<!DOCTYPE html>
<html lang="en">

<head>
 <meta charset="UTF-8">
 <meta http-equiv="X-UA-Compatible" content="IE=edge">
 <meta name="viewport" content="width=device-width, initial-scale=1.0">
 <title>Data Pasien</title>
 <!-- Favicon -->
 <link rel="shortcut icon" href="./img/svg/logo.svg" type="image/x-icon">
 <!-- Bootstrap -->
 <link href="https://cdn.jsdelivr.net/npm/bootstrap@5.0.2/dist/css/bootstrap.min.css" rel="stylesheet" integrity="sha384-EVSTQN3/azprG1Anm3QDgpJLIm9Nao0Yz1ztcQTwFspd3yD65VohhpuuCOmLASjC" crossorigin="anonymous"> <!-- Custom styles -->
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 <link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/5.15.3/css/all.min.css" integrity="sha512-iBBXm8fW90+nuLcSKlbmrPcLa0OT92xO1BIsZ+ywDWZCvqsWgccV3gFoRBv0z+8dLJgyAHIhR35VZc2oM/gI1w==" crossorigin="anonymous" referrerpolicy="no-referrer" />
 <!-- Custom styles -->
 <link rel="stylesheet" href="<?php echo e(url('design/css/style.min.css')); ?>">
 <link rel="stylesheet" href="<?php echo e(url('design/fonts/stylesheet.css')); ?>">
 <!-- Froala -->
 <link href="https://cdn.jsdelivr.net/npm/froala-editor@latest/css/froala_editor.pkgd.min.css" rel="stylesheet" type="text/css" />
 <!-- Project Style -->
 <link rel="stylesheet" href="<?php echo e(url('design/css/project-style.css')); ?>">
 <!-- Flatpicker -->
 <link rel="stylesheet" href="https://cdn.jsdelivr.net/npm/flatpickr/dist/flatpickr.min.css">
 <!-- DataTables -->
 <link rel="stylesheet" href="https://cdn.datatables.net/1.10.25/css/dataTables.bootstrap5.min.css">

</head>

<body>
 <div class="layer"></div>
 <!-- ! Body -->
 <div class="page-flex">
  <!-- ! Sidebar -->
  <?php echo $__env->make('component.sidebar', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?>
  <div class="main-wrapper">
   <!-- ! Main nav -->
   <?php echo $__env->make('component.navbar', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?>
   <!-- ! Main -->
   <main class="main users chart-page">
    <div class="container">
     <h2 class="main-title">Data Pasein / Edit</h2>
     <div class="row justify-content-center">
      <div class="col-10">
       <div class="white-block">
        <div class="row">
         <div class="col-6">
          <p class="stat-cards-info__num mb-3" style="font-size: 22px;">Data Pasien</p>
         </div>
        </div>
        <form id="formEdit" action="<?php echo e(url('data_pasien/'.$dataPasien->dp_id)); ?>" method="POST">
         <?php echo method_field('PUT'); ?>
         <?php echo csrf_field(); ?>
         <label class="form-label-wrapper">
          <p class="form-label">No. Rekam Medis</p>
          <input class="form-input" type="text" placeholder="Masukan nomor rekam medis" name="dp_no_rm" value="<?php echo e($dataPasien->dp_no_rm); ?>" required>
         </label>
         <label class="form-label-wrapper">
          <p class="form-label">No. KTP</p>
          <input class="form-input" type="number" placeholder="Masukan nomor KTP" name="dp_no_ktp" value="<?php echo e($dataPasien->dp_no_ktp); ?>" required>
         </label>
         <label class="form-label-wrapper">
          <p class="form-label">No. BPJS</p>
          <input class="form-input" type="number" placeholder="Masukan nomor BPJS" name="dp_no_bpjs" value="<?php echo e($dataPasien->dp_no_bpjs); ?>" required>
         </label>
         <label class="form-label-wrapper">
          <p class="form-label">Nama</p>
          <input class="form-input" type="text" placeholder="Masukan nama" name="dp_nama" value="<?php echo e($dataPasien->dp_nama); ?>" required>
         </label>
         <label class="form-label-wrapper">
          <p class="form-label">Jenis Kelamin</p>
          <select name="dp_jenis_kelamin" class="form-input selectpicker" data-size="3" type="text" placeholder="Masukan Jenis Kelamin" required>
           <option value="Laki-laki" <?php if ("Laki-laki" == $dataPasien->dp_jenis_kelamin) echo 'selected="selected"'; ?>>Laki-laki</option>
           <option value="Perempuan" <?php if ("Perempuan" == $dataPasien->dp_jenis_kelamin) echo 'selected="selected"'; ?>>Perempuan</option>
          </select>
         </label>
         <label class="form-label-wrapper">
          <p class="form-label">Tanggal Lahir</p>
          <input class="form-input tgl-lahir" type="text" placeholder="Masukan tanggal lahir" name="dp_tgl_lahir" value="<?php
                                                                                                                         $date = new DateTime($dataPasien->dp_tgl_lahir);
                                                                                                                         echo $date->format('d-M-Y');
                                                                                                                         ?>" required>
         </label>
         <label class="form-label-wrapper">
          <p class="form-label">No Handphone</p>
          <input class="form-input" type="number" placeholder="Masukan nomor handphone" name="dp_no_hp" value="<?php echo e($dataPasien->dp_no_hp); ?>" required>
         </label>
         <label class="form-label">Alamat</label>
         <textarea class="alamat" name="dp_alamat"><?php echo e($dataPasien->dp_alamat); ?></textarea>

         <button type="submit" class="btn btn-secondary">Simpan</button>
        </form>
       </div>
      </div>
     </div>
    </div>
   </main>
   <!-- ! Footer -->
   <?php echo $__env->make('component.footer', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?>
  </div>
 </div>



 <!-- jQuery -->
 <script src="https://cdnjs.cloudflare.com/ajax/libs/jquery/3.6.0/jquery.min.js" integrity="sha512-894YE6QWD5I59HgZOGReFYm4dnWc1Qt5NtvYSaNcOP+u1T9qYdvdihz0PPSiiqn/+/3e7Jo4EaG7TubfWGUrMQ==" crossorigin="anonymous" referrerpolicy="no-referrer"></script>
 <script src="https://code.jquery.com/ui/1.11.4/jquery-ui.js" integrity="sha256-DI6NdAhhFRnO2k51mumYeDShet3I8AKCQf/tf7ARNhI=" crossorigin="anonymous"></script>
 <!-- Bootstrap -->
 <script src="https://cdn.jsdelivr.net/npm/bootstrap@5.0.2/dist/js/bootstrap.bundle.min.js" integrity="sha384-MrcW6ZMFYlzcLA8Nl+NtUVF0sA7MsXsP1UyJoMp4YLEuNSfAP+JcXn/tWtIaxVXM" crossorigin="anonymous"></script>
 <!-- Chart library -->
 <script src="<?php echo e(url('design/plugins/chart.min.js')); ?>"></script>
 <!-- Icons library -->
 <script src="<?php echo e(url('design/plugins/feather.min.js')); ?>"></script>
 <!-- Custom scripts -->
 <script src="<?php echo e(url('design/js/script.js')); ?>"></script>
 <!-- Flatpicker -->
 <script src="https://cdn.jsdelivr.net/npm/flatpickr"></script>
 <!-- Froala -->
 <script type="text/javascript" src="https://cdn.jsdelivr.net/npm/froala-editor@latest/js/froala_editor.pkgd.min.js"></script>
 <!-- Notiflix -->
 <script src="https://cdn.jsdelivr.net/npm/notiflix@3.0.1/dist/notiflix-aio-3.0.1.min.js"></script>
 <!-- DataTables -->
 <script src="https://cdn.datatables.net/1.10.25/js/jquery.dataTables.min.js"></script>
 <script src="https://cdn.datatables.net/1.10.25/js/dataTables.bootstrap5.min.js"></script>


 <script>
  $(document).ready(function() {
   $(".tgl-lahir").flatpickr({
    altInput: true,
    altFormat: "j-F-Y",
    dateFormat: "d-M-Y"
   });

   $('#data_pasien').DataTable({
    "scrollX": true,
    'language': {
     search: '<div class="search-wrapper float-end"> <svg xmlns="http://www.w3.org/2000/svg" width="24" height="24" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round" class="feather feather-search" aria-hidden="true"><circle cx="11" cy="11" r="8"></circle><line x1="21" y1="21" x2="16.65" y2="16.65"></line></svg> <input type="text" placeholder="Cari ..." required=""> </div>',
     searchPlaceholder: 'Cari',
    }
   });

   new FroalaEditor('textarea.alamat', {
    quickInsertEnabled: false,
    attribution: false,
    placeholderText: false,
    height: 150,
    fontSizeDefaultSelection: '18',
    toolbarButtons: [
     ['bold', 'italic', 'underline'],
     ['alignLeft', 'alignCenter', 'formatOLSimple', 'alignRight', 'alignJustify', 'lineHeight', 'outdent', 'indent'],
     ['undo', 'redo', 'print', 'getPDF']
    ]
   });
  });
 </script>

 <?php echo $__env->make('component.notif', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?>

</body>

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