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<?php include "header.php";?>
<?php
// memulai session
// jika session belum dibuat, maka inisialisasi awal diberi nilai TRUE
//if (!isset($_SESSION['submit'])) {
//$_SESSION['submit'] = true;
//}
//?>
<link rel="icon" href="idilogo.png">
<style type="text/css">
<!--
-->
html{
background-size: cover;
height:100%;
}
#feedback-page{
text-align:center;
}
#form-main{
width:100%;
float:left;
padding-top:0px;
font-size:14px;
}
#form-div {
background-image: linear-gradient(to right, #4682B4, #00FFFF, #00FA9A);
background:url(image/tdoc.jpg) no-repeat;
padding-left:10px;
padding-right:10px;
padding-top:35px;
padding-bottom:50px;
width: 100%;
float: left;
left: 50%;
font-size:12px;
margin-top:30px;
margin-left: 10px;
-moz-border-radius: 7px;
-webkit-border-radius: 7px;
border: 1px solid #dedede;
}
.feedback-input {
color:#3c3c3c;
font-family: Helvetica, Arial, sans-serif;
font-weight:500;
font-size: 18px;
border-radius: 0;
line-height: 22px;
background-color: #fbfbfb;
padding: 13px 13px 13px 54px;
margin-bottom: 10px;
width:100%;
-webkit-box-sizing: border-box;
-moz-box-sizing: border-box;
-ms-box-sizing: border-box;
box-sizing: border-box;
border: 3px solid rgba(0,0,0,0);
margin-left: 50px;
}
.feedback-input:focus{
background: #fff;
box-shadow: 0;
border: 3px solid #3498db;
color: #3498db;
outline: none;
padding: 13px 13px 13px 54px;
}
.focused{
color:#30aed6;
border:#30aed6 solid 3px;
}
/* Icons ---------------------------------- */
#name{
background-image: url(http://rexkirby.com/kirbyandson/images/name.svg);
background-size: 30px 30px;
background-position: 11px 8px;
background-repeat: no-repeat;
}
#name:focus{
background-image: url(http://rexkirby.com/kirbyandson/images/name.svg);
background-size: 30px 30px;
background-position: 8px 5px;
background-position: 11px 8px;
background-repeat: no-repeat;
}
#email{
background-image: url(http://rexkirby.com/kirbyandson/images/email.svg);
background-size: 30px 30px;
background-position: 11px 8px;
background-repeat: no-repeat;
}
#email:focus{
background-image: url(http://rexkirby.com/kirbyandson/images/email.svg);
background-size: 30px 30px;
background-position: 11px 8px;
background-repeat: no-repeat;
}
#comment{
background-image: url(http://rexkirby.com/kirbyandson/images/comment.svg);
background-size: 30px 30px;
background-position: 11px 8px;
background-repeat: no-repeat;
}
textarea {
width: 100%;
height: 150px;
line-height: 150%;
resize:vertical;
padding: 10px;
}
input:hover, textarea:hover,
input:focus, textarea:focus {
background-color:white;
}
#button-blue{
font-family: 'Montserrat', Arial, Helvetica, sans-serif;
float:left;
width: 100%;
border: #fbfbfb solid 4px;
cursor:pointer;
background-color: #3498db;
color:white;
font-size:24px;
padding-top:22px;
padding-bottom:22px;
-webkit-transition: all 0.3s;
-moz-transition: all 0.3s;
transition: all 0.3s;
margin-top:-4px;
margin-left:10px;
font-weight:700;
}
#button-blue:hover{
background-color: rgba(0,0,0,0);
color: #0493bd;
}
.submit:hover {
color: #3498db;
}
.ease {
width: 0px;
height: 74px;
background-color: #fbfbfb;
-webkit-transition: .3s ease;
-moz-transition: .3s ease;
-o-transition: .3s ease;
-ms-transition: .3s ease;
transition: .3s ease;
}
.submit:hover .ease{
width:100%;
background-color:#EEE;
}
.container{
width: 100%;
margin-left:10px;
padding:10px;
}
@media only screen and (max-width: 580px) {
#form-div{
left: 3%;
margin-right: 3%;
width: 88%;
margin-left: 3%;
padding-left: 3%;
padding-right: 3%;
font-size: 14px;
}
</style>
<link rel="stylesheet" href="//code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css">
<link rel="stylesheet" href="//code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css">
<script src="https://code.jquery.com/jquery-1.12.4.js"></script>
<script src="https://code.jquery.com/ui/1.12.1/jquery-ui.js"></script>
<script>
<!--
$( function() {
$( "#datepicker1" ).datepicker({ dateFormat: 'dd-mm-yy' });
$( "#datepicker2" ).datepicker({ dateFormat: 'dd-mm-yy' });
$( "#datepicker3" ).datepicker({ dateFormat: 'dd-mm-yy' });
$( "#datepicker4" ).datepicker({ dateFormat: 'dd-mm-yy' });
$( "#datepicker5" ).datepicker({ dateFormat: 'dd-mm-yy' });
} );
function MM_findObj(n, d) { //v4.01
var p,i,x; if(!d) d=document; if((p=n.indexOf("?"))>0&&parent.frames.length) {
d=parent.frames[n.substring(p+1)].document; n=n.substring(0,p);}
if(!(x=d[n])&&d.all) x=d.all[n]; for (i=0;!x&&i<d.forms.length;i++) x=d.forms[i][n];
for(i=0;!x&&d.layers&&i<d.layers.length;i++) x=MM_findObj(n,d.layers[i].document);
if(!x && d.getElementById) x=d.getElementById(n); return x;
}
//-->
</script>
<title>Ikatan Dokter Indonesia</title>
<body>
<div class="container">
<div id="form-div">
<CENTER><strong class="h2"> REVISI DATA PRIBADI</strong></CENTER>
<p><label for=""></label> </p>
<br>
<?php
$tglBayar = date('Y-m-d');
$hari = date('Y-m-d');
$npm = $_GET['npm'];
//$nmlead = $_GET['nmlead'];
$data = mysqli_query($konek, "SELECT * FROM h_anggota WHERE npm='$_GET[npm]' " );
$d=mysqli_fetch_array($data);
$view = isset($d['npm']) ? $d['npm'] : null;
$mbstr2 = $d['mbstr'];
$iuran2 = $d['tgliuran'];
$tgl_lahir2 = $d['tgl_lahir'];
$date = new DateTime($mbstr2);
$mbstr = $date->format('d-m-Y');
$date = new DateTime($iuran2);
$iuran = $date->format('d-m-Y');
$date = new DateTime($tgl_lahir2);
$tgl_lahir = $date->format('d-m-Y');
?>
<form method="post" action="ang_pros2baru.php" enctype="multipart/form-data">
<div class="card-body">
<div class="row">
<div class="col-md-4">
<div class="form-group ">
<input name="view" type="hidden" class="form-control" value="<?php echo $_GET['view'] ?>" />
<p class="name"><input name="npm" readonly type="hidden" class="form-control" value="<?php echo $d['npm'] ?>" />
<label for="ket">NPA</label>
<p class="name"><input name="npa" class="form-control" readonly value="<?php echo $d['npa'] ?>" />
</p>
<label for="ket">Tanggal Cek</label>
<input name="tglreg" class="form-control" readonly type="date" value="<?php echo $hari ?>" size="11">
</p>
<label for="tbayar">Nama gelar Komplit</label>
<br>
<p class="name"><input name="nmlead" placeholder="Isi Nama" class="form-control" value="<?php echo $d['nmlead'] ?>" />
</p>
<label for="jumlah">Alamat Lengkap</label>
<br>
<textarea name="alamat" class="form-control" placeholder="Isi Alamat" required><?php echo $d['alamat'] ?></textarea>
</p>
<label for="jumlah">Tempat Lahir (Kota)</label>
<br>
<p class="name"><input name="tempatlahir" placeholder="Isi Kota Lahir" class="form-control" value="<?php echo $d['tempatlahir']; ?>" />
</p>
<label for="bukti" class="merah">Tanggal lahir : tanggal-Bulan-Tahun </label>
<input name="tgl_lahir" class="form-control" id="datepicker1" value="<?php echo $tgl_lahir ?>" size="11">
</p>
<label for="jumlah">Email yang digunakan di HP Aktif</label>
<br>
<input name="email" class="form-control" type="email" placeholder="Isi Email" value="<?php echo $d['email'] ?>" required/>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
<label for="jumlah">Nomor KTP </label>
<br>
<input class="form-control" name="ktp" type="text" placeholder="Isi Nomor Kependudukan KTP" maxlength="30" value="<?php echo $d['ktp'] ?>"/>
</p>
<label for="jumlah" >Keahlian </label>
<br>
<!-- <input class="form-control" name="ahli" type="text" placeholder="Isi Praktek sebagai" maxlength="100" value="<?php echo $d['ahli'] ?>" required/>
-->
<textarea name="ahli" class="form-control" placeholder="Isi Keahlian Praktek sebagai" required><?php echo $d['ahli'] ?></textarea>
</p>
<label for="jumlah">Mobile No/WA kode :62 ***** </label>
<br>
<input class="form-control" name="telp" type="text" placeholder="Isi No telp" maxlength="30" value="<?php echo $d['telp'] ?>"/>
</p>
<label for="jumlah">warga negara </label>
<br>
<input class="form-control" name="warganegara" type="text" placeholder="Isi Warganegara" value="Indonesia" size="30" required >
</p>
<?php
$gender= $d['gender']; ?>
<label for="jumlah">Agama</label>
<br>
<input class="form-control" name="agama" type="text" placeholder="Isi Agama" value="<?php echo $d['agama'] ?>" size="30" required >
</p>
<input type="radio" name="gender" value="l"<?php if($gender=='l') echo 'checked'?> > Laki-Laki <br>
<input type="radio" name="gender" value="p"<?php if($gender=='p') echo 'checked'?> > Perempuan <br>
</div>
</div>
<div class="col-md-4">
<div class="form-group">
</p>
</p>No STR <br>
<input name="nostr" type="text" class="form-control" placeholder="Isi No STR" maxlength="30" value="<?php echo $d['nostr'] ?>"/>
</p>
<label for="bukti" class="merah">Masa berlaku STR : tanggal-Bulan-Tahun </label>
<input name="mbstr" class="form-control" id="datepicker2" value="<?php echo $mbstr ?>" size="11">
</p>
<br><br>
<label for="jumlah"class="merah"><b>Tanggal Iuran Tahunan : tanggal-Bulan-Tahun </b></label><br>
*Tanggal Iuran bisa dilihat di kwitansi/kosongkan jika tidak tahu"
<br>
</p>
<input name="tgliuran" class="form-control" id="datepicker3" value="<?php echo $iuran ?>" size="11">
</p>
<br> <br> <br>
<label for="file"><h4>UPLOAD PASS FOTO</h4> </label><br>
Jika akan mengedit foto silahkan Upload Pass foto.
<br>( format foto : jpg,jpeg atau png. nama file tidak ada spasi dan simbol2x spt(@#$%^&-=*) <br>
Contoh nama file : drbandung.jpg ukuran max 250 kb
<p>
<p>
<input name="file" type="file" />
</p>
<div class="submit">
<input type="submit" id="button-blue" value="Submit" />
<div class="ease"></div>
</div>
</form>
</div>
</div>
</div>
</div>
</div>
<br> <br>
<!-- jQuery first, then Popper.js, then Bootstrap JS -->
</body>
<!-- proses edit data -->