@extends('layouts.container') @section('title', 'Pendaftaran Sub Spesialis Tambahan') @section('title_description', 'Add New') @section('css') @endsection @section('body-class', 'skin-black') @section('content') @if ($errors->count())
    @foreach ($errors->all() as $item)
  1. {{ $item }}
  2. @endforeach
@endif {{ Form::open(['route' => 'kompetensitambahanpendaftaran-create-data', 'role' => 'form', 'method' => 'PUT', 'files' => true]) }}
{{ Form::submit('Simpan Data', ['class' => 'btn btn-primary']) }}

Registrasi

{{ Form::label('no_registrasi', 'Nomor Registrasi') }} {{ Form::text('no_registrasi', old('no_registrasi'), ['class' => 'form-control no_registrasi bg-light-blue-gradient']) }} {{ Form::hidden('migrate3', '0', ['class' => 'form-control migrate3', 'id' => 'migrate3']) }}
{{ Form::label('nama_lengkap', 'Nama (sesuai STR/ijasah)*') }}
{{ Form::text('nama_lengkap', old('nama_lengkap'), ['class' => 'form-control nama_biodata_dokter']) }}
{{ Form::label('npa_idi', 'NPA IDI*') }} {{ Form::text('npa_idi', old('npa_idi'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('tempat_lahir', 'Tempat Lahir*') }} {{ Form::text('tempat_lahir', old('tempat_lahir'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('tgl_lahir', 'Tanggal Lahir*') }}
{{ Form::text('tgl_lahir', old('tgl_lahir'), ['readonly' => 'readonly', 'class' => 'form-control datepicker']) }}
{{ Form::label('jenis_kelamin', 'Jenis Kelamin*') }} {{ Form::select('jenis_kelamin', $jenis_kelamin, '', ['readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('alamat', 'Alamat Korespondensi*') }} {{ Form::text('alamat', old('alamat'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('no_telp', 'Nomor Telepon') }} {{ Form::text('no_telp', old('no_telp'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('email', 'Alamat Email') }} {{ Form::text('email', old('email'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('no_hp', 'Nomor HP*') }} {{ Form::text('no_hp', old('no_hp'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('no_hp2', 'Nomor HP Alternatif') }} {{ Form::text('no_hp2', old('no_hp2'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('keterangan', 'Keterangan') }} {{ Form::select('keterangan', $keterangan, '', ['readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('pas_foto', 'Foto* (Format: jpg/jpeg/png, ukuran maksimum 2Mb)') }}
{{ Form::file('pas_foto', ['readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('upload_sk_spesialis', 'Upload Data (Format: pdf, ukuran maksimum 2Mb)') }} {{ Form::file('upload_sk_spesialis', array('class' => 'form-control')) }}

Data Tambahan Sub Spesialis

{{ Form::label('tambahan_subspesialis', 'Tambahan Subspesialis') }}
{{ Form::text('tambahan_subspesialis', old('tambahan_subspesialis'), ['class' => 'form-control tambahan_subspesialis']) }}
{{ Form::label('tempat_rumah_sakit', 'Rumah Sakit Tempat Pelatihan*') }}
{{ Form::text('tempat_rumah_sakit', '', ['class' => 'form-control tempat_rumah_sakit']) }}
{{ Form::label('tgl_mulai', 'Mulai Pelatihan*') }}
{{ Form::text('tgl_mulai', old('tgl_mulai'), ['class' => 'form-control datepicker tgl_mulai']) }}
{{ Form::label('tgl_lulus', 'Selesai Pelatihan') }}
{{ Form::text('tgl_lulus', old('tgl_lulus'), ['class' => 'form-control datepicker']) }}

PAPDI Cabang

{{ Form::label('papdi_cabang', 'Papdi Cabang') }} {{ Form::text('papdi_cabang', old('papdi_cabang'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::close() }} @stop @section('js') @stop