@extends('layouts.container') @section('title', 'Pendaftaran Spesialis') @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(array('route' => 'pendaftaranspesialis-create-data', 'role' => 'form', 'method' => 'PUT', 'files' => true)) }}
{{ Form::submit('Simpan Data', array('class' => 'btn btn-primary')) }}

Registrasi

{{ Form::label('no_registrasi', 'Nomor Registrasi') }} {{ Form::text('no_registrasi', old('no_registrasi'), array('class' => 'form-control no_registrasi bg-light-blue-gradient')) }}
{{ Form::label('nama_lengkap', 'Nama (sesuai STR/ijasah)*') }} {{ Form::text('nama_lengkap', old('nama_lengkap'), array('class' => 'form-control')) }}
{{ Form::label('npa_idi', 'NPA IDI') }} {{ Form::text('npa_idi', old('npa_idi'), array('class' => 'form-control')) }}
{{ Form::label('nik', 'NIK') }} {{ Form::text('nik', old('nik'), array('class' => 'form-control')) }}
{{ Form::label('tempat_lahir', 'Tempat Lahir*') }} {{ Form::text('tempat_lahir', old('tempat_lahir'), array('class' => 'form-control')) }}
{{ Form::label('tgl_lahir', 'Tanggal Lahir*') }}
{{ Form::text('tgl_lahir', old('tgl_lahir'), array('class' => 'form-control datepicker')) }}
{{ Form::label('jenis_kelamin', 'Jenis Kelamin*') }} {{ Form::select('jenis_kelamin', $jenis_kelamin, '', array('class' => 'form-control')) }}
{{ Form::label('alamat', 'Alamat Korespondensi*') }} {{ Form::text('alamat', old('alamat'), array('class' => 'form-control')) }}
{{ Form::label('no_telp', 'Nomor Telepon') }} {{ Form::text('no_telp', old('no_telp'), array('class' => 'form-control')) }}
{{ Form::label('email', 'Alamat Email') }} {{ Form::text('email', old('email'), array('class' => 'form-control')) }}
{{ Form::label('no_hp', 'Nomor HP*') }} {{ Form::text('no_hp', old('no_hp'), array('class' => 'form-control')) }}
{{ Form::label('no_hp2', 'Nomor HP Alternatif') }} {{ Form::text('no_hp2', old('no_hp2'), array('class' => 'form-control')) }}
{{ Form::label('keterangan', 'Keterangan') }} {{ Form::select('keterangan', $keterangan, '', array('class' => 'form-control')) }}
{{ Form::label('pas_foto', 'Foto* (Format: jpg/jpeg/png, ukuran maksimum 2Mb)') }} {{ Form::file('pas_foto', array('class' => 'form-control')) }}
{{ Form::label('institusi_dokter_umum', 'Institusi Dokter Umum') }}
{{ Form::text('institusi_dokter_umum', old('institusi_dokter_umum'), array('class' => 'form-control institusi_dokter_umum')) }}
{{ Form::label('lulus_dokter_umum', 'Lulus Dokter Umum') }}
{{ Form::text('lulus_dokter_umum', old('lulus_dokter_umum'), array('class' => 'form-control datepicker')) }}
{{ Form::label('spesialis', 'Sumber Dana Pendidikan Spesialis*') }} {{ Form::select('spesialis', $spesialis, '', array('class' => 'form-control')) }}
{{ Form::label('upload_sk_spesialis', 'Upload Data (Format: pdf, ukuran maksimum 2Mb)') }} {{ Form::file('upload_sk_spesialis', array('class' => 'form-control')) }}

Adaptasi

{{ Form::label('institusi_ipln', 'Tempat Pendidikan Asal di Luar Negeri*') }}
{{ Form::text('institusi_ipln', old('institusi_ipln'), array('class' => 'form-control institusi_ipln')) }}
{{ Form::label('tgl_lulus_ipln', 'Tanggal Lulus Ijasah Tempat Pendidikan Luar Negeri*') }}
{{ Form::text('tgl_lulus_ipln', old('tgl_lulus_ipln'), array('class' => 'form-control datepicker')) }}
{{ Form::label('institusi_pa', 'Tempat Pendidikan Adaptasi*') }}
{{ Form::text('institusi_pa', '', array('class' => 'form-control institusi_pa')) }}
{{ Form::label('tgl_mulai_pa', 'Mulai Pendidikan Adaptasi*') }}
{{ Form::text('tgl_mulai_pa', old('tgl_mulai_pa'), array('class' => 'form-control datepicker tgl_mulai')) }}
{{ Form::label('tgl_lulus_pa', 'Selesai Pendidikan Adaptasi*') }}
{{ Form::text('tgl_lulus_pa', old('tgl_lulus_pa'), array('class' => 'form-control datepicker')) }}

Reguler

{{ Form::label('institusi_reg', 'Tempat Pendidikan Reguler*') }}
{{ Form::text('institusi_reg', old('institusi_reg'), array('class' => 'form-control institusi_reg')) }}
{{ Form::label('tgl_ijasah_reg', 'Tanggal Lulus Ijasah Pendidikan Reguler*') }}
{{ Form::text('tgl_ijasah_reg', old('tgl_ijasah_reg'), array('class' => 'form-control datepicker tgl_ijasah_reg')) }}
{{ Form::label('tgl_mulai_reg', 'Mulai Pendidikan Reguler*') }}
{{ Form::text('tgl_mulai_reg', old('tgl_mulai_reg'), array('class' => 'form-control datepicker tgl_mulai')) }}
{{ Form::label('tgl_lulus_reg', 'Selesai Pendidikan Reguler*') }}
{{ Form::text('tgl_lulus_reg', old('tgl_lulus_reg'), array('class' => 'form-control datepicker')) }}

Ujian Board

{{ Form::label('ujian_board1', 'Ujian Board 1') }}
{{ Form::text('ujian_board1', old('ujian_board1'), array('class' => 'form-control')) }}
{{ Form::label('ujian_board2', 'Ujian Board 2') }}
{{ Form::text('ujian_board2', old('ujian_board2'), array('class' => 'form-control')) }}
{{ Form::label('status_mengulang', 'Mengulang') }} {{ Form::select('status_mengulang', array(), '', array('class' => 'form-control')) }}
{{ Form::label('tgl_ujian_k', 'Tanggal Ujian Komprehensif') }}
{{ Form::text('tgl_ujian_k', old('tgl_ujian_k'), array('class' => 'form-control datepicker')) }}

PAPDI Cabang

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