diff --git a/app/components/app/assessment-education/entry-form.vue b/app/components/app/assessment-education/entry-form.vue
new file mode 100644
index 00000000..5985d785
--- /dev/null
+++ b/app/components/app/assessment-education/entry-form.vue
@@ -0,0 +1,137 @@
+<script setup lang="ts">
+import { toTypedSchema } from '@vee-validate/zod'
+import { Form } from '~/components/pub/ui/form'
+
+import * as DE from '~/components/pub/my-ui/doc-entry'
+import Separator from '~/components/pub/ui/separator/Separator.vue'
+
+import { BaseSelect, BaseTextarea, CheckboxGeneral, CheckboxSpecial } from './field'
+
+// constant
+import {
+  abilityCode,
+  willCode,
+  medObstacleCode,
+  learnMethodCode,
+  langClassCode,
+  translatorSrcCode,
+} from '~/lib/clinical.constants'
+
+const props = defineProps<{
+  schema: any
+  initialValues?: any
+}>()
+
+const formSchema = toTypedSchema(props.schema)
+const formRef = ref()
+
+defineExpose({
+  validate: () => formRef.value?.validate(),
+  resetForm: () => formRef.value?.resetForm(),
+  setValues: (values: any, shouldValidate = true) => formRef.value?.setValues(values, shouldValidate),
+  values: computed(() => formRef.value?.values),
+})
+</script>
+
+<template>
+  <Form
+    ref="formRef"
+    v-slot="{ values }"
+    as=""
+    keep-values
+    :validation-schema="formSchema"
+    :validate-on-mount="false"
+    validation-mode="onSubmit"
+    :initial-values="initialValues ? initialValues : {}"
+  >
+    <p class="mb-2 text-sm font-semibold 2xl:mb-3 2xl:text-base">Kebutuhan Edukasi</p>
+    <DE.Block
+      :col-count="4"
+      :cell-flex="false"
+    >
+      <CheckboxGeneral
+        field-name="generalEducationNeeds"
+        label="Informasi Umum"
+        :col-span="2"
+      />
+      <CheckboxSpecial
+        field-name="specificEducationNeeds"
+        label="Edukasi Khusus"
+        :col-span="2"
+      />
+    </DE.Block>
+
+    <div class="h-6">
+      <Separator />
+    </div>
+
+    <p class="mb-2 text-sm font-semibold 2xl:mb-3 2xl:text-base">Asesmen Kemampuan dan Kemauan Belajar</p>
+    <DE.Block
+      :col-count="3"
+      :cell-flex="false"
+    >
+      <BaseSelect
+        field-name="learningAbility"
+        label="Kemampuan Belajar"
+        :items="abilityCode"
+      />
+
+      <BaseSelect
+        field-name="learningWillingness"
+        label="Kemauan Belajar"
+        :items="willCode"
+      />
+
+      <BaseSelect
+        field-name="barrier"
+        label="Hambatan"
+        :items="medObstacleCode"
+      />
+
+      <BaseSelect
+        field-name="learningMethod"
+        label="Metode Pembelajaran"
+        :items="learnMethodCode"
+      />
+
+      <BaseSelect
+        field-name="language"
+        label="Bahasa"
+        :items="langClassCode"
+      />
+
+      <BaseSelect
+        field-name="languageBarrier"
+        label="Hambatan Bahasa"
+        :items="translatorSrcCode"
+      />
+      <BaseSelect
+        field-name="beliefValue"
+        label="Keyakinan pada Nilai-Nilai yang Dianut"
+        :items="{
+          ya: 'IYA',
+          tidak: 'TIDAK',
+        }"
+      />
+    </DE.Block>
+    <div class="h-6">
+      <Separator />
+    </div>
+
+    <p class="mb-2 text-sm font-semibold 2xl:mb-3 2xl:text-base">Rencana Edukasi</p>
+    <DE.Block>
+      <BaseTextarea
+        field-name="recommendation"
+        label="Plan A"
+      />
+      <BaseTextarea
+        field-name="recommendation"
+        label="Plan B"
+      />
+      <BaseTextarea
+        field-name="recommendation"
+        label="Plan Plan Pak Supir"
+      />
+    </DE.Block>
+  </Form>
+</template>
diff --git a/app/components/app/assessment-education/field/base-checkbox.vue b/app/components/app/assessment-education/field/base-checkbox.vue
new file mode 100644
index 00000000..81e8bed0
--- /dev/null
+++ b/app/components/app/assessment-education/field/base-checkbox.vue
@@ -0,0 +1,64 @@
+<script setup lang="ts">
+import * as DE from '~/components/pub/my-ui/doc-entry'
+import { Checkbox } from '~/components/pub/ui/checkbox'
+
+import type { CheckItem } from '~/lib/utils'
+
+const props = defineProps<{
+  label: string
+  fieldName: string
+  items: CheckItem[]
+  colSpan?: number
+}>()
+
+const { label, fieldName, items } = props
+</script>
+
+<template>
+  <DE.Cell :col-span="colSpan || 1">
+    <DE.Label :label-for="fieldName">
+      {{ label }}
+    </DE.Label>
+
+    <DE.Field :id="fieldName">
+      <FormField
+        :name="fieldName"
+        v-slot="{ value, handleChange }"
+      >
+        <FormItem>
+          <div
+            v-for="item in items"
+            :key="item.id"
+            class="ml-1 flex flex-row items-start space-x-3 space-y-0"
+          >
+            <FormControl>
+              <Checkbox
+                :id="`cb-${fieldName}-${item.id}`"
+                :checked="value?.includes(item.id)"
+                @update:checked="
+                  (checked) => {
+                    const newValue = [...(value || [])]
+                    if (checked) {
+                      if (!newValue.includes(item.id)) newValue.push(item.id)
+                    } else {
+                      const idx = newValue.indexOf(item.id)
+                      if (idx > -1) newValue.splice(idx, 1)
+                    }
+                    handleChange(newValue)
+                  }
+                "
+              />
+            </FormControl>
+            <FormLabel
+              :for="`cb-${fieldName}-${item.id}`"
+              class="font-normal leading-none peer-disabled:cursor-not-allowed peer-disabled:opacity-70 md:!text-xs 2xl:text-sm"
+            >
+              {{ item.label }}
+            </FormLabel>
+          </div>
+          <FormMessage />
+        </FormItem>
+      </FormField>
+    </DE.Field>
+  </DE.Cell>
+</template>
diff --git a/app/components/app/assessment-education/field/base-select.vue b/app/components/app/assessment-education/field/base-select.vue
new file mode 100644
index 00000000..14c3ebc5
--- /dev/null
+++ b/app/components/app/assessment-education/field/base-select.vue
@@ -0,0 +1,62 @@
+<script setup lang="ts">
+import Select from '~/components/pub/my-ui/form/select.vue'
+import { cn, mapToComboboxOptList } from '~/lib/utils'
+
+import * as DE from '~/components/pub/my-ui/doc-entry'
+
+const props = defineProps<{
+  fieldName: string
+  label: string
+  items: Record<string, string>
+  placeholder?: string
+  class?: string
+  selectClass?: string
+  fieldGroupClass?: string
+  labelClass?: string
+  isRequired?: boolean
+}>()
+
+const { placeholder = 'Pilih', class: containerClass, selectClass, fieldGroupClass, labelClass } = props
+
+const religionOptions = mapToComboboxOptList(props.items)
+</script>
+
+<template>
+  <DE.Cell :class="cn('select-field-group', fieldGroupClass, containerClass)">
+    <DE.Label
+      :label-for="fieldName"
+      :class="cn('select-field-label', labelClass)"
+      :is-required="isRequired"
+    >
+      {{ label }}
+    </DE.Label>
+    <DE.Field
+      :id="fieldName"
+      :class="cn('select-field-wrapper')"
+    >
+      <FormField
+        v-slot="{ componentField }"
+        :name="fieldName"
+      >
+        <FormItem>
+          <FormControl>
+            <Select
+              :id="fieldName"
+              v-bind="componentField"
+              :items="religionOptions"
+              :placeholder="placeholder"
+              :preserve-order="false"
+              :class="
+                cn(
+                  'text-sm transition-all duration-200 focus:outline-none focus:ring-1 focus:ring-black focus:ring-offset-0',
+                  selectClass,
+                )
+              "
+            />
+          </FormControl>
+          <FormMessage />
+        </FormItem>
+      </FormField>
+    </DE.Field>
+  </DE.Cell>
+</template>
diff --git a/app/components/app/assessment-education/field/base-textarea.vue b/app/components/app/assessment-education/field/base-textarea.vue
new file mode 100644
index 00000000..9d006152
--- /dev/null
+++ b/app/components/app/assessment-education/field/base-textarea.vue
@@ -0,0 +1,36 @@
+<script setup lang="ts">
+import * as DE from '~/components/pub/my-ui/doc-entry'
+
+const props = defineProps<{
+  label: string
+  fieldName: string
+  placeholder?: string
+  colSpan?: number
+}>()
+
+const { label, fieldName, placeholder = 'Masukkan catatan' } = props
+</script>
+
+<template>
+  <DE.Cell :col-span="colSpan || 1">
+    <DE.Label :label-for="fieldName">
+      {{ label }}
+    </DE.Label>
+    <DE.Field :id="fieldName">
+      <FormField
+        v-slot="{ componentField }"
+        :name="fieldName"
+      >
+        <FormItem>
+          <FormControl>
+            <Textarea
+              v-bind="componentField"
+              :placeholder="placeholder"
+            />
+          </FormControl>
+          <FormMessage />
+        </FormItem>
+      </FormField>
+    </DE.Field>
+  </DE.Cell>
+</template>
diff --git a/app/components/app/assessment-education/field/checkbox-general.vue b/app/components/app/assessment-education/field/checkbox-general.vue
new file mode 100644
index 00000000..049a9925
--- /dev/null
+++ b/app/components/app/assessment-education/field/checkbox-general.vue
@@ -0,0 +1,23 @@
+<script setup lang="ts">
+import BaseCheckbox from './base-checkbox.vue'
+import { generalEduCode } from '~/lib/clinical.constants'
+import { mapToCheckItems } from '~/lib/utils'
+
+interface Props {
+  label: string
+  fieldName: string
+  colSpan?: number
+}
+defineProps<Props>()
+
+const generalItems = mapToCheckItems(generalEduCode)
+</script>
+
+<template>
+  <BaseCheckbox
+    :field-name="fieldName"
+    :label="label"
+    :col-span="colSpan"
+    :items="generalItems"
+  />
+</template>
diff --git a/app/components/app/assessment-education/field/checkbox-special.vue b/app/components/app/assessment-education/field/checkbox-special.vue
new file mode 100644
index 00000000..0754726c
--- /dev/null
+++ b/app/components/app/assessment-education/field/checkbox-special.vue
@@ -0,0 +1,22 @@
+<script setup lang="ts">
+import BaseCheckbox from './base-checkbox.vue'
+import { specialEduCode } from '~/lib/clinical.constants'
+import { mapToCheckItems } from '~/lib/utils'
+interface Props {
+  label: string
+  fieldName: string
+  colSpan?: number
+}
+defineProps<Props>()
+
+const specialItems = mapToCheckItems(specialEduCode)
+</script>
+
+<template>
+  <BaseCheckbox
+    :field-name="fieldName"
+    :label="label"
+    :col-span="colSpan"
+    :items="specialItems"
+  />
+</template>
diff --git a/app/components/app/assessment-education/field/index.ts b/app/components/app/assessment-education/field/index.ts
new file mode 100644
index 00000000..489b19a9
--- /dev/null
+++ b/app/components/app/assessment-education/field/index.ts
@@ -0,0 +1,5 @@
+export { default as BaseSelect } from './base-select.vue'
+export { default as BaseTextarea } from './base-textarea.vue'
+export { default as CheckboxGeneral } from './checkbox-general.vue'
+export { default as CheckboxSpecial } from './checkbox-special.vue'
+export { default as SelectAssessmentCode } from './select-assessment-code.vue'
diff --git a/app/components/app/assessment-education/field/select-assessment-code.vue b/app/components/app/assessment-education/field/select-assessment-code.vue
new file mode 100644
index 00000000..9d006152
--- /dev/null
+++ b/app/components/app/assessment-education/field/select-assessment-code.vue
@@ -0,0 +1,36 @@
+<script setup lang="ts">
+import * as DE from '~/components/pub/my-ui/doc-entry'
+
+const props = defineProps<{
+  label: string
+  fieldName: string
+  placeholder?: string
+  colSpan?: number
+}>()
+
+const { label, fieldName, placeholder = 'Masukkan catatan' } = props
+</script>
+
+<template>
+  <DE.Cell :col-span="colSpan || 1">
+    <DE.Label :label-for="fieldName">
+      {{ label }}
+    </DE.Label>
+    <DE.Field :id="fieldName">
+      <FormField
+        v-slot="{ componentField }"
+        :name="fieldName"
+      >
+        <FormItem>
+          <FormControl>
+            <Textarea
+              v-bind="componentField"
+              :placeholder="placeholder"
+            />
+          </FormControl>
+          <FormMessage />
+        </FormItem>
+      </FormField>
+    </DE.Field>
+  </DE.Cell>
+</template>
diff --git a/app/components/content/assessment-education/add.vue b/app/components/content/assessment-education/add.vue
new file mode 100644
index 00000000..37324769
--- /dev/null
+++ b/app/components/content/assessment-education/add.vue
@@ -0,0 +1,72 @@
+<script setup lang="ts">
+import * as z from 'zod'
+import type { ExposedForm } from '~/types/form'
+
+import Action from '~/components/pub/my-ui/nav-footer/ba-dr-su.vue'
+
+const schema = z.object({
+  generalEducationNeeds: z
+    .array(z.string(), {
+      required_error: 'Mohon pilih setidaknya item',
+    })
+    .min(1, 'Mohon pilih setidaknya item'),
+
+  specificEducationNeeds: z
+    .array(z.string(), {
+      required_error: 'Mohon pilih setidaknya item',
+    })
+    .min(1, 'Mohon pilih setidaknya item'),
+
+  learningAbility: z.string({
+    required_error: 'Mohon pilih kemampuan belajar',
+  }),
+
+  learningWillingness: z.string({
+    required_error: 'Mohon pilih kemauan belajar',
+  }),
+
+  barrier: z.string({
+    required_error: 'Mohon pilih hambatan',
+  }),
+
+  learningMethod: z.string({
+    required_error: 'Mohon pilih metode pembelajaran',
+  }),
+
+  language: z.string({
+    required_error: 'Mohon pilih bahasa',
+  }),
+
+  languageBarrier: z.string({
+    required_error: 'Mohon pilih hambatan bahasa',
+  }),
+
+  beliefValue: z.string({
+    required_error: 'Mohon pilih keyakinan pada nilai-nilai yang dianut',
+  }),
+})
+
+const form = ref<ExposedForm<any> | null>(null)
+
+async function handleActionClick(eventType: string) {
+  if (eventType === 'submit') {
+    const isValid = await form.value?.validate()
+    console.log(isValid)
+  }
+
+  if (eventType === 'cancel') {
+  }
+}
+</script>
+
+<template>
+  <div class="mb-5 border-b border-b-slate-300 pb-3 text-lg font-semibold xl:text-xl">Tambah Asesmen Edukasi</div>
+  <AppAssessmentEducationEntryForm
+    ref="form"
+    :schema="schema"
+  />
+
+  <div class="my-2 flex justify-end py-2">
+    <Action @click="handleActionClick" />
+  </div>
+</template>
diff --git a/app/lib/clinical.constants.ts b/app/lib/clinical.constants.ts
new file mode 100644
index 00000000..f88fc55c
--- /dev/null
+++ b/app/lib/clinical.constants.ts
@@ -0,0 +1,87 @@
+export const generalEduCode = {
+  'right-obg': 'Hak dan kewajiban pasien dan keluarga',
+  'general-consent': 'General Consent',
+  service: 'Pelayanan yang disediakan (jam pelayanan, akses pelayanan dan proses pelayanan)',
+  'all-care-service': 'Sumber alternatif asuhan di tempat lain/faskes lain',
+  'home-plan': 'Rencana tindakan di rumah',
+  'home-care': 'Kebutuhan perawatan di rumah',
+  orientation: 'Orientasi Ruangan',
+  'fall-risk-prevention': 'Pencegahan risiko jatuh',
+  'alt-care': 'Alternatif pelayanan',
+  'act-delay': 'Penundaan Tindakan',
+  others: 'Lain-lain',
+} as const
+
+export type GeneralEduCodeKey = keyof typeof generalEduCode
+
+export const specialEduCode = {
+  'disease-diag-dev': 'Diagnosa penyakit dan perkembangannya',
+  'safe-med-usage': 'Penggunaan obat yang aman',
+  'side-effect': 'Efek samping dan reaksi obat',
+  diet: 'Diet/Nutrisi',
+  'pain-mgmt': 'Manajemen nyeri',
+  'medical-eq-usage': 'Penggunaan Peralatan Medis',
+  'rehab-technique': 'Teknik Rehabilitasi',
+  'prevention-act': 'Tindakan pencegahan (cuci tangan, pemasangan gelang)',
+} as const
+
+export type SpecialEduCodeKey = keyof typeof specialEduCode
+
+export const eduAssessmentCode = {
+  'learn-ability': 'Kemampuan Belajar',
+  'learn-will': 'Kemauan Belajar',
+  obstacle: 'Hambatan',
+  'learn-method': 'Metode Pembelajaran',
+  lang: 'Bahasa',
+  'lang-obstacle': 'Hambatan Bahasa',
+  belief: 'Keyakinan',
+} as const
+
+export type EduAssessmentCodeKey = keyof typeof eduAssessmentCode
+
+export const abilityCode = {
+  able: 'Mampu',
+  'not-able': 'Tidak Mampu',
+} as const
+
+export type AbilityCodeKey = keyof typeof abilityCode
+
+export const willCode = {
+  ready: 'Siap',
+  interested: 'Tertarik',
+  'not-interested': 'Tidak Tertarik',
+} as const
+
+export type WillCodeKey = keyof typeof willCode
+
+export const medObstacleCode = {
+  hearing: 'Pendengaran',
+  sight: 'Penglihatan',
+  physical: 'Fisik',
+  emotional: 'Emosional',
+  cognitif: 'Kognitif',
+} as const
+
+export type MedObstacleCodeKey = keyof typeof medObstacleCode
+
+export const learnMethodCode = {
+  demo: 'Demonstrasi',
+  'discuss-leaflet': 'Diskusi Leaflet',
+} as const
+
+export type LearnMethodCodeKey = keyof typeof learnMethodCode
+
+export const langClassCode = {
+  ind: 'Indonesia',
+  region: 'Daerah',
+  foreign: 'Asing',
+} as const
+
+export type LangClassCodeKey = keyof typeof langClassCode
+
+export const translatorSrcCode = {
+  team: 'Tim Penerjemah',
+  family: 'Keluarga',
+} as const
+
+export type TranslatorSrcCodeKey = keyof typeof translatorSrcCode
diff --git a/app/lib/utils.ts b/app/lib/utils.ts
index 357d8700..02a7b112 100644
--- a/app/lib/utils.ts
+++ b/app/lib/utils.ts
@@ -7,6 +7,10 @@ export interface SelectOptionType<_T = string> {
   label: string
   code?: string
 }
+export interface CheckItem {
+  id: string
+  label: string
+}
 
 export function cn(...inputs: ClassValue[]) {
   return twMerge(clsx(inputs))
@@ -27,6 +31,15 @@ export function mapToComboboxOptList(items: Record<string, string>): SelectOptio
   return result
 }
 
+export function mapToCheckItems<T extends Record<string, string>, K extends keyof T & string>(
+  items: T,
+): { id: K; label: T[K] }[] {
+  return Object.entries(items).map(([key, value]) => ({
+    id: key as K,
+    label: value as T[K],
+  }))
+}
+
 /**
  * Mengkonversi string menjadi title case (huruf pertama setiap kata kapital)
  * @param str - String yang akan dikonversi
@@ -36,7 +49,6 @@ export function toTitleCase(str: string): string {
   return str.toLowerCase().replace(/\b\w/g, (char) => char.toUpperCase())
 }
 
-
 /**
  * Menghitung umur berdasarkan tanggal lahir
  * @param birthDate - Tanggal lahir dalam format Date atau string
diff --git a/app/pages/(features)/rehab/encounter/[id]/education-assessment/add.vue b/app/pages/(features)/rehab/encounter/[id]/education-assessment/add.vue
new file mode 100644
index 00000000..98eee259
--- /dev/null
+++ b/app/pages/(features)/rehab/encounter/[id]/education-assessment/add.vue
@@ -0,0 +1,43 @@
+<script setup lang="ts">
+import type { PagePermission } from '~/models/role'
+import Error from '~/components/pub/my-ui/error/error.vue'
+import { PAGE_PERMISSIONS } from '~/lib/page-permission'
+
+definePageMeta({
+  middleware: ['rbac'],
+  roles: ['doctor', 'nurse', 'admisi', 'pharmacy', 'billing', 'management'],
+  title: 'Tambah Assessment Education',
+})
+
+const route = useRoute()
+
+useHead({
+  title: () => route.meta.title as string,
+})
+
+const roleAccess: PagePermission = PAGE_PERMISSIONS['/patient']
+
+const { checkRole, hasReadAccess } = useRBAC()
+
+// Check if user has access to this page
+// const hasAccess = checkRole(roleAccess)
+const hasAccess = true
+if (!hasAccess) {
+  navigateTo('/403')
+}
+
+// Define permission-based computed properties
+const canRead = hasReadAccess(roleAccess)
+</script>
+
+<template>
+  <div>
+    <div v-if="canRead">
+      <ContentAssessmentEducationAdd />
+    </div>
+    <Error
+      v-else
+      :status-code="403"
+    />
+  </div>
+</template>