@extends('layouts.container') @section('title', 'Pendaftaran Fellowship') @section('title_description', 'Edit Pendaftaran Fellowship: ' . $pendaftaranFellowship[0]->no_registrasi) @section('css') @endsection @section('body-class', 'skin-black') @section('content') @if ($errors->any())
@endif {{ Form::model($pendaftaranFellowship, array('route' => array('fellowshippendaftaran-edit-data', $pendaftaranFellowship[0]->id_register_sp), 'method' => 'PUT', 'files' => true)) }}
{{ Form::submit('Simpan Perubahan', array('class' => 'btn btn-primary')) }}

Registrasi

{{ Form::label('no_registrasi', 'Nomor Registrasi') }} {{ Form::text('no_registrasi', $pendaftaranFellowship[0]->no_registrasi, array('class' => 'form-control bg-light-blue-gradient no_registrasi')) }} {{ Form::hidden('migrate2', @$migrate2->id_biodata_dokter, array('class' => 'form-control migrate2', 'id' => 'migrate2')) }}
{{ Form::label('nama_lengkap', 'Nama (sesuai STR/ijasah)*') }}
{{ Form::text('nama_lengkap', $pendaftaranFellowship[0]['BiodataDokter']['Biodata']->nama_lengkap, array('class' => 'form-control nama_biodata_dokter')) }}
{{ Form::label('npa_idi', 'NPA IDI*') }} {{ Form::text('npa_idi', $pendaftaranFellowship[0]['BiodataDokter']->npa_idi, array('readonly' => 'readonly', 'class' => 'form-control')) }}
{{ Form::label('tempat_lahir', 'Tempat Lahir*') }} {{ Form::text('tempat_lahir', $pendaftaranFellowship[0]['BiodataDokter']['Biodata']->tempat_lahir, array('readonly' => 'readonly', 'class' => 'form-control')) }}
{{ Form::label('tgl_lahir', 'Tanggal Lahir*') }}
{{ Form::text('tgl_lahir', $pendaftaranFellowship[0]['BiodataDokter']['Biodata']->tanggal_lahir, array('readonly' => 'readonly', 'class' => 'form-control datepicker')) }}
{{ Form::label('jenis_kelamin', 'Jenis Kelamin*') }} {{ Form::select('jenis_kelamin', $jenis_kelamin, $pendaftaranFellowship[0]['BiodataDokter']['Biodata']->jenis_kelamin, array('readonly' => 'readonly', 'class' => 'form-control')) }}
{{ Form::label('alamat', 'Alamat Korespondensi*') }} {{ Form::text('alamat', $pendaftaranFellowship[0]['BiodataDokter']['Biodata']->alamat, array('readonly' => 'readonly', 'class' => 'form-control')) }}
{{ Form::label('no_telp', 'Nomor Telepon') }} {{ Form::text('no_telp', $pendaftaranFellowship[0]['BiodataDokter']['Biodata']->nomor_telepon, array('readonly' => 'readonly', 'class' => 'form-control')) }}
{{ Form::label('email', 'Alamat Email') }} {{ Form::text('email', $pendaftaranFellowship[0]['BiodataDokter']['Biodata']->email, array('readonly' => 'readonly', 'class' => 'form-control')) }}
{{ Form::label('no_hp', 'Nomor HP*') }} {{ Form::text('no_hp', $pendaftaranFellowship[0]['BiodataDokter']['Biodata']->nomor_hp, array('readonly' => 'readonly', 'class' => 'form-control')) }}
{{ Form::label('no_hp2', 'Nomor HP Alternatif') }} {{ Form::text('no_hp2', $pendaftaranFellowship[0]['BiodataDokter']['Biodata']->nomor_hp2, array('readonly' => 'readonly', 'class' => 'form-control')) }}
{{ Form::label('keterangan', 'Keterangan') }} {{ Form::select('keterangan', $keterangan, $pendaftaranFellowship[0]['BiodataDokter']['Biodata']->id_keterangan, array('readonly' => 'readonly', 'class' => 'form-control')) }}
{{ Form::label('pas_foto', 'Foto* (Format: jpg/jpeg/png, ukuran maksimum 2Mb)') }}
{{ Form::file('pas_foto', array('readonly' => 'readonly', 'class' => 'form-control')) }}
{{ substr($pendaftaranFellowship[0]['BiodataDokter']['Biodata']->file_foto, 0, strpos($pendaftaranFellowship[0]['BiodataDokter']['Biodata']->file_foto, '#')) }}
{{ Form::label('upload_sk_spesialis', 'Upload Data (Format: pdf, ukuran maksimum 2Mb)') }}
{{ Form::submit('Simpan Perubahan', array('class' => 'btn btn-primary')) }}

Data Fellowship

{{ Form::label('nama_fellowship', 'Nama Fellowship') }}
{{ Form::text('nama_fellowship', (@$dataSp2Fellowship->NamaFellowship->nama_fellowship) ? @$dataSp2Fellowship->NamaFellowship->nama_fellowship : old('nama_fellowship'), array('class' => 'form-control nama_fellowship')) }}
{{ Form::label('tempat_rumah_sakit', 'Rumah Sakit Tempat Pendidikan*') }}
{{ Form::text('tempat_rumah_sakit', (@$dataSp2Fellowship->RumahSakit->nama_rumah_sakit) ? @$dataSp2Fellowship->RumahSakit->nama_rumah_sakit : old('tempat_rumah_sakit'), array('class' => 'form-control tempat_rumah_sakit')) }}
{{ Form::label('tgl_mulai', 'Mulai Pendidikan*') }}
{{ Form::text('tgl_mulai', (@$dataSp2Fellowship->mulai_pendidikan) ? @$dataSp2Fellowship->mulai_pendidikan : old('tgl_mulai'), array('class' => 'form-control datepicker tgl_mulai')) }}
{{ Form::label('tgl_lulus', 'Selesai Pendidikan') }}
{{ Form::text('tgl_lulus', (@$dataSp2Fellowship->selesai_pendidikan) ? @$dataSp2Fellowship->selesai_pendidikan : old('tgl_lulus'), array('class' => 'form-control datepicker')) }}

PAPDI Cabang

{{ Form::label('papdi_cabang', 'PAPDI Cabang') }}
{{ Form::input('text', 'papdi_cabang', isset($dataPAPDICabang->nama_institusi) ? $dataPAPDICabang->nama_institusi : @$permission[3]->nama_institusi, array('readonly' => 'readonly', 'class' => 'form-control', $permission ? $permission[0] : '')) }}
{{ Form::close() }} @endsection @section('js') @endsection