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<?php include "header.php"; ?>
<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<title>IDI</title>
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<link rel="stylesheet" href="style2.css">
<link rel="icon" href="idilogo.png">
<style type="text/css">
<!--
-->
@import url(http://fonts.googleapis.com/css?family=Montserrat:400,700);
html{
background:url(image/medical.jpg) no-repeat;
background-size: cover;
height:100%;
}
#feedback-page{
text-align:center;
}
#form-main{
width:100%;
float:left;
padding-top:0px;
}
#form-div {
background-color:rgba(72,72,72,0.4);
padding-left:35px;
padding-right:35px;
padding-top:35px;
padding-bottom:50px;
width: 450px;
float: left;
left: 50%;
position: absolute;
margin-top:30px;
margin-left: -260px;
-moz-border-radius: 7px;
-webkit-border-radius: 7px;
}
.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);
}
.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;
}
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;
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:white;
}
@media only screen and (max-width: 580px) {
#form-div{
left: 3%;
margin-right: 3%;
width: 88%;
margin-left: 0;
padding-left: 3%;
padding-right: 3%;
}
</style>
<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() {
$( "#datepicker" ).datepicker({ dateFormat: 'yy-mm-dd' });
$( "#datepicker2" ).datepicker({ dateFormat: 'yy-mm-dd' });
$( "#datepicker3" ).datepicker({ dateFormat: 'yy-mm-dd' });
} );
function MM_findObj(n, d) { //v4.01
var p,i,x; if(!d) d=document; if((p=n.indexOf("?"))>0&&parent.frames.length) {
d=parent.frames[n.substring(p+1)].document; n=n.substring(0,p);}
if(!(x=d[n])&&d.all) x=d.all[n]; for (i=0;!x&&i<d.forms.length;i++) x=d.forms[i][n];
for(i=0;!x&&d.layers&&i<d.layers.length;i++) x=MM_findObj(n,d.layers[i].document);
if(!x && d.getElementById) x=d.getElementById(n); return x;
}
//-->
</script>
</head>
<div class="container">
<br><br><br>
<nav class="navbar navbar-inverse">
<div class="container-fluid">
<div class="navbar-header">
<a class="navbar-brand" href="index.php">Ikatan Dokter Indonesia</a>
</div>
</div>
</nav>
<div id="form-main">
<div id="form-div">
<?php
if(isset($_GET['nama'])){
if($_GET['nama'] == "kosong")
{
echo "<h4 style='color:red'> Nama tidak boleh kosong !</h4>";
}
}
if(isset($_GET['nama'])){
if($_GET['nama'] == "kosong")
{
echo "<h4 style='color:red'> Nama tidak boleh kosong !</h4>";
}
}
?>
<?php
if(isset($_GET["hasil"])){
if($_GET["hasil"] == "gagal"){
echo "<h4 style='color:red'> No ID Sudah ada !</h4>";
} else {
echo "Data berhasil diinput";
}
}
?>
<div align="center"><strong>FORM Reg </strong><br>
<br>
<?php
$project = 'Green Cleosa';
$day = 'Green Cleosa';
$dayList = array(
'Green Cleosa' => 'NRP',
'AGD' => 'AGD',
);
// https://www.malasngoding.com
// menghubungkan dengan koneksi database
// mengambil data barang dengan kode paling besar
$query = mysqli_query($konek, "SELECT max(npm) as kodeTerbesar FROM mahasiswa");
$data = mysqli_fetch_array($query);
$kodeBarang = $data['kodeTerbesar'];
// mengambil angka dari kode barang terbesar, menggunakan fungsi substr
// dan diubah ke integer dengan (int)
$urutan = (int) substr($kodeBarang, -3, 3);
// bilangan yang diambil ini ditambah 1 untuk menentukan nomor urut berikutnya
$urutan++;
// membentuk kode barang baru
// perintah sprintf("%03s", $urutan); berguna untuk membuat string menjadi 3 karakter
// misalnya perintah sprintf("%03s", 15); maka akan menghasilkan '015'
// angka yang diambil tadi digabungkan dengan kode huruf yang kita inginkan, misalnya BRG
//$huruf = substr("$project",0, 3);
$huruf = $dayList[$day];
$kodeid= $huruf . sprintf("%03s", $urutan);
$tglBayar = date('Y-m-d');
$project ='Ikatan Dokter Indonesia';
//$tanggal = '2015-06-03';
?>
<?php
$sqlSiswa = mysqli_query($konek, "select * from d_prakang WHERE id='$_GET[id]'");
$dp=mysqli_fetch_array($sqlSiswa);
$npm=$dp['npm'];
$wilker=$dp['wilker'];
$hari=$dp['hari'];
$jam=$dp['jam1'];
?>
</div>
<form method="POST" action="proseschap.php" enctype="multipart/form-data" >
<label for="npm">Project</label><br>
<input name="project" class="form-control" readonly value="<?php echo $project ?>" />
</p>
<label for="ket">Tanggal Daftar</label>
<input name="tglreg" class="form-control" type="text" id="datepicker" value="<?php echo $tglBayar ?>" size="11">
</p>
<label for="npm">NIP</label><br>
<input name="npm" class="form-control" readonly placeholder="Isi ID" value="<?php echo $npm ?>" />
</p>
<label for="Nama">Nama</label><br>
<input name="pasien" class="form-control" placeholder="Isi Nama" value="" />
</p>
<label for="sales">Mobile No</label><br>
<input name="telp" class="form-control" placeholder="Isi No HP" value="" />
</p>
<label for="sales">Email</label><br>
<input name="email2" class="form-control" placeholder="Isi Alamat Email" value="" />
</p>
<label for="sales">Tempat praktek</label><br>
<input name="tempat" class="form-control" readonly value="<?php echo $wilker ?>"/>
</p>
<label for="sales">Hari</label><br>
<input name="hari" class="form-control" readonly value="<?php echo $hari; ?>"/>
</p>
<label for="sales">Jam</label><br>
<input name="jam" class="form-control" readonly value="<?php echo $jam ?>"/>
</p>
<label for="keterangan">Note</label>
<textarea name="note" rows="2" class="form-control" id="note" placeholder="Isi Keterangan" ></textarea>
<br>
<div class="form-group">
<img src="generate.php" alt="gambar" />
</div>
<div class="form-group">
<input class="form-control" name="kode" value="" placeholder="kode captcha Huruf besar kecil pengaruh" maxlength="5"/>
</div>
</p>
<p> </p>
<div class="submit">
<input type="submit" id="button-blue" value="Submit" />
<div class="ease">
</div>
</div>
</form>
</div>