109 lines
2.7 KiB
HTML
109 lines
2.7 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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<table class="border-table"
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style="margin-top: 1rem; width: 100%; table-layout: fixed;">
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<tr>
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<th style="width: 3rem; text-align:center;">NO</th>
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<th style="width: 9rem; text-align:center;">Tanggal/jam</th>
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<th style="width: auto;">
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Implementasi, Monitoring, Fasilitasi, koordinasi, komunikasi dan kolaborasi,
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advokasi, hasil pelayanan, Terminasi
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</th>
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<th style="width: 9rem; text-align:center;">MPP</th>
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</tr>
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{{ range .FormB }}
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<tr>
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<td style="text-align: center;">{{ .Number }}</td>
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<td style="text-align: center;">{{ .Date }}</td>
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<td style="white-space: normal; word-wrap: break-word;">
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{{ .Value }}
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</td>
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<td style="text-align: center; white-space: normal;">
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{{ .Employee_Name }}
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</td>
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</tr>
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{{ end }}
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</table>
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<div style="height: 3rem;"></div>
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</body>
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</html> |