From fdd7063d80665fdead3ff03aa424b85d5ff54a33 Mon Sep 17 00:00:00 2001
From: bhaktiar-igd <211+bhaktiar-igd@noreply.localhost>
Date: Thu, 23 Jul 2026 06:18:40 +0000
Subject: [PATCH] Update app/Views/input.php

---
 app/Views/input.php | 2368 ++++++++++++++++++++++++++-----------------
 1 file changed, 1433 insertions(+), 935 deletions(-)
diff --git a/app/Views/input.php b/app/Views/input.php
index 0c561f4..dd65edc 100644
--- a/app/Views/input.php
+++ b/app/Views/input.php
@@ -1,936 +1,1434 @@
-<!DOCTYPE html>
-<html lang="id">
-<head>
-  <meta charset="UTF-8">
-  <title>Form Input Pasien Ambulans Emergensi 119 RSSA</title>
-  <meta name="viewport" content="width=device-width, initial-scale=1">
-
-  <link href="https://cdn.jsdelivr.net/npm/bootstrap@5.3.0/dist/css/bootstrap.min.css" rel="stylesheet">
-
-  <style>
-    body {
-      background-color: #f8f9fa;
-      padding: 2rem;
-    }
-
-    .form-label {
-      font-weight: 500;
-    }
-
-    #inputTujuanContainer {
-      display: none;
-    }
-
-    .perawat-wrapper {
-      position: relative;
-      margin-bottom: 1rem;
-    }
-
-    .hapus-perawat-btn {
-      position: absolute;
-      top: 4px;
-      right: 8px;
-      font-size: 16px;
-      color: #dc3545;
-      background: none;
-      border: none;
-      cursor: pointer;
-    }
-
-    .hapus-perawat-btn:hover {
-      color: #a71d2a;
-    }
-  </style>
-</head>
-
-<body>
-
-<div class="container py-5">
-  <div class="card shadow p-4">
-
-    <h4 class="mb-4 text-primary">
-      🚑 Form Input Pasien Ambulans Emergensi 119 RSSA
-    </h4>
-
-    <!-- FORM START -->
-    <form id="formPasien" method="post" action="<?= base_url('pasien/simpan') ?>">
-
-      <?= csrf_field(); ?>
-
-      <!-- ================= HEADER ================= -->
-<div class="row mb-3">
-
-  <div class="col-md-2">
-    <label class="form-label">Tanggal & Jam</label>
-    <input 
-      type="datetime-local" 
-      id="tanggal" 
-      name="tanggal"
-      class="form-control">
-  </div>
-
-  <div class="col-md-2">
-    <label class="form-label">Register Ambulans</label>
-    <input 
-      type="text" 
-      class="form-control" 
-      name="register"
-      value="<?= $register ?>"
-      readonly>
-  </div>
-
-<div class="col-md-2 position-relative">
-  <label class="form-label">No RM</label>
-
-  <div class="input-group">
-    <input 
-      type="text"
-      id="noRM"
-      name="no_rm"
-      class="form-control"
-      placeholder="Ketik RM"
-    >
-
-    <button type="button" class="btn btn-primary" onclick="searchRM()">
-      🔍
-    </button>
-  </div>
-
-  <div id="rmResult" class="list-group position-absolute w-100 z-3"></div>
-</div>
-
-  <div class="col-md-3">
-    <label class="form-label">Nama Penelpon</label>
-    <input 
-      type="text" 
-      class="form-control" 
-      id="penelpon"
-      name="nama_penelpon"
-      placeholder="Nama penelpon">
-  </div>
-
-  <div class="col-md-3">
-  <label class="form-label">No. Penelpon</label>
-  <input 
-    type="tel" 
-    class="form-control"
-    id="no_penelpon"
-    name="no_penelpon"
-    placeholder="08xxxx">
-</div>
-
-</div>
-
-      <!-- ================= IDENTITAS ================= -->
-<div class="row mb-3">
-
-  <div class="col-md-2">
-    <label class="form-label">Atribut</label>
-    <select class="form-select" id="panggilanDepan" name="panggilan_depan">
-      <option>...</option>
-      <option>By.</option>
-      <option>An.</option>
-      <option>Sdr.</option>
-      <option>Nn.</option>
-      <option>Tn.</option>
-      <option>Ny.</option>
-    </select>
-  </div>
-
-  <div class="col-md-4">
-    <label class="form-label">Nama Pasien</label>
-    <input type="text" class="form-control" id="nama" name="nama">
-  </div>
-
-  <div class="col-md-2">
-    <label class="form-label">JK</label>
-    <select class="form-select" id="gender" name="gender">
-      <option>...</option>
-      <option>Laki-laki</option>
-      <option>Perempuan</option>
-    </select>
-  </div>
-
-  <div class="col-md-2">
-    <label class="form-label">Tanggal Lahir</label>
-    <input type="date" id="tanggalLahir" class="form-control" name="tanggal_lahir">
-  </div>
-
-  <div class="col-md-2">
-    <label class="form-label">Umur</label>
-    <input type="text" id="umur" class="form-control" name="umur" readonly>
-  </div>
-
-</div>
-
-<!-- ================= ALAMAT + POSISI ================= -->
-<div class="row mb-3">
-
-  <!-- ALAMAT (kiri) -->
-  <div class="col-md-6">
-    <label class="form-label">Alamat</label>
-    <textarea id="alamat" name="alamat" class="form-control" rows="4"></textarea>
-  </div>
-
-  <!-- POSISI PASIEN (kanan) -->
-  <div class="col-md-6">
-
-    <!-- HEADER: Judul kiri, Lantai kanan -->
-    <div class="d-flex justify-content-between align-items-center mb-2">
-      <label class="form-label mb-0">
-        Posisi Pasien (Saat Ditemukan)
-      </label>
-
-      <div class="d-flex align-items-center">
-        <label for="lantai" class="me-2 mb-0">Lantai</label>
-        <select id="lantai" name="lantai" class="form-select form-select-sm">
-        <option value="">Pilih</option>
-          <?php for($i = 1; $i <= 50; $i++): ?>
-            <option value="<?= $i ?>">Lantai <?= $i ?></option>
-          <?php endfor; ?>
-        </select>
-      </div>
-    </div>
-
-    <!-- CHECKBOX -->
-    <div class="form-check">
-      <input class="form-check-input" type="checkbox" id="tidur" name="posisi_pasien[]" value="kamar_tidur">
-      <label class="form-check-label" for="tidur">Di Kamar Tidur</label>
-    </div>
-
-    <div class="form-check">
-      <input class="form-check-input" type="checkbox" id="tamu" name="posisi_pasien[]" value="ruang_tamu">
-      <label class="form-check-label" for="tamu">Di Ruang Tamu</label>
-    </div>
-
-    <div class="form-check">
-      <input class="form-check-input" type="checkbox" id="mandi" name="posisi_pasien[]" value="kamar_mandi">
-      <label class="form-check-label" for="mandi">Di Kamar Mandi</label>
-    </div>
-
-    <div class="d-flex align-items-center mb-2">
-      <input 
-        class="form-check-input me-2" 
-        type="checkbox" 
-        id="ruanglain" 
-        name="posisi_pasien[]" 
-        value="lainnya"
-        onchange="toggleInputRuangLain()">
-
-      <label class="form-check-label me-2" for="ruanglain">
-        Di Ruang Lain:
-      </label>
-
-      <input 
-        type="text" 
-        id="inputRuangLain" 
-        name="posisi_lainnya"
-        class="form-control form-control-sm w-50" 
-        placeholder="Sebutkan..." 
-        disabled>
-    </div>
-
-  </div>
-
-  <div class="row mb-3">
-
-  <!-- Keluhan Utama -->
-  <div class="col-md-12">
-    <label class="form-label">Keluhan Utama</label>
-    <textarea 
-      class="form-control" 
-      name="keluhan_utama" 
-      rows="2"
-      placeholder="Contoh: sesak napas, nyeri dada, kecelakaan, dll"></textarea>
-    </div>
-
-</div>
-<div class="row mb-3">
-
-  <!-- 1. Kesadaran -->
-  <div class="col-md-4">
-    <label class="form-label">Kesadaran</label>
-    <select class="form-select" id="kesadaran" name="kesadaran">
-      <option>...</option>
-      <option>Sadar</option>
-      <option>Tidak Sadar</option>
-      <option>Gelisah</option>
-    </select>
-  </div>
-
-  <!-- 2. Kategori -->
-  <div class="col-md-4">
-    <label class="form-label">Kategori</label>
-    <select class="form-select" id="kategori" name="kategori">
-      <option value="">...</option>
-      <option value="Trauma">Trauma</option>
-      <option value="Non Trauma">Non Trauma</option>
-    </select>
-  </div>
-
-  <!-- 3. Order Type -->
-  <div class="col-md-4">
-    <label class="form-label">Order Type</label>
-    <select class="form-select" id="orderType" name="order_type">
-      <option value="Pending Order">🟢 Pending Order</option>
-      <option value="Non Emergency">🟡 Non Emergency</option>
-      <option value="True Emergency">🔴 True Emergency</option>
-    </select>
-  </div>
-
-</div>
-<div class="row g-3">
-
-  <!-- KIRI: PERNAFASAN + SUHU + BAHAYA -->
-  <div class="col-md-3">
-    <div class="border rounded p-3 h-100">
-
-      <!-- Pernafasan -->
-<label class="fw-bold">Pernafasan</label>
-
-<!-- SESAK -->
-<div class="mt-2">
-    <div class="d-flex gap-3">
-    <div class="form-check">
-      <input class="form-check-input" type="radio" name="sesak" value="ya" id="sesakYa">
-      <label class="form-check-label" for="sesakYa">Sesak</label>
-    </div>
-
-    <div class="form-check">
-      <input class="form-check-input" type="radio" name="sesak" value="tidak" id="sesakTidak">
-      <label class="form-check-label" for="sesakTidak">Tidak Sesak</label>
-    </div>
-  </div>
-</div>
-
-<!-- BATUK -->
-<div class="mt-2">
-  <div class="d-flex gap-3">
-    <div class="form-check">
-      <input class="form-check-input" type="radio" name="batuk" value="ya" id="batukYa">
-      <label class="form-check-label" for="batukYa">Batuk</label>
-    </div>
-
-    <div class="form-check">
-      <input class="form-check-input" type="radio" name="batuk" value="tidak" id="batukTidak">
-      <label class="form-check-label" for="batukTidak">Tidak Batuk</label>
-    </div>
-  </div>
-</div>
-
-      <!-- Suhu -->
-      <label class="fw-bold">Suhu Tubuh</label>
-      <div class="d-flex gap-3 mt-2 mb-3">
-        <div class="form-check">
-          <input class="form-check-input" type="radio" name="suhu" value="demam" id="demam">
-          <label class="form-check-label" for="demam">Demam</label>
-        </div>
-
-        <div class="form-check">
-          <input class="form-check-input" type="radio" name="suhu" value="tidak_demam" id="tidak_demam">
-          <label class="form-check-label" for="tidak_demam">Tidak</label>
-        </div>
-      </div>
-
-      <!-- Bahaya -->
-      <label class="fw-bold">Kondisi Bahaya</label>
-
-      <div class="d-flex gap-3 mt-2">
-        <div class="form-check">
-          <input class="form-check-input" type="radio" name="bahaya" value="ada" id="bahayaAda">
-          <label class="form-check-label" for="bahayaAda">Ada</label>
-        </div>
-
-        <div class="form-check">
-          <input class="form-check-input" type="radio" name="bahaya" value="tidak" id="bahayaTidakAda" checked>
-          <label class="form-check-label" for="bahayaTidakAda">Tidak</label>
-        </div>
-      </div>
-
-      <!-- DETAIL (selalu tampil, tapi disabled) -->
-      <div id="bahayaInputDiv" class="mt-2 opacity-50">
-        <input type="text" 
-              class="form-control" 
-              name="bahaya_detail" 
-              placeholder="Jenis bahaya..." 
-              disabled>
-      </div>
-
-    </div>
-  </div>
-
-  <!-- TENGAH: KETERBATASAN GERAK -->
-<div class="col-md-3">
-  <div class="border rounded p-3 h-100">
-    <label class="form-label fw-bold">Keterbatasan Gerak</label>
-
-    <div class="d-flex flex-column gap-2 mt-2">
-
-      <div class="form-check">
-        <input class="form-check-input" type="radio" name="gerak" value="tangan">
-        <label class="form-check-label">Tangan</label>
-      </div>
-
-      <div class="form-check">
-        <input class="form-check-input" type="radio" name="gerak" value="kaki">
-        <label class="form-check-label">Kaki</label>
-      </div>
-
-      <div class="form-check">
-        <input class="form-check-input" type="radio" name="gerak" value="semua">
-        <label class="form-check-label">Semua Anggota Gerak</label>
-      </div>
-
-      <div class="form-check">
-        <input class="form-check-input" type="radio" name="gerak" value="normal">
-        <label class="form-check-label">Tidak Ada Keterbatasan</label>
-      </div>
-
-    </div>
-
-
-          <!-- Berat Badan -->
-      <label class="fw-bold">Berat Badan</label>
-      <div class="input-group mt-2 mb-3">
-        <input type="number" class="form-control" id="beratBadan" name="berat_badan" placeholder="Berat badan pasien">
-        <span class="input-group-text">Kg</span>
-      </div>
-    </div>
-  </div>
-
-  <!-- KANAN: NYERI -->
-<div class="col-md-6">
-  <div class="border rounded p-3 h-100">
-    <label class="form-label fw-bold">Nyeri / Luka</label>
-
-    <!-- RADIO -->
-    <div class="d-flex gap-3 mt-2 mb-2">
-      <div class="form-check">
-        <input class="form-check-input" type="radio" name="status_nyeri" id="adaNyeri" value="ya">
-        <label class="form-check-label" for="adaNyeri">Nyeri</label>
-      </div>
-
-      <div class="form-check">
-        <input class="form-check-input" type="radio" name="status_nyeri" id="tidakNyeri" value="tidak" checked>
-        <label class="form-check-label" for="tidakNyeri">Tidak Nyeri</label>
-      </div>
-    </div>
-
-    <!-- DETAIL (selalu tampil, tapi default nonaktif) -->
-    <div id="detailNyeri" class="opacity-50">
-      <label class="form-label fw-semibold mb-2">Lokasi Nyeri</label>
-
-      <div class="row row-cols-2 row-cols-md-4 g-2">
-        <?php 
-        $lokasi = ['kepala','leher','dada','punggung','perut','panggul','tangan','kaki'];
-        foreach($lokasi as $l): ?>
-          <div class="col">
-            <div class="form-check">
-              <input class="form-check-input" 
-                     type="checkbox" 
-                     name="lokasi_nyeri[]" 
-                     value="<?= $l ?>" 
-                     id="nyeri_<?= $l ?>" 
-                     disabled>
-              <label class="form-check-label" for="nyeri_<?= $l ?>">
-                <?= ucfirst($l) ?>
-              </label>
-            </div>
-          </div>
-        <?php endforeach; ?>
-      </div>
-
-      <input type="text" name="nyeri_lain" class="form-control mt-3" 
-             placeholder="Lain-lain..." disabled>
-    </div>
-
-  </div>
-</div>
-
-  <!-- Informasi Lain -->
-<div class="row mt-3">
-  <div class="col-md-12">
-    <label class="form-label">Informasi Lain</label>
-    <input 
-      type="text" 
-      class="form-control" 
-      name="informasi_lain"
-      placeholder="Contoh: alergi obat, kondisi khusus, permintaan khusus, Peralatan Khusus, dll">
-  </div>
-</div>
-
-</div>
-<!-- ================= TUJUAN ================= -->
-<div class="row mt-3 g-3">
-
-  <!-- TUJUAN -->
-  <div class="col-md-5">
-    <div class="border rounded p-3 h-100">
-      <label for="tujuan" class="form-label fw-bold">🎯 Tujuan</label>
-
-      <select class="form-select" id="tujuan" name="tujuan">
-        <option value="">-- Pilih Tujuan --</option>
-        <option value="RFDK">RFDK – Rumah ke Faskes Dalam Kota</option>
-        <option value="F-FDK">F-FDK – Fasilitas Umum ke Faskes Dalam Kota</option>
-        <option value="AFDK">AFDK – Antar Faskes Dalam Kota</option>
-        <option value="AFLK">AFLK – Antar Faskes Luar Kota</option>
-        <option value="PDK">PDK – Pulang Dalam Kota</option>
-        <option value="PLK">PLK – Pulang Luar Kota</option>
-      </select>
-
-      <div class="mt-3">
-        <label class="form-label small">Detail Tujuan</label>
-        <input 
-          type="text" 
-          class="form-control" 
-          name="tujuan_detail"
-          placeholder="Nama RS / alamat / keterangan">
-      </div>
-
-    </div>
-  </div>
-
-  <!-- PERSETUJUAN BIAYA -->
-  <div class="col-md-3">
-    <div class="border rounded p-3 h-100">
-      <label class="form-label fw-bold">Persetujuan Biaya</label>
-
-      <div class="d-flex gap-3 mt-2 mb-3">
-        <div class="form-check">
-          <input class="form-check-input" type="radio" name="persetujuan" value="setuju">
-          <label class="form-check-label">Setuju</label>
-        </div>
-
-        <div class="form-check">
-          <input class="form-check-input" type="radio" name="persetujuan" value="tidak">
-          <label class="form-check-label">Tidak</label>
-        </div>
-      </div>
-
-      <label class="form-label small">Nominal Biaya</label>
-      <div class="input-group">
-        <span class="input-group-text">Rp</span>
-        <input 
-          type="number" 
-          class="form-control" 
-          name="biaya"
-          placeholder="Masukkan nominal">
-      </div>
-
-    </div>
-  </div>
-
-  <!-- VALIDASI + PETUGAS -->
-  <div class="col-md-4">
-    <div class="border rounded p-3 h-100">
-      <label class="form-label fw-bold">Validasi Pelayanan</label>
-
-      <input 
-        type="text" 
-        class="form-control mt-2 mb-3" 
-        name="validasi"
-        placeholder="Valid / Tidak Valid">
-
-      <!-- PETUGAS (SELECT) -->
-      <label class="form-label small">Petugas Penerima</label>
-      <select id="petugas" name="petugas_id" style="width:100%"></select>
-
-    </div>
-  </div>
-
-</div>
-
-<!-- ================= BUTTON ================= -->
-<div class="d-flex justify-content-between mt-4">
-  <button type="button" class="btn btn-secondary" onclick="location.reload()">
-    Reset
-  </button>
-
-  <button type="submit" id="btnSubmit" class="btn btn-success">
-    Simpan Pasien
-  </button>
-</div>
-
-</form>
-<!-- FORM END -->
-
-</div>
-</div>
-
-
-<script src="https://code.jquery.com/jquery-3.6.0.min.js"></script>
-<link href="https://cdn.jsdelivr.net/npm/select2@4.1.0-rc.0/dist/css/select2.min.css" rel="stylesheet" />
-<script src="https://cdn.jsdelivr.net/npm/select2@4.1.0-rc.0/dist/js/select2.min.js"></script>
-<script>
-
-let isSubmitting = false;
-
-document.getElementById('formPasien').addEventListener('submit', function(e){
-
-    if(isSubmitting){
-        e.preventDefault();
-        return;
-    }
-
-    if(!confirm("Yakin simpan data pasien?")){
-        e.preventDefault();
-        return;
-    }
-
-    isSubmitting = true;
-
-    const btn = document.getElementById('btnSubmit');
-    if(btn){
-        btn.disabled = true;
-        btn.innerText = 'Menyimpan...';
-    }
-
-});
-
-window.addEventListener('pageshow', function () {
-    const btn = document.getElementById('btnSubmit');
-    if(btn){
-        btn.disabled = false;
-        btn.innerText = 'Simpan Pasien';
-    }
-    isSubmitting = false;
-});
-
-  $(document).ready(function() {
-
-      $('#petugas').select2({
-          width: '100%',
-          placeholder: 'Ketik nama petugas...',
-          minimumInputLength: 2,
-          ajax: {
-              url: '/pegawai/search',
-              dataType: 'json',
-              delay: 300,
-              data: function (params) {
-                  return { q: params.term };
-              },
-              processResults: function (data) {
-                  return {
-                      results: data
-                  };
-              }
-          }
-      });
-
- 
-
-// ================= TOGGLE RADIO (ENABLE / DISABLE) =================
-function toggleByRadio(name, targetId, activeValue) {
-    const radios = document.querySelectorAll(`input[name="${name}"]`);
-    const target = document.getElementById(targetId);
-
-    radios.forEach(el => {
-        el.addEventListener("change", function () {
-
-            const aktif = this.value === activeValue;
-
-            // enable / disable semua input di dalam target
-            target.querySelectorAll('input').forEach(input => {
-                input.disabled = !aktif;
-            });
-
-            // efek visual (abu kalau nonaktif)
-            target.classList.toggle('opacity-50', !aktif);
-        });
-    });
-}
-
-toggleByRadio("status_nyeri", "detailNyeri", "ya");
-toggleByRadio("bahaya", "bahayaInputDiv", "ada");
-
-document.querySelectorAll('input[type="radio"]:checked')
-.forEach(el => el.dispatchEvent(new Event('change')));
-
-document.getElementById('noRM').addEventListener('input', searchRM);
-});
-
-// ================= auto umur =================
-document.getElementById('tanggalLahir')
-.addEventListener('change', hitungUmur);
-
-function hitungUmur()
-{
-    const val = document.getElementById('tanggalLahir').value;
-
-    if(!val) {
-        document.getElementById('umur').value = '';
-        return;
-    }
-
-    const lahir = new Date(val);
-    const today = new Date();
-
-    if(isNaN(lahir.getTime())) {
-        document.getElementById('umur').value = '';
-        return;
-    }
-
-    let tahun = today.getFullYear() - lahir.getFullYear();
-    let bulan = today.getMonth() - lahir.getMonth();
-    let hari = today.getDate() - lahir.getDate();
-
-    if (hari < 0) {
-        bulan--;
-        const lastMonth = new Date(today.getFullYear(), today.getMonth(), 0);
-        hari += lastMonth.getDate();
-    }
-
-    if (bulan < 0) {
-        tahun--;
-        bulan += 12;
-    }
-
-    document.getElementById('umur').value =
-        `${tahun} Th ${bulan} Bln ${hari} Hr`;
-}
-
-
-function toggleInputRuangLain(){
-  const check = document.getElementById('ruanglain');
-  const input = document.getElementById('inputRuangLain');
-
-  input.disabled = !check.checked;
-  if(!check.checked) input.value = '';
-}
-
-// ================= Fungsi Modal RM =================
-let currentRegisterId = null;
-
-function openCekRM(){
-    currentRegisterId = null;
-    new bootstrap.Modal(document.getElementById('modalCekRM')).show();
-}
-
-
-function cekRM(){
-
-    let rm = document.getElementById('inputRM').value;
-
-    fetch("<?= base_url('rm/cek') ?>", {
-        method: "POST",
-        headers: {
-            "Content-Type": "application/x-www-form-urlencoded"
-        },
-        body: "rm=" + rm
-    })
-    .then(res => res.json())
-    .then(res => {
-
-        let hasil = document.getElementById('hasilRM');
-
-        if(res.status === 'found'){
-
-            let p = res.data;
-
-            hasil.innerHTML = `
-                <div class="alert alert-success">
-                    <b>✔ RM Ditemukan</b><br>
-                    Nama: ${p.nama}<br>
-                    Gender: ${p.gender ?? '-'}<br>
-                    Alamat: ${p.alamat ?? '-'}
-                </div>
-
-                <button class="btn btn-success" onclick="linkRM('${rm}')">
-                    ✔ Konfirmasi RM
-                </button>
-            `;
-
-        } else {
-
-            hasil.innerHTML = `
-                <div class="alert alert-danger">
-                    ⚠ RM tidak ditemukan
-                </div>
-
-                <button class="btn btn-warning" onclick="linkRM('${rm}')">
-                    Tetap Gunakan RM Ini
-                </button>
-            `;
-        }
-
-    });
-}
-
-function linkRM(rm){
-
-    fetch("<?= base_url('rm/link') ?>", {
-        method: "POST",
-        headers: {
-            "Content-Type": "application/x-www-form-urlencoded"
-        },
-        body: "register_id=" + currentRegisterId + "&rm=" + rm
-    })
-    .then(res => res.json())
-    .then(res => {
-        if(res.status === 'success'){
-            alert("RM berhasil di-update");
-            location.reload();
-        }
-    });
-
-}
-
-//Fungsi Pencari RM//
-let rmTimeout;
-
-function searchRM() {
-    clearTimeout(rmTimeout);
-
-    rmTimeout = setTimeout(() => {
-
-        let q = document.getElementById('noRM').value;
-
-        if (!q) {
-            alert("RM masih kosong");
-            return;
-        }
-
-        fetch("<?= base_url('rm/search') ?>", {
-            method: "POST",
-            headers: {
-                "Content-Type": "application/x-www-form-urlencoded"
-            },
-            body: "q=" + encodeURIComponent(q)
-        })
-        .then(res => res.json())
-        .then(res => {
-
-            let box = document.getElementById('rmResult');
-
-            // ================== RM TIDAK ADA ==================
-            if (!res.data || res.data.length === 0) {
-
-                box.innerHTML = `
-                    <div class="list-group-item text-danger">
-                        ❌ RM tidak ditemukan
-                    </div>
-
-                    <div class="list-group-item">
-                        <button class="btn btn-warning w-100"
-                            onclick="useNewRM('${q}')">
-                            ➕ Gunakan RM ini (Pasien Baru)
-                        </button>
-                    </div>
-                `;
-                return;
-            }
-
-            // ================== RM DITEMUKAN ==================
-            let html = `
-                <div class="list-group-item bg-light">
-                    <b>⚠ RM ditemukan</b><br>
-                    Pilih data pasien:
-                </div>
-            `;
-
-            res.data.forEach(p => {
-                html += `
-                    <button type="button"
-                        class="list-group-item list-group-item-action"
-                        onclick="confirmRM('${p.rm}','${p.nama}','${p.alamat}','${p.gender}','${p.tanggal_lahir}')">
-
-                        <b>${p.rm}</b> - ${p.nama}
-                        <br>
-                        <small class="text-muted">${p.alamat ?? ''}</small>
-                    </button>
-                `;
-            });
-
-            box.innerHTML = html;
-        });
-
-    }, 300);
-}
-
-function confirmRM(rm, nama, alamat, gender, tanggal_lahir)
-{
-    if(!rm) {
-        alert("Data RM tidak ditemukan");
-        return;
-    }
-
-    if(!confirm(`Gunakan data RM: ${nama}?`)) return;
-
-    document.getElementById('noRM').value = rm;
-    document.getElementById('nama').value = nama ?? '';
-    document.getElementById('alamat').value = alamat ?? '';
-    document.getElementById('gender').value = gender ?? '';
-    document.getElementById('tanggalLahir').value = tanggal_lahir ?? '';
-
-    // trigger umur
-    const tgl = document.getElementById('tanggalLahir');
-    if(tgl) tgl.dispatchEvent(new Event('change'));
-
-    document.getElementById('rmResult').innerHTML = `
-        <div class="alert alert-success py-2">
-            ✔ RM aktif: <b>${rm}</b><br>
-            👤 ${nama}
-        </div>
-    `;
-}
-
-function useNewRM(rm)
-{
-    document.getElementById('noRM').value = rm;
-
-    document.getElementById('rmResult').innerHTML = `
-        <div class="alert alert-warning alert-dismissible fade show" role="alert">
-            ⚠ RM ${rm} sebagai PASIEN BARU
-
-            <button type="button" class="btn-close" data-bs-dismiss="alert" aria-label="Close"></button>
-        </div>
-    `;
-    setTimeout(() => {
-    let el = document.querySelector('.alert-warning');
-    if(el) el.remove();
-  }, 2000);
-}
-
-function fillRM(rm,nama,alamat,gender,tgl)
-{
-    document.getElementById('noRM').value = rm;
-    document.getElementById('nama').value = nama;
-    document.getElementById('alamat').value = alamat;
-    document.getElementById('gender').value = gender;
-
-    document.getElementById('rmResult').innerHTML = '';
-
-    if(tgl){
-        document.getElementById('tanggalLahir').value = tgl;
-        document.getElementById('tanggalLahir').dispatchEvent(new Event('change'));
-    }
-}
-
-
-
-</script>
-<!-- ================= Modal RM ================= -->
-<div class="modal fade" id="modalCekRM" tabindex="-1">
-  <div class="modal-dialog">
-    <div class="modal-content">
-      <div class="modal-header">
-        <h5 class="modal-title">Cek RM</h5>
-        <button type="button" class="btn-close" data-bs-dismiss="modal"></button>
-      </div>
-      <div class="modal-body">
-        <input type="hidden" id="registerId">
-        <label>Masukkan RM</label>
-        <input type="text" id="inputRM" class="form-control">
-        <button class="btn btn-primary mt-2" onclick="cekRM()">
-          🔍 Cek RM
-        </button>
-        <hr>
-        <div id="hasilRM"></div>
-      </div>
-
-    </div>
-  </div>
-</div>
-<script src="https://cdn.jsdelivr.net/npm/bootstrap@5.3.3/dist/js/bootstrap.bundle.min.js"></script>
-</body>
+<!DOCTYPE html>
+<html lang="id">
+<head>
+  <meta charset="UTF-8">
+  <title>Form Input Pasien Ambulans Emergensi 119 RSSA</title>
+  <meta name="viewport" content="width=device-width, initial-scale=1">
+
+  <link href="https://cdn.jsdelivr.net/npm/bootstrap@5.3.0/dist/css/bootstrap.min.css" rel="stylesheet">
+
+  <style>
+    body {
+      background-color: #f8f9fa;
+      padding: 2rem;
+    }
+
+    .form-label {
+      font-weight: 500;
+    }
+
+    #inputTujuanContainer {
+      display: none;
+    }
+
+    .perawat-wrapper {
+      position: relative;
+      margin-bottom: 1rem;
+    }
+
+    .hapus-perawat-btn {
+      position: absolute;
+      top: 4px;
+      right: 8px;
+      font-size: 16px;
+      color: #dc3545;
+      background: none;
+      border: none;
+      cursor: pointer;
+    }
+
+    .hapus-perawat-btn:hover {
+      color: #a71d2a;
+    }
+  </style>
+</head>
+
+<body>
+
+<div class="container py-5">
+  <div class="card shadow p-4">
+
+    <h4 class="mb-4 text-primary">
+      🚑 Form Input Pasien Ambulans Emergensi 119 RSSA
+    </h4>
+
+    <?php if (session()->has('errors')): ?>
+    <div class="alert alert-danger">
+        <strong>Periksa kembali data berikut:</strong>
+        <ul class="mb-0">
+            <?php foreach (session('errors') as $error): ?>
+                <li><?= esc($error) ?></li>
+            <?php endforeach; ?>
+        </ul>
+    </div>
+    <?php endif; ?>
+
+    <!-- FORM START -->
+    <form id="formPasien"
+      method="post"
+      action="<?= base_url('pasien/'.($edit_mode ? 'update/'.$id : 'simpan')) ?>">
+
+      <?= csrf_field(); ?>
+
+      <!-- ================= HEADER ================= -->
+<div class="row mb-3">
+
+<div class="col-md-3">
+  <label class="form-label">Tanggal & Jam</label>
+
+  <input type="datetime-local"
+       name="tanggal"
+       class="form-control"
+       value="<?= isset($pasien['created_at']) 
+            ? date('Y-m-d\TH:i', strtotime($pasien['created_at'])) 
+            : date('Y-m-d\TH:i') ?>"
+       <?= $edit_mode ? 'readonly' : '' ?>>
+</div>
+
+ <div class="col-md-2">
+    <label class="form-label">Register Ambulans</label>
+    <input 
+      type="text" 
+      class="form-control" 
+      name="register"
+      value="<?= $register ?? '' ?>"
+      readonly>
+</div>
+
+<div class="col-md-2 position-relative">
+  <label class="form-label">No RM</label>
+
+  <div class="input-group">
+    <input  
+      type="text"  
+      id="noRM"  
+      name="rm"  
+      class="form-control"  
+      placeholder="Ketik RM"  
+      pattern="[0-9]*"  
+      inputmode="numeric"
+      value="<?= isset($pasien['rm']) ? esc($pasien['rm']) : '' ?>"
+    >
+
+    <button type="button" class="btn btn-primary" onclick="searchRM()">
+      🔍
+    </button>
+  </div>
+
+  <div id="rmResult" class="list-group position-absolute w-100 z-3"></div>
+</div>
+
+<div class="col-md-3">
+    <label class="form-label">
+        Nama Penelpon <span class="text-danger">*</span>
+    </label>
+
+    <input
+        type="text"
+        class="form-control <?= session('errors.nama_penelpon') ? 'is-invalid' : '' ?>"
+        id="penelpon"
+        name="nama_penelpon"
+        placeholder="Nama penelpon"
+        value="<?= old('nama_penelpon', $pasien['nama_penelpon'] ?? '') ?>">
+
+    <?php if(session('errors.nama_penelpon')): ?>
+        <div class="invalid-feedback">
+            <?= session('errors.nama_penelpon') ?>
+        </div>
+    <?php endif; ?>
+</div>
+
+<div class="col-md-2">
+    <label class="form-label">
+        No. Penelpon <span class="text-danger">*</span>
+    </label>
+
+    <input
+        type="tel"
+        class="form-control <?= session('errors.no_penelpon') ? 'is-invalid' : '' ?>"
+        id="no_penelpon"
+        name="no_penelpon"
+        placeholder="08xxxx"
+        value="<?= old('no_penelpon', $pasien['no_penelpon'] ?? '') ?>">
+
+    <?php if(session('errors.no_penelpon')): ?>
+        <div class="invalid-feedback">
+            <?= session('errors.no_penelpon') ?>
+        </div>
+    <?php endif; ?>
+</div>
+
+</div>
+
+<!-- ================= IDENTITAS ================= -->
+<div class="row mb-3">
+
+<div class="col-md-2" style="max-width: 120px;">
+    <label class="form-label">Atribut</label>
+    <select class="form-select" id="panggilanDepan" name="panggilan_depan">
+        <option value="">Pilih</option>
+        <?php
+        $opsi = ['By.','An.','Sdr.','Nn.','Tn.','Ny.'];
+        foreach ($opsi as $o):
+        ?>
+            <option value="<?= $o ?>"
+                <?= old('panggilan_depan', $pasien['atribut'] ?? '') == $o ? 'selected' : '' ?>>
+                <?= $o ?>
+            </option>
+        <?php endforeach; ?>
+    </select>
+</div>
+
+<div class="col-md-4">
+    <label class="form-label">
+        Nama Pasien <span class="text-danger">*</span>
+    </label>
+
+    <input type="text"
+        class="form-control <?= session('errors.nama') ? 'is-invalid' : '' ?>"
+        id="nama"
+        name="nama"
+        value="<?= old('nama', $pasien['nama'] ?? '') ?>">
+
+    <?php if(session('errors.nama')): ?>
+        <div class="invalid-feedback">
+            <?= session('errors.nama') ?>
+        </div>
+    <?php endif; ?>
+</div>
+
+<div class="col-md-2">
+    <label class="form-label">
+        Jenis Kelamin <span class="text-danger">*</span>
+    </label>
+
+    <select class="form-select <?= session('errors.gender') ? 'is-invalid' : '' ?>"
+            id="gender"
+            name="gender">
+
+        <option value="">...</option>
+
+        <option value="Laki-laki"
+            <?= old('gender', $pasien['gender'] ?? '') == 'Laki-laki' ? 'selected' : '' ?>>
+            Laki-laki
+        </option>
+
+        <option value="Perempuan"
+            <?= old('gender', $pasien['gender'] ?? '') == 'Perempuan' ? 'selected' : '' ?>>
+            Perempuan
+        </option>
+
+    </select>
+
+    <?php if(session('errors.gender')): ?>
+        <div class="invalid-feedback">
+            <?= session('errors.gender') ?>
+        </div>
+    <?php endif; ?>
+</div>
+
+<div class="col-md-2">
+    <label class="form-label">
+        Tanggal Lahir <span class="text-danger">*</span>
+    </label>
+
+    <input type="date"
+        id="tanggalLahir"
+        class="form-control <?= session('errors.tanggal_lahir') ? 'is-invalid' : '' ?>"
+        name="tanggal_lahir"
+        value="<?= old('tanggal_lahir', !empty($pasien['tgl_lahir']) ? date('Y-m-d', strtotime($pasien['tgl_lahir'])) : '') ?>">
+
+    <?php if(session('errors.tanggal_lahir')): ?>
+        <div class="invalid-feedback">
+            <?= session('errors.tanggal_lahir') ?>
+        </div>
+    <?php endif; ?>
+</div>
+
+<div class="col-md-2">
+    <label class="form-label">Umur</label>
+    <input type="text" id="umur" class="form-control" readonly>
+</div>
+
+</div>
+
+<!-- ================= ALAMAT + POSISI ================= -->
+<div class="row mb-3">
+
+ <!-- ALAMAT (kiri) -->
+<div class="col-md-6">
+<label class="form-label">
+    Alamat <span class="text-danger">*</span>
+</label>
+
+<textarea id="alamat"
+          name="alamat"
+          rows="4"
+          class="form-control <?= session('errors.alamat') ? 'is-invalid' : '' ?>"><?= old('alamat', $pasien['alamat'] ?? '') ?></textarea>
+
+<?php if(session('errors.alamat')): ?>
+<div class="invalid-feedback d-block">
+    <?= session('errors.alamat') ?>
+</div>
+<?php endif; ?>
+</div>
+
+  <!-- POSISI PASIEN (kanan) -->
+  <div class="col-md-6">
+
+  <?php
+  $pos = json_decode($order['posisi'] ?? '{}', true);
+
+  $posisiPasien = old('posisi_pasien', $pos['lokasi'] ?? '');
+  $lantai       = old('posisi_lantai', $pos['lantai'] ?? '');
+  $lainnya      = old('posisi_lainnya', $pos['lainnya'] ?? '');
+  ?>
+
+  <!-- HEADER: Judul kiri, Lantai kanan -->
+  <div class="d-flex justify-content-between align-items-center mb-2">
+      <label class="form-label mb-0">
+          Posisi Pasien (Saat Ditemukan)
+      </label>
+
+      <div class="d-flex align-items-center">
+          <label for="lantai" class="me-2 mb-0">Lantai</label>
+
+          <select id="lantai"
+                  name="posisi_lantai"
+                  class="form-select form-select-sm">
+
+              <option value="">Pilih</option>
+
+              <?php for ($i = 1; $i <= 50; $i++): ?>
+                  <option value="<?= $i ?>"
+                      <?= ($lantai == $i) ? 'selected' : '' ?>>
+                      Lantai <?= $i ?>
+                  </option>
+              <?php endfor; ?>
+
+          </select>
+      </div>
+  </div>
+
+  <!-- RADIO BUTTON -->
+  <div class="form-check">
+      <input class="form-check-input"
+            type="radio"
+            id="tidur"
+            name="posisi_pasien"
+            value="kamar_tidur"
+            <?= $posisiPasien === 'kamar_tidur' ? 'checked' : '' ?>>
+      <label class="form-check-label" for="tidur">
+          Di Kamar Tidur
+      </label>
+  </div>
+
+  <div class="form-check">
+      <input class="form-check-input"
+            type="radio"
+            id="tamu"
+            name="posisi_pasien"
+            value="ruang_tamu"
+            <?= $posisiPasien === 'ruang_tamu' ? 'checked' : '' ?>>
+      <label class="form-check-label" for="tamu">
+          Di Ruang Tamu
+      </label>
+  </div>
+
+  <div class="form-check">
+      <input class="form-check-input"
+            type="radio"
+            id="mandi"
+            name="posisi_pasien"
+            value="kamar_mandi"
+            <?= $posisiPasien === 'kamar_mandi' ? 'checked' : '' ?>>
+      <label class="form-check-label" for="mandi">
+          Di Kamar Mandi
+      </label>
+  </div>
+
+  <div class="d-flex align-items-center mb-2">
+      <input class="form-check-input me-2"
+            type="radio"
+            id="ruanglain"
+            name="posisi_pasien"
+            value="lainnya"
+            onchange="toggleInputRuangLain()"
+            <?= $posisiPasien === 'lainnya' ? 'checked' : '' ?>>
+
+      <label class="form-check-label me-2" for="ruanglain">
+          Di Ruang Lain:
+      </label>
+
+      <input type="text"
+            id="inputRuangLain"
+            name="posisi_lainnya"
+            class="form-control form-control-sm w-50"
+            placeholder="Sebutkan..."
+            value="<?= esc($lainnya) ?>"
+            <?= $posisiPasien === 'lainnya' ? '' : 'disabled' ?>>
+  </div>
+
+  </div>
+  <div class="row mb-3">
+
+<!-- Keluhan Utama -->
+<div class="col-md-12">
+    <label class="form-label">Keluhan Utama</label>
+
+    <textarea
+        class="form-control <?= session('errors.keluhan_utama') ? 'is-invalid' : '' ?>"
+        name="keluhan_utama"
+        rows="2"
+        placeholder="Contoh: sesak napas, nyeri dada, kecelakaan, dll"><?= old('keluhan_utama', $order['keluhan_utama'] ?? '') ?></textarea>
+
+    <?php if(session('errors.keluhan_utama')): ?>
+        <div class="invalid-feedback">
+            <?= session('errors.keluhan_utama') ?>
+        </div>
+    <?php endif; ?>
+</div>
+
+<!-- 1. Kesadaran -->
+<div class="col-md-4">
+    <label class="form-label">
+        Kesadaran <span class="text-danger">*</span>
+    </label>
+
+    <select
+        class="form-select <?= session('errors.kesadaran') ? 'is-invalid' : '' ?>"
+        id="kesadaran"
+        name="kesadaran">
+
+        <option value="">...</option>
+
+        <option value="Sadar"
+            <?= old('kesadaran', $order['kesadaran'] ?? '') == 'Sadar' ? 'selected' : '' ?>>
+            Sadar
+        </option>
+
+        <option value="Tidak Sadar"
+            <?= old('kesadaran', $order['kesadaran'] ?? '') == 'Tidak Sadar' ? 'selected' : '' ?>>
+            Tidak Sadar
+        </option>
+
+        <option value="Gelisah"
+            <?= old('kesadaran', $order['kesadaran'] ?? '') == 'Gelisah' ? 'selected' : '' ?>>
+            Gelisah
+        </option>
+
+    </select>
+
+    <?php if(session('errors.kesadaran')): ?>
+        <div class="invalid-feedback">
+            <?= session('errors.kesadaran') ?>
+        </div>
+    <?php endif; ?>
+</div>
+
+<!-- 2. Kategori -->
+<div class="col-md-4">
+    <label class="form-label">
+        Kategori <span class="text-danger">*</span>
+    </label>
+
+    <select
+        class="form-select <?= session('errors.kategori') ? 'is-invalid' : '' ?>"
+        id="kategori"
+        name="kategori">
+
+        <option value="">...</option>
+
+        <option value="Trauma"
+            <?= old('kategori', $order['kategori'] ?? '') == 'Trauma' ? 'selected' : '' ?>>
+            Trauma
+        </option>
+
+        <option value="Non Trauma"
+            <?= old('kategori', $order['kategori'] ?? '') == 'Non Trauma' ? 'selected' : '' ?>>
+            Non Trauma
+        </option>
+
+    </select>
+
+    <?php if(session('errors.kategori')): ?>
+        <div class="invalid-feedback">
+            <?= session('errors.kategori') ?>
+        </div>
+    <?php endif; ?>
+</div>
+<!-- 3. Order Type -->
+<div class="col-md-4">
+    <label class="form-label">
+        Order Type <span class="text-danger">*</span>
+    </label>
+
+    <select
+        class="form-select <?= session('errors.order_type') ? 'is-invalid' : '' ?>"
+        id="orderType"
+        name="order_type">
+
+        <option value="Pending Order"
+            <?= old('order_type', $order['order_type'] ?? 'Pending Order') == 'Pending Order' ? 'selected' : '' ?>>
+            🟢 Pending Order
+        </option>
+
+        <option value="Non Emergency"
+            <?= old('order_type', $order['order_type'] ?? '') == 'Non Emergency' ? 'selected' : '' ?>>
+            🟡 Non Emergency
+        </option>
+
+        <option value="True Emergency"
+            <?= old('order_type', $order['order_type'] ?? '') == 'True Emergency' ? 'selected' : '' ?>>
+            🔴 True Emergency
+        </option>
+
+    </select>
+
+    <?php if(session('errors.order_type')): ?>
+        <div class="invalid-feedback">
+            <?= session('errors.order_type') ?>
+        </div>
+    <?php endif; ?>
+</div>
+
+</div>
+<div class="row g-3">
+
+<!-- KIRI: PERNAFASAN -->
+<div class="col-md-3">
+    <div class="border rounded p-3 h-100">
+
+        <?php
+        // ✅ WAJIB: decode JSON dulu
+        $pernafasan = json_decode($order['pernafasan'] ?? '{}', true);
+
+        $sesak = old('sesak', $pernafasan['sesak'] ?? '');
+        $batuk = old('batuk', $pernafasan['batuk'] ?? '');
+        ?>
+
+        <label class="fw-bold">Pernafasan</label>
+
+        <!-- SESAK -->
+        <div class="mt-2">
+            <div class="d-flex gap-3">
+
+                <div class="form-check">
+                    <input class="form-check-input"
+                           type="radio"
+                           name="sesak"
+                           value="ya"
+                           id="sesakYa"
+                           <?= $sesak === 'ya' ? 'checked' : '' ?>>
+                    <label class="form-check-label" for="sesakYa">
+                        Sesak
+                    </label>
+                </div>
+
+                <div class="form-check">
+                    <input class="form-check-input"
+                           type="radio"
+                           name="sesak"
+                           value="tidak"
+                           id="sesakTidak"
+                           <?= $sesak === 'tidak' ? 'checked' : '' ?>>
+                    <label class="form-check-label" for="sesakTidak">
+                        Tidak Sesak
+                    </label>
+                </div>
+
+            </div>
+        </div>
+
+        <!-- BATUK -->
+        <div class="mt-2">
+            <div class="d-flex gap-3">
+
+                <div class="form-check">
+                    <input class="form-check-input"
+                           type="radio"
+                           name="batuk"
+                           value="ya"
+                           id="batukYa"
+                           <?= $batuk === 'ya' ? 'checked' : '' ?>>
+                    <label class="form-check-label" for="batukYa">
+                        Batuk
+                    </label>
+                </div>
+
+                <div class="form-check">
+                    <input class="form-check-input"
+                           type="radio"
+                           name="batuk"
+                           value="tidak"
+                           id="batukTidak"
+                           <?= $batuk === 'tidak' ? 'checked' : '' ?>>
+                    <label class="form-check-label" for="batukTidak">
+                        Tidak Batuk
+                    </label>
+                </div>
+
+            </div>
+        </div>
+
+
+    
+      <!-- Suhu -->
+<?php $suhu = old('suhu', $order['suhu'] ?? ''); ?>
+
+<label class="fw-bold">
+    Suhu Tubuh <span class="text-danger">*</span>
+</label>
+
+<div class="d-flex gap-3 mt-2 mb-2">
+
+    <div class="form-check">
+        <input class="form-check-input <?= session('errors.suhu') ? 'is-invalid' : '' ?>"
+               type="radio"
+               id="demam"
+               name="suhu"
+               value="demam"
+               <?= $suhu == 'demam' ? 'checked' : '' ?>>
+
+        <label class="form-check-label" for="demam">
+            Demam
+        </label>
+    </div>
+
+    <div class="form-check">
+        <input class="form-check-input <?= session('errors.suhu') ? 'is-invalid' : '' ?>"
+               type="radio"
+               id="tidak_demam"
+               name="suhu"
+               value="tidak_demam"
+               <?= $suhu == 'tidak_demam' ? 'checked' : '' ?>>
+
+        <label class="form-check-label" for="tidak_demam">
+            Tidak Demam
+        </label>
+    </div>
+
+</div>
+
+<?php if(session('errors.suhu')): ?>
+<div class="text-danger small">
+    <?= session('errors.suhu') ?>
+</div>
+<?php endif; ?>
+
+
+
+  <?php
+  $bahaya = json_decode($order['bahaya'] ?? '{}', true);
+  $statusBahaya = $bahaya['status'] ?? '';
+  $detailBahaya = $bahaya['detail'] ?? '';
+  ?>
+  <!-- Kondisi Bahaya -->
+  <label class="fw-bold">Kondisi Bahaya</label>
+  <div class="d-flex gap-3 mt-2">
+      <div class="form-check">
+          <input class="form-check-input"
+                type="radio"
+                name="bahaya"
+                value="ada"
+                id="bahayaAda"
+                <?= $statusBahaya === 'ada' ? 'checked' : '' ?>>
+          <label class="form-check-label" for="bahayaAda">
+              Ada
+          </label>
+      </div>
+      <div class="form-check">
+          <input class="form-check-input"
+                type="radio"
+                name="bahaya"
+                value="tidak"
+                id="bahayaTidakAda"
+                <?= $statusBahaya === 'tidak' ? 'checked' : '' ?>>
+          <label class="form-check-label" for="bahayaTidakAda">
+              Tidak
+          </label>
+      </div>
+  </div>
+  <!-- Detail Bahaya -->
+  <div id="bahayaInputDiv"
+      class="mt-2 <?= $statusBahaya === 'ada' ? '' : 'opacity-50' ?>">
+      <input type="text"
+            class="form-control"
+            name="bahaya_detail"
+            placeholder="Jenis bahaya..."
+            value="<?= esc($detailBahaya) ?>"
+            <?= $statusBahaya === 'ada' ? '' : 'disabled' ?>>
+  </div>
+            </div>
+            </div>
+  <div class="col-md-3">
+    <div class="border rounded p-3 h-100">
+        <label class="form-label fw-bold">Keterbatasan Gerak</label>
+        <div class="d-flex flex-column gap-2 mt-2">
+            <div class="form-check">
+                <input class="form-check-input"
+                       type="radio"
+                       name="gerak"
+                       id="gerakTangan"
+                       value="tangan"
+                       <?= ($order['keterbatasan'] ?? '') === 'tangan' ? 'checked' : '' ?>>
+                <label class="form-check-label">Tangan</label>
+            </div>
+
+            <div class="form-check">
+                <input class="form-check-input"
+                       type="radio"
+                       name="gerak"
+                       value="kaki"
+                       <?= ($order['keterbatasan'] ?? '') === 'kaki' ? 'checked' : '' ?>>
+                <label class="form-check-label">Kaki</label>
+            </div>
+
+            <div class="form-check">
+                <input class="form-check-input"
+                       type="radio"
+                       name="gerak"
+                       value="semua"
+                       <?= ($order['keterbatasan'] ?? '') === 'semua' ? 'checked' : '' ?>>
+                <label class="form-check-label">Semua Anggota Gerak</label>
+            </div>
+
+            <div class="form-check">
+                <input class="form-check-input"
+                       type="radio"
+                       name="gerak"
+                       value="normal"
+                       <?= ($order['keterbatasan'] ?? '') === 'normal' ? 'checked' : '' ?>>
+                <label class="form-check-label">Tidak Ada Keterbatasan</label>
+            </div>
+
+        </div>
+
+    
+            <!-- Berat Badan -->
+            <label class="fw-bold">Berat Badan</label>
+
+            <div class="input-group mt-2 mb-3">
+                <input type="number"
+                      class="form-control"
+                      id="beratBadan"
+                      name="berat_badan"
+                      placeholder="BB Pasien"
+                      value="<?= esc($order['berat_badan'] ?? '') ?>">
+
+                <span class="input-group-text">Kg</span>
+            </div>
+            </div>
+            </div>
+
+<?php
+// ✅ decode JSON nyeri
+$nyeri = json_decode($order['nyeri'] ?? '{}', true);
+
+$statusNyeri = $nyeri['status'] ?? 'tidak';
+$lokasiNyeri = $nyeri['lokasi'] ?? [];
+$nyeriLain   = $nyeri['lain'] ?? '';
+
+// pastikan array
+if (!is_array($lokasiNyeri)) {
+    $lokasiNyeri = [$lokasiNyeri];
+}
+?>
+
+<!-- KANAN: NYERI -->
+<div class="col-md-6">
+  <div class="border rounded p-3 h-100">
+    <label class="form-label fw-bold">Nyeri / Luka</label>
+
+    <!-- RADIO -->
+    <div class="d-flex gap-3 mt-2 mb-2">
+      <div class="form-check">
+        <input class="form-check-input"
+               type="radio"
+               name="status_nyeri"
+               id="adaNyeri"
+               value="ya"
+               <?= $statusNyeri === 'ya' ? 'checked' : '' ?>>
+        <label class="form-check-label" for="adaNyeri">Nyeri</label>
+      </div>
+
+      <div class="form-check">
+        <input class="form-check-input"
+               type="radio"
+               name="status_nyeri"
+               id="tidakNyeri"
+               value="tidak"
+               <?= $statusNyeri === 'tidak' ? 'checked' : '' ?>>
+        <label class="form-check-label" for="tidakNyeri">Tidak Nyeri</label>
+      </div>
+    </div>
+
+    <!-- DETAIL -->
+    <div id="detailNyeri"
+         class="<?= $statusNyeri === 'ya' ? '' : 'opacity-50' ?>">
+
+      <label class="form-label fw-semibold mb-2">
+        Lokasi Nyeri
+      </label>
+
+      <div class="row row-cols-2 row-cols-md-4 g-2">
+        <?php
+        $lokasiList = [
+            'kepala','leher','dada','punggung',
+            'perut','panggul','tangan','kaki'
+        ];
+
+        foreach ($lokasiList as $l):
+        ?>
+          <div class="col">
+            <div class="form-check">
+              <input class="form-check-input"
+                     type="checkbox"
+                     name="lokasi_nyeri[]"
+                     value="<?= $l ?>"
+                     id="nyeri_<?= $l ?>"
+                     <?= in_array($l, $lokasiNyeri) ? 'checked' : '' ?>
+                     <?= $statusNyeri !== 'ya' ? 'disabled' : '' ?>>
+
+              <label class="form-check-label"
+                     for="nyeri_<?= $l ?>">
+                <?= ucfirst($l) ?>
+              </label>
+            </div>
+          </div>
+        <?php endforeach; ?>
+      </div>
+
+      <input type="text"
+             name="nyeri_lain"
+             class="form-control mt-3"
+             placeholder="Lain-lain..."
+             value="<?= esc($nyeriLain) ?>"
+             <?= $statusNyeri !== 'ya' ? 'disabled' : '' ?>>
+    </div>
+  </div>
+</div>
+
+<!-- Informasi Lain -->
+<div class="row mt-3">
+    <div class="col-md-12">
+        <label class="form-label fw-bold">Informasi Lain</label>
+
+        <textarea
+            class="form-control"
+            name="informasi_lain"
+            rows="1"
+            placeholder="Contoh: alergi obat, kondisi khusus, permintaan khusus, peralatan khusus, dll"><?= esc($order['informasi_lain'] ?? '') ?></textarea>
+
+    </div>
+</div>
+
+</div>
+<!-- ================= TUJUAN ================= -->
+<div class="row mt-3 g-3">
+
+    <div class="col-md-5">
+        <div class="border rounded p-3 h-100 shadow-sm">
+            <label for="tujuan" class="form-label fw-bold">
+                🎯 Tujuan Transport
+            </label>
+
+            <select class="form-select" id="tujuan" name="tujuan" required>
+                <option value="">-- Pilih Tujuan --</option>
+
+                <option value="RFDK"
+                    <?= ($order['tujuan'] ?? '') === 'RFDK' ? 'selected' : '' ?>>
+                    RFDK – Rumah ke Faskes Dalam Kota
+                </option>
+
+                <option value="F-FDK"
+                    <?= ($order['tujuan'] ?? '') === 'F-FDK' ? 'selected' : '' ?>>
+                    F-FDK – Fasilitas Umum ke Faskes Dalam Kota
+                </option>
+
+                <option value="AFDK"
+                    <?= ($order['tujuan'] ?? '') === 'AFDK' ? 'selected' : '' ?>>
+                    AFDK – Antar Faskes Dalam Kota
+                </option>
+
+                <option value="AFLK"
+                    <?= ($order['tujuan'] ?? '') === 'AFLK' ? 'selected' : '' ?>>
+                    AFLK – Antar Faskes Luar Kota
+                </option>
+
+                <option value="PDK"
+                    <?= ($order['tujuan'] ?? '') === 'PDK' ? 'selected' : '' ?>>
+                    PDK – Pulang Dalam Kota
+                </option>
+
+                <option value="PLK"
+                    <?= ($order['tujuan'] ?? '') === 'PLK' ? 'selected' : '' ?>>
+                    PLK – Pulang Luar Kota
+                </option>
+            </select>
+
+            <div class="mt-3">
+                <label for="tujuan_detail" class="form-label small fw-semibold">
+                    Detail Tujuan
+                </label>
+
+                <input
+                    type="text"
+                    id="tujuan_detail"
+                    class="form-control"
+                    name="tujuan_detail"
+                    placeholder="Contoh: Nama RS / Alamat / Keterangan Lain"
+                    value="<?= esc($order['tujuan_detail'] ?? '') ?>">
+            </div>
+        </div>
+    </div>
+
+
+<?php $persetujuan = $order['persetujuan'] ?? ''; ?>
+
+<!-- PERSETUJUAN BIAYA -->
+<div class="col-md-3">
+    <div class="border rounded p-3 h-100">
+        <label class="form-label fw-bold">Persetujuan Biaya</label>
+
+        <div class="d-flex flex-column gap-1 mt-2 mb-3">
+
+            <!-- SETUJU -->
+            <div class="form-check">
+                <input class="form-check-input"
+                       type="radio"
+                       name="persetujuan"
+                       id="persetujuanSetuju"
+                       value="setuju"
+                       <?= $persetujuan === 'setuju' ? 'checked' : '' ?>>
+                <label class="form-check-label" for="persetujuanSetuju">
+                    Setuju
+                </label>
+            </div>
+
+            <!-- TIDAK -->
+            <div class="form-check">
+                <input class="form-check-input"
+                       type="radio"
+                       name="persetujuan"
+                       id="persetujuanTidak"
+                       value="tidak"
+                       <?= $persetujuan === 'tidak' ? 'checked' : '' ?>>
+                <label class="form-check-label" for="persetujuanTidak">
+                    Tidak Setuju
+                </label>
+            </div>
+
+            <!-- MENUNGGU -->
+            <div class="form-check">
+                <input class="form-check-input"
+                       type="radio"
+                       name="persetujuan"
+                       id="persetujuanMenunggu"
+                       value="menunggu"
+                       <?= $persetujuan === 'menunggu' ? 'checked' : '' ?>>
+                <label class="form-check-label" for="persetujuanMenunggu">
+                    Menunggu Persetujuan
+                </label>
+            </div>
+
+        </div>
+
+        <label class="form-label small">Nominal Biaya</label>
+
+        <div class="input-group">
+            <span class="input-group-text">Rp</span>
+            <input type="number"
+                   class="form-control"
+                   name="biaya"
+                   placeholder="Isi Nominal"
+                   value="<?= esc($order['biaya'] ?? '') ?>">
+        </div>
+    </div>
+</div>
+
+ <!-- VALIDASI + PETUGAS -->
+<div class="col-md-4">
+    <div class="border rounded p-3 h-100">
+        <label class="form-label fw-bold">
+            Validasi Pelayanan
+        </label>
+
+        <input type="text"
+               class="form-control mt-1 mb-3"
+               name="validasi"
+               placeholder="Valid / Tidak Valid"
+               value="<?= esc($order['validasi'] ?? '') ?>">
+
+        <!-- PETUGAS -->
+            <label class="form-label small">
+                Petugas Predispatch
+            </label>
+
+            <input type="hidden"
+                name="petugas_id_old"
+                value="<?= $order['petugas_id'] ?? '' ?>">
+
+            <select id="petugas"
+                    name="petugas_id"
+                    class="form-select"
+                    style="width:100%">
+            </select>
+</div>
+        </div>
+<!-- ================= BUTTON ================= -->
+<div class="d-flex justify-content-between mt-4">
+    <button type="button"
+            class="btn btn-secondary"
+            onclick="history.back()">
+        Kembali
+    </button>
+    <button type="submit"
+            id="btnSubmit"
+            class="btn btn-success">
+        Simpan Pasien
+    </button>
+</div>
+
+</form>
+<!-- FORM END -->
+
+</div>
+</div>
+
+
+<script src="https://code.jquery.com/jquery-3.6.0.min.js"></script>
+<link href="https://cdn.jsdelivr.net/npm/select2@4.1.0-rc.0/dist/css/select2.min.css" rel="stylesheet" />
+<script src="https://cdn.jsdelivr.net/npm/select2@4.1.0-rc.0/dist/js/select2.min.js"></script>
+
+<script>
+let isSubmitting = false;
+let rmTimeout;
+let currentRegisterId = null;
+
+// =====================================================
+// DOM READY
+// =====================================================
+document.addEventListener('DOMContentLoaded', function () {
+
+    const tglInput = document.getElementById('tanggalLahir');
+    const umurInput = document.getElementById('umur');
+
+    if (!tglInput || !umurInput) return;
+
+    function hitungUmur() {
+        const val = tglInput.value;
+
+        if (!val) {
+            umurInput.value = '';
+            return;
+        }
+
+        const lahir = new Date(val);
+        const today = new Date();
+
+        let tahun = today.getFullYear() - lahir.getFullYear();
+        let bulan = today.getMonth() - lahir.getMonth();
+        let hari = today.getDate() - lahir.getDate();
+
+        if (hari < 0) {
+            bulan--;
+            const lastMonth = new Date(today.getFullYear(), today.getMonth(), 0);
+            hari += lastMonth.getDate();
+        }
+
+        if (bulan < 0) {
+            tahun--;
+            bulan += 12;
+        }
+
+        umurInput.value = `${tahun} Th ${bulan} Bln ${hari} Hr`;
+    }
+    window.hitungUmur = hitungUmur;
+    // jalan saat pertama load (edit mode)
+    setTimeout(hitungUmur, 100);
+
+    // jalan saat user ganti tanggal
+    tglInput.addEventListener('change', hitungUmur);
+
+
+    // ================= FORM SUBMIT =================
+    const form = document.getElementById('formPasien');
+    form.addEventListener('keydown', function(e) {
+            if (e.key === 'Enter') {
+
+                const tag = e.target.tagName.toLowerCase();
+
+                // textarea tetap bisa enter (newline)
+                if (tag === 'textarea') return;
+
+                e.preventDefault();
+
+                // ambil semua input yang bisa difokus
+                const focusable = form.querySelectorAll(
+                    'input:not([type=hidden]):not([disabled]), select, textarea, button'
+                );
+
+                const index = Array.prototype.indexOf.call(focusable, e.target);
+
+                if (index > -1 && index < focusable.length - 1) {
+                    focusable[index + 1].focus();
+                }
+            }
+        });
+    if (form) {
+        form.addEventListener('submit', function (e) {
+
+            if (isSubmitting) {
+                e.preventDefault();
+                return false;
+            }
+
+            if (!confirm('Yakin simpan data pasien?')) {
+                e.preventDefault();
+                return false;
+            }
+
+            isSubmitting = true;
+
+            const btn = document.getElementById('btnSubmit');
+            if (btn) {
+                btn.disabled = true;
+                btn.innerHTML = 'Menyimpan...';
+            }
+        });
+    }
+
+    // ================= SELECT2 PETUGAS =================
+        $('#petugas').select2({
+            width: '100%',
+            placeholder: 'Ketik nama petugas...',
+            minimumInputLength: 1,
+            ajax: {
+                url: '<?= base_url('pegawai/search') ?>',
+                dataType: 'json',
+                delay: 250,
+                data: function (params) {
+                    return { q: params.term };
+                },
+                processResults: function (data) {
+                    return {
+                        results: data
+                    };
+                }
+            }
+        });
+
+        // ✅ inject value saat edit
+        <?php if (!empty($order['petugas_id']) && !empty($order['petugas_nama'])): ?>
+            var option = new Option(
+                "<?= esc($order['petugas_nama']) ?>",
+                "<?= $order['petugas_id'] ?>",
+                true,
+                true
+            );
+            $('#petugas').append(option).trigger('change');
+        <?php endif; ?>
+
+        // ✅ auto fokus langsung bisa ngetik
+        $(document).on('select2:open', function () {
+            setTimeout(function () {
+                document.querySelector('.select2-search__field')?.focus();
+            }, 0);
+        });
+
+    // ================= TOGGLE RADIO =================
+    toggleByRadio('status_nyeri', 'detailNyeri', 'ya');
+    toggleByRadio('bahaya', 'bahayaInputDiv', 'ada');
+
+    document.querySelectorAll('input[type="radio"]:checked')
+        .forEach(el => el.dispatchEvent(new Event('change')));
+
+    // ================= SEARCH RM =================
+    const noRM = document.getElementById('noRM');
+    if (noRM) {
+        noRM.addEventListener('input', searchRM);
+    }
+
+// ================= RUANG LAIN =================
+    toggleInputRuangLain();
+});
+
+// =====================================================
+// RESET SAAT BACK
+// =====================================================
+window.addEventListener('pageshow', function () {
+    isSubmitting = false;
+
+    const btn = document.getElementById('btnSubmit');
+    if (btn) {
+        btn.disabled = false;
+        btn.innerHTML = 'Simpan Pasien';
+    }
+});
+
+// =====================================================
+// TOGGLE RADIO
+// =====================================================
+function toggleByRadio(name, targetId, activeValue) {
+    const radios = document.querySelectorAll(`input[name="${name}"]`);
+    const target = document.getElementById(targetId);
+
+    if (!target) return;
+
+    radios.forEach(el => {
+        el.addEventListener('change', function () {
+            const aktif = this.value === activeValue;
+
+            target.querySelectorAll('input, select, textarea').forEach(input => {
+                input.disabled = !aktif;
+            });
+
+            target.classList.toggle('opacity-50', !aktif);
+        });
+    });
+}
+
+// =====================================================
+// RUANG LAIN
+// =====================================================
+function toggleInputRuangLain() {
+    const checkbox = document.getElementById('ruanglain');
+    const input = document.getElementById('inputRuangLain');
+
+    if (!checkbox || !input) return;
+
+    input.disabled = !checkbox.checked;
+
+    if (!checkbox.checked) {
+        input.value = '';
+    }
+}
+
+// =====================================================
+// MODAL CEK RM
+// =====================================================
+function openCekRM() {
+    currentRegisterId = null;
+    new bootstrap.Modal(document.getElementById('modalCekRM')).show();
+}
+
+function cekRM() {
+    const rm = document.getElementById('inputRM').value;
+
+    fetch("<?= base_url('rm/cek') ?>", {
+        method: 'POST',
+        headers: {
+            'Content-Type': 'application/x-www-form-urlencoded'
+        },
+        body: 'rm=' + encodeURIComponent(rm)
+    })
+    .then(res => res.json())
+    .then(res => {
+        const hasil = document.getElementById('hasilRM');
+
+        if (res.status === 'found') {
+            const p = res.data;
+
+            hasil.innerHTML = `
+                <div class="alert alert-success">
+                    <b>✔ RM Ditemukan</b><br>
+                    Nama: ${p.nama}<br>
+                    Gender: ${p.gender ?? '-'}<br>
+                    Alamat: ${p.alamat ?? '-'}
+                </div>
+
+                <button type="button" class="btn btn-success"
+                    onclick="linkRM('${rm}')">
+                    ✔ Konfirmasi RM
+                </button>
+            `;
+        } else {
+            hasil.innerHTML = `
+                <div class="alert alert-danger">
+                    ⚠ RM tidak ditemukan
+                </div>
+
+                <button type="button" class="btn btn-warning"
+                    onclick="linkRM('${rm}')">
+                    Tetap Gunakan RM Ini
+                </button>
+            `;
+        }
+    });
+}
+
+function linkRM(rm) {
+    fetch("<?= base_url('rm/link') ?>", {
+        method: 'POST',
+        headers: {
+            'Content-Type': 'application/x-www-form-urlencoded'
+        },
+        body: 'register_id=' + currentRegisterId + '&rm=' + encodeURIComponent(rm)
+    })
+    .then(res => res.json())
+    .then(res => {
+        if (res.status === 'success') {
+            alert('RM berhasil di-update');
+            location.reload();
+        }
+    });
+}
+
+// =====================================================
+// SEARCH RM
+// =====================================================
+function searchRM() {
+    clearTimeout(rmTimeout);
+
+    rmTimeout = setTimeout(() => {
+        const q = document.getElementById('noRM').value.trim();
+        const box = document.getElementById('rmResult');
+
+        if (!q) {
+            box.innerHTML = '';
+            return;
+        }
+
+        fetch("<?= base_url('rm/search') ?>", {
+            method: 'POST',
+            headers: {
+                'Content-Type': 'application/x-www-form-urlencoded'
+            },
+            body: 'q=' + encodeURIComponent(q)
+        })
+        .then(res => res.json())
+        .then(res => {
+
+            if (!res.data || res.data.length === 0) {
+                box.innerHTML = `
+                    <div class="list-group-item text-danger">
+                        ❌ RM tidak ditemukan
+                    </div>
+
+                    <div class="list-group-item">
+                        <button type="button"
+                                class="btn btn-warning w-100"
+                                onclick="useNewRM('${q}')">
+                            ➕ Gunakan RM Ini (Pasien Baru)
+                        </button>
+                    </div>
+                `;
+                return;
+            }
+
+            let html = `
+                <div class="list-group-item bg-light">
+                    <b>⚠ RM ditemukan</b><br>
+                    Pilih data pasien:
+                </div>
+            `;
+
+            res.data.forEach(p => {
+                html += `
+                    <button type="button"
+                            class="list-group-item list-group-item-action"
+                            onclick="confirmRM(
+                                '${p.rm}',
+                                '${(p.nama ?? '').replace(/'/g, "\\'")}',
+                                '${(p.alamat ?? '').replace(/'/g, "\\'")}',
+                                '${p.gender ?? ''}',
+                                '${p.tanggal_lahir ?? ''}'
+                            )">
+                        <b>${p.rm}</b> - ${p.nama}
+                        <br>
+                        <small class="text-muted">${p.alamat ?? ''}</small>
+                    </button>
+                `;
+            });
+
+            box.innerHTML = html;
+        });
+
+    }, 300);
+}
+
+function confirmRM(rm, nama, alamat, gender, tanggal_lahir) {
+    if (!rm) {
+        alert('Data RM tidak ditemukan');
+        return;
+    }
+
+    if (!confirm(`Gunakan data RM: ${nama}?`)) {
+        return;
+    }
+
+    document.getElementById('noRM').value = rm;
+    document.getElementById('nama').value = nama ?? '';
+    document.getElementById('alamat').value = alamat ?? '';
+    document.getElementById('gender').value = gender ?? '';
+    document.getElementById('tanggalLahir').value = tanggal_lahir ?? '';
+
+    hitungUmur();
+
+    document.getElementById('rmResult').innerHTML = `
+        <div class="alert alert-success py-2">
+            ✔ RM aktif: <b>${rm}</b><br>
+            👤 ${nama}
+        </div>
+    `;
+}
+
+function useNewRM(rm) {
+    document.getElementById('noRM').value = rm;
+
+    document.getElementById('rmResult').innerHTML = `
+        <div class="alert alert-warning alert-dismissible fade show">
+            ⚠ RM ${rm} sebagai PASIEN BARU
+            <button type="button"
+                    class="btn-close"
+                    data-bs-dismiss="alert"></button>
+        </div>
+    `;
+
+    setTimeout(() => {
+        const el = document.querySelector('.alert-warning');
+        if (el) el.remove();
+    }, 2000);
+}
+
+function fillRM(rm, nama, alamat, gender, tgl) {
+    document.getElementById('noRM').value = rm;
+    document.getElementById('nama').value = nama ?? '';
+    document.getElementById('alamat').value = alamat ?? '';
+    document.getElementById('gender').value = gender ?? '';
+    document.getElementById('rmResult').innerHTML = '';
+
+    if (tgl) {
+        document.getElementById('tanggalLahir').value = tgl;
+        hitungUmur();
+    }
+}
+
+</script>
+
+<!-- ================= Modal RM ================= -->
+<div class="modal fade" id="modalCekRM" tabindex="-1">
+  <div class="modal-dialog">
+    <div class="modal-content">
+      <div class="modal-header">
+        <h5 class="modal-title">Cek RM</h5>
+        <button type="button" class="btn-close" data-bs-dismiss="modal"></button>
+      </div>
+      <div class="modal-body">
+        <input type="hidden" id="registerId">
+        <label>Masukkan RM</label>
+        <input type="text" id="inputRM" class="form-control">
+        <button class="btn btn-primary mt-2" onclick="cekRM()">
+          🔍 Cek RM
+        </button>
+        <hr>
+        <div id="hasilRM"></div>
+      </div>
+
+    </div>
+  </div>
+</div>
+<script src="https://cdn.jsdelivr.net/npm/bootstrap@5.3.3/dist/js/bootstrap.bundle.min.js"></script>
+</body>
 </html>
\ No newline at end of file
