147 lines
3.3 KiB
HTML
147 lines
3.3 KiB
HTML
<html>
|
|
|
|
<head>
|
|
<meta charset="UTF-8" />
|
|
<style>
|
|
body {
|
|
padding: 10px 30px;
|
|
}
|
|
table {
|
|
width: 100%;
|
|
border-collapse: collapse
|
|
}
|
|
|
|
.border-table,
|
|
.border-table td,
|
|
.border-table th {
|
|
border: 1px solid black;
|
|
}
|
|
|
|
.section-title {
|
|
margin-top: 1rem;
|
|
margin-bottom: 0rem;
|
|
}
|
|
td {
|
|
vertical-align: top;
|
|
}
|
|
@page {
|
|
size: 148mm 210mm;
|
|
}
|
|
</style>
|
|
</head>
|
|
|
|
<body style="font-family: Arial, sans-serif; line-height: 1.4">
|
|
<table style="margin-top: 1rem;">
|
|
<tr>
|
|
<td>
|
|
<img src="logo-1.png" alt="logo" style="height: 70px; margin-bottom: 20px;" />
|
|
</td>
|
|
<td>
|
|
<div>
|
|
SURAT RENCANA KONTROL
|
|
</div>
|
|
<div>
|
|
RSUD dr. Saiful Anwar
|
|
</div>
|
|
</td>
|
|
<td style="text-align: right;">
|
|
No. : {{ .Number }}
|
|
</td>
|
|
</tr>
|
|
<tr>
|
|
<td>
|
|
<div>
|
|
Kepada Yth
|
|
</div>
|
|
</td>
|
|
<td>
|
|
<div>
|
|
{{ .Doctor_Name }}
|
|
</div>
|
|
<div>
|
|
Sp./Sub. {{ .DstUnit_Name }}
|
|
</div>
|
|
</td>
|
|
</tr>
|
|
</table>
|
|
|
|
<div style="margin-top: 1rem;">
|
|
Mohon Pemeriksaan dan Penanganan Lebih Lanjut:
|
|
</div>
|
|
|
|
<table style="margin-top: 1rem;">
|
|
<tr>
|
|
<td style="width: 9rem;">
|
|
No.Kartu
|
|
</td>
|
|
<td style="width: 10px;">:</td>
|
|
<td>
|
|
{{ .CardNumber }}
|
|
</td>
|
|
</tr>
|
|
<tr>
|
|
<td>
|
|
Nama Peserta
|
|
</td>
|
|
<td>: </td>
|
|
<td>
|
|
{{ .Name }}
|
|
</td>
|
|
</tr>
|
|
<tr>
|
|
<td>
|
|
Tgl.Lahir
|
|
</td>
|
|
<td>: </td>
|
|
<td>
|
|
{{ .BirthDate }}
|
|
</td>
|
|
</tr>
|
|
<tr>
|
|
<td>
|
|
Diagnosa
|
|
</td>
|
|
<td>: </td>
|
|
<td>
|
|
{{ .Diagnose }}
|
|
</td>
|
|
</tr>
|
|
<tr>
|
|
<td>
|
|
Rencana Kontrol
|
|
</td>
|
|
<td>: </td>
|
|
<td>
|
|
{{ .PlanDate }}
|
|
</td>
|
|
</tr>
|
|
</table>
|
|
|
|
<div style="margin: 1rem 0;">
|
|
Demikian atas bantuannya, diucapkan banyak terima kasih.
|
|
</div>
|
|
|
|
<table style="width:100%">
|
|
<tbody>
|
|
<tr>
|
|
<td style="width:20%"></td>
|
|
<td></td>
|
|
<td style="width:20%; text-align: center;">Mengetahui:</td>
|
|
</tr>
|
|
<tr>
|
|
<td style="height:100px"></td>
|
|
<td></td>
|
|
<td></td>
|
|
</tr>
|
|
<tr>
|
|
<td>Tgl. Cetak: {{ .PrintDate }}</td>
|
|
<td></td>
|
|
<td style="text-align: center;">{{ .ResponsibleDoctor_Name }}</td>
|
|
</tr>
|
|
</tbody>
|
|
</table>
|
|
|
|
<div style="height: 3rem;"></div>
|
|
</body>
|
|
|
|
</html> |