@extends('layouts.container') @section('title', $title) @section('title_description', '') @section('css') @endsection @section('body-class', 'skin-black') @section('content') @if ($errors->count())
    @foreach ($errors->all() as $item)
  1. {{ $item }}
    2. @endforeach
@endif {{ Form::open(['route' => $routeSave, 'role' => 'form', 'method' => 'PUT', 'files' => true]) }}
{{ Form::submit('Simpan Data', ['class' => 'btn btn-primary']) }}
{{ Form::label('nama_biodata_dokter', 'Nama (sesuai STR/ijasah)*') }}
{{ Form::text('nama_biodata_dokter', old('nama_biodata_dokter'), ['class' => 'form-control nama_biodata_dokter']) }} Tanggal Lahir* {{ Form::text('tgl_lahir', old('tgl_lahir'), ['id' => 'tgl_lahir', 'readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('no_registrasi', 'No. Registrasi') }}
{{ Form::text('no_registrasi', old('no_registrasi'), ['id' => 'no_registrasi', 'readonly' => 'readonly', 'class' => 'form-control']) }} Tanggal Lulus {{ Form::text('tgl_lulus', old('tgl_lulus'), ['id' => 'tgl_lulus', 'readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('alamat', 'Alamat Korespondensi') }} {{ Form::text('alamat', old('alamat'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('papdi_cabang', 'PAPDI Cabang') }} {{ Form::text('papdi_cabang', old('papdi_cabang'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
@if ( $currentRouteName[0] == 'fellowshippenerbitansertifikat' || $currentRouteName[0] == 'fellowshipresertifikasipenerbitansertifikat')
{{ Form::label('tempat_rumah_sakit', $tempat_pendidikan_title) }} {{ Form::text('tempat_rumah_sakit', old('tempat_rumah_sakit'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('nama_fellowship', $program_studi_title) }} {{ Form::text('nama_fellowship', old('nama_fellowship'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
@elseif( $currentRouteName[0] == 'kompetensitambahanpenerbitansertifikat' || $currentRouteName[0] == 'kompetensitambahanresertifikasipenerbitansertifikat')
{{ Form::label('tempat_rumah_sakit', $tempat_pendidikan_title) }} {{ Form::text('tempat_rumah_sakit', old('tempat_rumah_sakit'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('tambahan_subspesialis', $program_studi_title) }} {{ Form::text('tambahan_subspesialis', old('tambahan_subspesialis'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
@else
{{ Form::label('tempat_pendidikan', $tempat_pendidikan_title) }} {{ Form::text('tempat_pendidikan', old('papdi_cabang'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('program_studi', $program_studi_title) }} {{ Form::text('program_studi', old('program_studi'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
@endif
{{ Form::label('no_telp', 'No. Telepon') }} {{ Form::text('no_telp', old('no_telp'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('no_hp1', 'No. HP') }} {{ Form::text('no_hp1', old('no_hp1'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
{{ Form::label('no_hp2', 'No. HP Alternatif') }} {{ Form::text('no_hp2', old('no_hp2'), ['readonly' => 'readonly', 'class' => 'form-control']) }}
@if (isset($currentRouteName[1]) && in_array($currentRouteName[0], [ 'resertifikasipenerbitansertifikat', 'subspesialisresertifikasipenerbitansertifikat', 'fellowshipresertifikasipenerbitansertifikat', 'kompetensitambahanresertifikasipenerbitansertifikat', ]))
{{ Form::label('no_urut_nasional_sebelumnya', 'Nomor Sertifikat Sebelumnya') }}
{{ Form::text('no_urut_nasional_sebelumnya', old('no_urut_nasional_sebelumnya'), ['class' => 'form-control', 'readonly' => 'readonly']) }} {{ Form::text('st_sebelumnya', old('st_sebelumnya') ? old('st_sebelumnya') : $penomoran_sertifikat, ['id' => 'st_sebelumnya', 'class' => 'form-control', 'readonly' => 'readonly']) }} {{ Form::text('urut_ujian_board_sebelumnya', old('urut_ujian_board_sebelumnya') ? old('urut_ujian_board_sebelumnya') : $urut_ujian_board, ['id' => 'urut_ujian_board_sebelumnya', 'class' => 'form-control']) }} {{ Form::text('bulan_lulus_sebelumnya', old('urut_ujian_board_sebelumnya') ? old('urut_ujian_board_sebelumnya') : '', ['id' => 'bulan_lulus_sebelumnya', 'class' => 'form-control', 'readonly' => 'readonly']) }} {{ Form::text('tahun_lulus_sebelumnya', old('urut_ujian_board_sebelumnya') ? old('urut_ujian_board_sebelumnya') : '', ['id' => 'tahun_lulus_sebelumnya', 'class' => 'form-control', 'readonly' => 'readonly']) }}
@endif
{{ Form::label('no_urut_nasional', 'Nomor Sertifikat') }}
{{ Form::text('no_urut_nasional', old('no_urut_nasional'), ['class' => 'form-control']) }} {{ Form::text('st', old('st') ? old('st') : $penomoran_sertifikat, ['readonly' => 'readonly', 'id' => 'st', 'class' => 'form-control']) }} {{ Form::text('urut_ujian_board', old('urut_ujian_board') ? old('urut_ujian_board') : $urut_ujian_board, ['id' => 'urut_ujian_board', 'class' => 'form-control']) }} {{ Form::text('bulan_lulus', old('bulan_lulus') ? old('bulan_lulus') : date('m'), ['id' => 'bulan_lulus', 'class' => 'form-control']) }} {{ Form::text('tahun_lulus', old('tahun_lulus') ? old('tahun_lulus') : date('Y'), ['id' => 'tahun_lulus', 'class' => 'form-control']) }}
{{ Form::label('tgl_konfirmasi_data_ok', 'Tanggal Konfirmasi Data OK') }} {{ Form::text('tgl_konfirmasi_data_ok', old('tgl_konfirmasi_data_ok'), ['class' => 'form-control datepicker']) }}
{{ Form::label('tgl_dibuat_sertifikat', 'Tanggal Dibuat Sertifikat') }} {{ Form::text('tgl_dibuat_sertifikat', old('tgl_dibuat_sertifikat'), ['class' => 'form-control datepicker']) }}
{{ Form::close() }} @stop @section('js') @stop