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kicap1992
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src/admin_registrasi/index.html
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src/admin_registrasi/index.html
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<!DOCTYPE html>
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<html lang="en">
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<head>
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<meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
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<meta http-equiv="X-UA-Compatible" content="IE=edge">
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<meta name="viewport" content="width=device-width, initial-scale=1, user-scalable=no">
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<meta name="description" content="">
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<meta name="author" content="">
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<title>Halaman Utama - Admin Registrasi</title>
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<!-- Main Styles -->
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<link rel="stylesheet" href="../assets/styles/style.min.css">
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<!-- mCustomScrollbar -->
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<link rel="stylesheet" href="../assets/plugin/mCustomScrollbar/jquery.mCustomScrollbar.min.css">
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<!-- Waves Effect -->
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<link rel="stylesheet" href="../assets/plugin/waves/waves.min.css">
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<!-- Dark Themes -->
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<link rel="stylesheet" href="../assets/styles/style-dark.min.css">
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<link rel="stylesheet" href="../assets/sweet-alert/sweetalert.css">
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<style type="text/css">
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.swal-modal .swal-text {
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text-align: center;
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}
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</style>
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</head>
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<body>
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<div class="main-menu">
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<header class="header">
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<a href="../index.html" class="logo">NinjaTeam</a>
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<button type="button" class="button-close fa fa-times js__menu_close"></button>
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<div class="user">
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<a href="../#" class="avatar"><img src="../http://placehold.it/80x80" alt=""><span class="status online"></span></a>
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<h5 class="name"><a href="../profile.html">Emily Stanley</a></h5>
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<h5 class="position">Administrator</h5>
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</div>
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<!-- /.user -->
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</header>
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<!-- /.header -->
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<div class="content">
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<div class="navigation">
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<h5 class="title">Navigation</h5>
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<!-- /.title -->
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<ul class="menu js__accordion">
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<li class="current">
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<a class="waves-effect" href="../index.html"><i class="menu-icon fa fa-home"></i><span>Dashboard</span></a>
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</li>
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</ul>
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</div>
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<!-- /.navigation -->
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</div>
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<!-- /.content -->
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</div>
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<!-- /.main-menu -->
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<div class="fixed-navbar">
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<div class="pull-left">
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<button type="button" class="menu-mobile-button glyphicon glyphicon-menu-hamburger js__menu_mobile"></button>
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<h1 class="page-title">Home</h1>
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<!-- /.page-title -->
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</div>
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<!-- /.pull-left -->
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<div class="pull-right">
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<div class="ico-item">
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</div>
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<div class="ico-item toggle-hover js__drop_down ">
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</div>
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</div>
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<!-- /.pull-right -->
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</div>
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<!-- /.fixed-navbar -->
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<div id="wrapper">
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<div class="main-content">
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<div class="row small-spacing">
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<div class="col-xs-12">
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<div class="box-content">
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<h4 class="box-title" >Registrasi Pasien</h4>
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<form id="sini_form" >
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<div class="card-content">
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<div class="row small-spacing">
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<div class="col-xs-6">
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<div class="form-group">
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<label >Nomor Urut Tahun</label>
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<input type="text" class="form-control" id="nomor_urut_tahun" name="nomor_urut_tahun" placeholder="Masukkan NIP Guru" maxlength="18" onkeypress="return isNumberKey(event)" >
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</div>
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<div class="form-group">
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<label for="exampleInputPassword1">Nomor Urut Bulan</label>
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<input type="text" class="form-control" id="nomor_urut_bulan" name="nomor_urut_bulan" placeholder="Masukkan Nama">
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</div>
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<div class="form-group">
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<label for="exampleInputPassword1">Nomor Register</label>
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<input type="text" class="form-control" id="nomor_register" name="nomor_register" placeholder="Masukkan Nomor Register Pasien" minlength="8" maxlength="8" required>
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</div>
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<div class="form-group">
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<label >Tanggal</label>
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<input type="text" class="form-control" id="tanggal" name="tanggal" placeholder="Masukkan Jumlah Simpanan Pokok" maxlength="11">
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</div>
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<div class="form-group">
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<label >Nama</label>
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<input type="text" class="form-control" id="nama" name="nama" placeholder="Masukkan Nama Pasien" maxlength="100" required>
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</div>
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<div class="form-group">
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<label >Jenis Kelamin</label>
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<select class="form-control" id="jenis_kelamin" name="jenis_kelamin" required>
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<option disabled="" selected="" value="">-Pilih Jenis Kelamin</option>
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<option value="Laki-laki">Laki-laki</option>
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<option value="Perempuan">Perempuan</option>
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</select>
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</div>
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<div class="form-group">
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<label >Umur</label>
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<input type="text" class="form-control" id="umur" name="umur" placeholder="Masukkan Umur Pasien" maxlength="2" onkeypress="return isNumberKey(event)" required>
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</div>
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<div class="form-group">
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<label >Agama</label>
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<select class="form-control" id="agama" name="agama" required>
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<option disabled="" selected="" value="">-Pilih Agama</option>
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<option value="Islam">Islam</option>
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<option value="Kristen">Kristen</option>
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<option value="Katolik">Katolik</option>
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<option value="Hindu">Hindu</option>
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<option value="Buddha">Buddha</option>
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<option value="Konghucu">Konghucu</option>
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</select>
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</div>
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<div class="form-group">
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<label >Alamat</label>
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<textarea name="alamat" id="alamat" class="form-control" placeholder="Masukkan Alamat" style="resize: none;"></textarea>
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</div>
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</div>
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<!-- /.col-xs-3 -->
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<div class="col-xs-6">
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<div class="form-group">
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<label >Diagnosa</label>
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<textarea name="diagnosa" id="diagnosa" class="form-control" placeholder="Masukkan Diagnosa" style="resize: none;" required></textarea>
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</div>
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<div class="form-group">
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<label >Jenis Kasus</label>
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<select class="form-control" id="jenis_kasus" name="jenis_kasus" required>
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<option disabled="" selected="" value="">-Pilih Jenis Kasus</option>
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<option value="Interna">Interna</option>
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<option value="Bedah">Bedah</option>
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<option value="Anak">Anak</option>
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<option value="OBGYN">OBGYN</option>
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<option value="Mata">Mata</option>
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<option value="KLL">KLL</option>
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</select>
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</div>
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<div class="form-group">
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<label >L/B</label>
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<select class="form-control" id="lb" name="lb" required>
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<option disabled="" selected="" value="">-Pilih L / B</option>
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<option value="L">L</option>
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<option value="B">B</option>
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</select>
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</div>
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<div class="form-group">
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<input type="checkbox" id="umum" name="umum" value="1">
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<label ><b>Umum</b> </label>
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</div>
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<div class="form-group">
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<input type="checkbox" id="askes" name="askes" value="1">
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<label ><b>ASKES</b> </label>
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</div>
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<div class="form-group">
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<input type="checkbox" id="rujukan" name="rujukan" value="1">
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<label ><b>Rujukan</b> </label>
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</div>
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<div class="form-group">
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<input type="checkbox" id="dirujuk" name="dirujuk" value="1">
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<label ><b>Dirujuk</b> </label>
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</div>
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<div class="form-group">
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<label >Keterangan</label>
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<textarea name="ket" id="ket" class="form-control" placeholder="Masukkan Keterangan" style="resize: none;" required></textarea>
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</div>
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</div>
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</div>
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<!-- /.row -->
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<div class="form-group" style="text-align: center;">
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<button type="button" class="btn btn-primary waves-effect waves-light" onclick="daftar_pasien()">Registrasi Pasien</button>
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</div>
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</div>
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</form>
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</div>
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<!-- /.box-content -->
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</div>
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</div>
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<!-- /.row -->
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<footer class="footer">
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<ul class="list-inline">
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<li>2021 © Rumah Sakit Fatima.</li>
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</ul>
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</footer>
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</div>
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<!-- /.main-content -->
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</div><!--/#wrapper -->
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<!-- HTML5 shim and Respond.js for IE8 support of HTML5 elements and media queries -->
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<!--[if lt IE 9]>
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<script src="../assets/script/html5shiv.min.js"></script>
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<script src="../assets/script/respond.min.js"></script>
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<![endif]-->
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<!--
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================================================== -->
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<!-- Placed at the end of the document so the pages load faster -->
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<script src="../assets/scripts/jquery.min.js"></script>
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<script src="../assets/scripts/modernizr.min.js"></script>
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<script src="../assets/plugin/bootstrap/js/bootstrap.min.js"></script>
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<script src="../assets/plugin/mCustomScrollbar/jquery.mCustomScrollbar.concat.min.js"></script>
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<script src="../assets/plugin/nprogress/nprogress.js"></script>
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<script src="../assets/plugin/sweet-alert/sweetalert.min.js"></script>
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<script src="../assets/plugin/waves/waves.min.js"></script>
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<script src="../assets/scripts/main.min.js"></script>
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<script src="../sweet-alert/url.js"></script>
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<script src="../main.js"></script>
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<script src="../sweet-alert/block/jquery.blockUI.js"></script>
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<script>
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function daftar_pasien(){
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console.log('sini daftar pasien');
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let data = $("#sini_form").serializeArray();
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data = objectifyForm(data)
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// $.ajax({
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// url: url+"api/registrasi/",
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// type: 'post',
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// data: {data : data },
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// beforeSend: function(res) {
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// $.blockUI({
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// message: "Sedang Diproses",
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// css: {
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// border: 'none',
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// padding: '15px',
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// backgroundColor: '#000',
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// '-webkit-border-radius': '10px',
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// '-moz-border-radius': '10px',
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// opacity: .5,
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// color: '#fff'
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// } });
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// },
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// success: function (response) {
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// // $('#sini_form')[0].reset();
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// $.unblockUI();
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// console.log(response)
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// swal({
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// title : "Success",
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// text: "Registrasi Pasien Berhasil Ditambah, ",
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// icon: "success",
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// buttons: {
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// cancel: false,
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// confirm: true,
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// },
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// })
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// },
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// error: function(XMLHttpRequest, textStatus, errorThrown) {
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// console.log(errorThrown)
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// $.unblockUI();
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// switch (XMLHttpRequest.status) {
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// case 0:
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// toastnya('Server Mati atau dalam Maintainance')
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// break;
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// }
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// }
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// });
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console.log(data)
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}
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</script>
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</body>
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</html>
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