
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</tr>
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{{ end }}
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{{ else }}
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<tr>
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<td></td>
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</tr>
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{{ end }}
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</table>
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</section>
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<section>
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<h4 class="section-title">PERENCANAAN:</h4>
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<table style="margin-top: 0.3rem;">
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<tr>
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<td>
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{{ .Planning }}
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</td>
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</tr>
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</table>
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</section>
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<table style="margin-top: 3rem;">
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<tr>
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<td></td>
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<td style="text-align: center; width: 15rem;">
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{{ .Date }}<br>
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</td>
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</tr>
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<tr><td style="height: 7rem;"></td></tr>
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<tr>
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<td></td>
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<td style="text-align: center; width: 15rem;">
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({{ .Employee_Name }})
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</td>
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</tr>
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</table>
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<div style="height: 3rem;"></div>
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</body>
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</html> |