silaras-rssa/app/Views/pasien/edit.php

<!-- ================= REGISTER (LOCK TOTAL) ================= -->
<div class="mb-2">
  <label class="form-label">Register Ambulans</label>
  <input type="text"
         value="<?= esc($pasien['register']) ?>"
         class="form-control"
         disabled>
</div>

<!-- ================= RM (ONLY ADMIN EDITABLE) ================= -->
<div class="mb-2">
  <label class="form-label">No RM</label>
  <input type="text"
         name="rm"
         value="<?= esc($pasien['rm']) ?>"
         class="form-control"
         <?= (session()->get('role') !== 'admin') ? 'readonly' : '' ?>>
</div>

<!-- ================= IDENTITAS PASIEN ================= -->
<div class="mb-2">
  <label class="form-label">Atribut</label>
  <input type="text" name="atribut"
         value="<?= esc($pasien['atribut']) ?>"
         class="form-control">
</div>

<div class="mb-2">
  <label class="form-label">Nama Pasien</label>
  <input type="text" name="nama"
         value="<?= esc($pasien['nama']) ?>"
         class="form-control">
</div>

<div class="mb-2">
  <label class="form-label">Jenis Kelamin</label>
  <select name="gender" class="form-select">
    <option value="L" <?= ($pasien['gender']=='L')?'selected':'' ?>>Laki-laki</option>
    <option value="P" <?= ($pasien['gender']=='P')?'selected':'' ?>>Perempuan</option>
  </select>
</div>

<div class="mb-2">
  <label class="form-label">Tanggal Lahir</label>
  <input type="date"
         name="tgl_lahir"
         value="<?= esc($pasien['tgl_lahir']) ?>"
         class="form-control">
</div>

<div class="mb-2">
  <label class="form-label">Alamat</label>
  <textarea name="alamat" class="form-control"><?= esc($pasien['alamat']) ?></textarea>
</div>

<hr>

<!-- ================= ORDER PASIEN ================= -->
<div class="mb-2">
  <label class="form-label">Keluhan Utama</label>
  <input type="text" name="keluhan_utama"
         value="<?= esc($order['keluhan_utama'] ?? '') ?>"
         class="form-control">
</div>

<div class="mb-2">
  <label class="form-label">Kesadaran</label>
  <input type="text" name="kesadaran"
         value="<?= esc($order['kesadaran'] ?? '') ?>"
         class="form-control">
</div>

<!-- ================= TUJUAN ================= -->
<div class="mb-2">
  <label class="form-label">Tujuan</label>
  <select name="tujuan" class="form-select">
    <option value="RFDK" <?= ($order['tujuan']=='RFDK')?'selected':'' ?>>
      Rumah ke Faskes Dalam Kota
    </option>
    <option value="F-FDK" <?= ($order['tujuan']=='F-FDK')?'selected':'' ?>>
      Fasilitas Umum ke Faskes Dalam Kota
    </option>
    <option value="AFDK" <?= ($order['tujuan']=='AFDK')?'selected':'' ?>>
      Antar Faskes Dalam Kota
    </option>
    <option value="AFLK" <?= ($order['tujuan']=='AFLK')?'selected':'' ?>>
      Antar Faskes Luar Kota
    </option>
    <option value="PDK" <?= ($order['tujuan']=='PDK')?'selected':'' ?>>
      Pulang Dalam Kota
    </option>
    <option value="PLK" <?= ($order['tujuan']=='PLK')?'selected':'' ?>>
      Pulang Luar Kota
    </option>
  </select>
</div>

<div class="mb-2">
  <label class="form-label">Detail Tujuan</label>
  <input type="text"
         name="tujuan_detail"
         value="<?= esc($order['tujuan_detail'] ?? '') ?>"
         class="form-control">
</div>

<hr>

<!-- ================= MEDIS ================= -->
<div class="mb-2">
  <label class="form-label">Suhu</label>
  <input type="text"
         name="suhu"
         value="<?= esc($order['suhu'] ?? '') ?>"
         class="form-control">
</div>

<div class="mb-2">
  <label class="form-label">Berat Badan</label>
  <input type="text"
         name="berat_badan"
         value="<?= esc($order['berat_badan'] ?? '') ?>"
         class="form-control">
</div>

<div class="mb-2">
  <label class="form-label">Persetujuan Biaya</label>
  <input type="text"
         name="persetujuan"
         value="<?= esc($order['persetujuan'] ?? '') ?>"
         class="form-control">
</div>

<div class="mb-2">
  <label class="form-label">Estimasi Biaya</label>
  <input type="number"
         name="biaya"
         value="<?= esc($order['biaya'] ?? '') ?>"
         class="form-control">
</div>

<!-- ================= INFORMASI LAIN ================= -->
<div class="mb-2">
  <label class="form-label">Informasi Lain</label>
  <textarea 
      name="informasi_lain"
      class="form-control"
      rows="3"
      placeholder="Informasi tambahan terkait pasien / transfer..."><?= esc($order['informasi_lain'] ?? '') ?></textarea>
</div>


<!-- ================= KIE PROSES TRANSFER ================= -->
<div class="mb-2">
  <label class="form-label">KIE Proses Transfer</label>
  <textarea 
      name="kie_transfer"
      class="form-control"
      rows="4"
      placeholder="Edukasi proses transfer kepada pasien/keluarga..."><?= esc($order['kie_transfer'] ?? '') ?></textarea>
</div>

<div class="mb-2">
  <label class="form-label">Validasi</label>
  <input type="text"
         name="validasi"
         value="<?= esc($order['validasi'] ?? '') ?>"
         class="form-control">
</div>

<!-- ================= BUTTON ================= -->
<div class="mt-3">
  <button type="submit" class="btn btn-success w-100">
    💾 Simpan Perubahan
  </button>
</div>