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<?php include "header.php";
// cek apakah yang mengakses halaman ini sudah login
if($_SESSION['status']<>"login"){
header("location:location:../login.php");
}
?>
<?php
$view = isset($_GET['view']) ? $_GET['view'] : null;
?>
<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
<meta name="description" content="">
<meta name="author" content="">
<head>
<title>IDI Kota Bandung</title>
<!-- Custom fonts for this template-->
<link href="vendor/fontawesome-free/css/all.min.css" rel="stylesheet" type="text/css">
<link href="https://fonts.googleapis.com/css?family=Nunito:200,200i,300,300i,400,400i,600,600i,700,700i,800,800i,900,900i" rel="stylesheet">
<!-- Custom styles for this template-->
<link href="css/sb-admin-2.min.css" rel="stylesheet">
<!-- Custom styles for this page -->
<link href="vendor/datatables/dataTables.bootstrap4.min.css" rel="stylesheet">
<?php
// memulai session
// jika session belum dibuat, maka inisialisasi awal diberi nilai TRUE
//if (!isset($_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">
<script type="text/javascript">
function show(str){
document.getElementById('sh2').style.display = 'none';
document.getElementById('sh1').style.display = 'block';
}
function show2(sign){
document.getElementById('sh2').style.display = 'block';
document.getElementById('sh1').style.display = 'none';
}
</script>
<title>Ikatan Dokter Indonesia</title>
<body>
<body id="page-top">
<body>
<!-- Page Wrapper -->
<div id="wrapper">
<?php include "sidebar.php"; ?>
<!-- Content Wrapper -->
<div id="content-wrapper" class="d-flex flex-column">
<!-- Main Content -->
<div id="content">
<?php include "topbar.php";?>
<!-- Begin Page Content -->
<div class="container-fluid">
<!-- DataTales Example -->
<div class="card shadow mb-8">
<div class="card-header py-3">
<h6 class="m-0 font-weight-bold text-primary">List Post</h6>
</div>
<div class="card-body">
<div class="table-responsive">
<div class="container">
<div id="form-div">
<center><button><i class="fa fa-home"></i></button> <a class='btn btn-success btn-sm' href='upd_sip2.php?npm=<?php echo $_GET['npm']; ?>&noreg=<?php echo $_GET['noreg']; ?>'> Home Back to Status </a></center>
<br>
<CENTER><strong class="h2"> REVISI DATA PEMOHON</strong></CENTER>
<p><label for=""></label> </p>
<?php
$tglBayar = date('Y-m-d');
$hari = date('Y-m-d');
// $npm = $_GET['npm'];
//$nmlead = $_GET['nmlead'];
$data = mysqli_query($konek, "SELECT * FROM h_registrasi WHERE noreg='$_GET[noreg]' " );
$d=mysqli_fetch_array($data);
$kota=$d['kota'];
$perihal=$d['perihal'];
$mbstr3 = $d['mbstr2'];
// $view = isset($d['npm']) ? $d['npm'] : null;
?>
<form method="post" action="ang_pros2.php" enctype="multipart/form-data">
<div class="card-body">
<input name="view" type="hidden" class="form-control" value="<?php echo $_GET['view'] ?>" />
<p class="name"><input name="npm" readonly class="form-control" value="<?php echo $d['npm'] ?>" />
<p class="name"><input name="noreg" readonly class="form-control" value="<?php echo $d['noreg'] ?>" />
</br>
<label for="tbayar">Nomor Surat Rekomendasi</label>
<input name="noreko" placeholder="Isi No Rekomendasi" class="form-control" value="<?php echo $d['noreko'] ?>" />
</p>
<label for="tbayar">Nama</label>
<input name="nmlead" placeholder="Isi Nama" class="form-control" value="<?php echo $d['nmlead'] ?>" />
</p>
<label for="jumlah">Alamat</label>
<textarea name="alamat" class="form-control" placeholder="Isi Alamat" required><?php echo $d['alamat'] ?></textarea>
<br>
<?php
$kota= $d['kota'];
?>
<strong>Status Pengajuan Rekom Kota :</strong><br>
<input type="radio" name="kota" value="bandung"<?php if($kota=='bandung') echo 'checked' ?> > Kota Bandung (Anggota IDI)<br>
<input type="radio" name="kota" value="luar_kota"<?php if ("luar_kota"==$kota) echo 'checked';?> > Luar Kota Bandung (Anggota IDI)<br>
<input type="radio" name="kota" value=""<?php if (""==$kota) echo 'checked';?> > Non Anggota <br>
</br>
<label for="tbayar">Asal Cabang / untuk Non Anggota IDI </label>
<input name="asalcb" placeholder="Isi Asal Cabang Non Anggota" class="form-control" value="<?php echo $d['asalcb'] ?>" />
</p>
<label for="jumlah" >Keahlian /PPDS (edit Bagian) </label>
<textarea name="ahli" class="form-control" placeholder="Isi Keahlian Praktek sebagai" ><?php echo $d['ahli'] ?></textarea>
</br>
<label for="bukti" class="merah">Nomor STR</label>
<input name="nostr" class="form-control" type="text" value="<?php echo $d['nostr'] ?>" size="11">
</p>
<br>
<b>Pilih Masa berlaku STR :</b> </p>
<input type="radio" name="mbstr2" id="e1" onChange="show2()" value="1"<?php if($mbstr3=='1') echo 'checked'?>><b>STR Selama Mengikuti PPDS</b> <br>
<input type="radio" name="mbstr2" id="e1" onChange="show2()"value="2"<?php if($mbstr3=='2') echo 'checked'?>><b>STR Seumur hidup</b> <br>
<input type="radio" name="mbstr2" onChange="show(this.value)" value="3"<?php if($mbstr3=='3') echo 'checked'?>><b>Masa STR 5 Tahunan</b><br>
<br>
<div id="sh1">
<label for="bukti" class="merah">Masa berlaku STR format : (Bulan-Tanggal-Tahun)</label>
<input name="mbstr" class="form-control" type="" value="<?php echo $d['mbstr'] ?>" size="11">
</div>
<div id="sh2" style="display:none;">STR 1
</div>
<br>
</br>
</p>
<label for="bukti" class="merah">NPA</label>
<input name="npa" class="form-control" type="text" value="<?php echo $d['npa'] ?>" size="11">
</p>
<label for="bukti" class="merah">Tujuan /Kepala/instansi/ Kepada Rekom </label>
<input name="tujuan" class="form-control" type="text" value="<?php echo $d['tujuan'] ?>" size="11">
</p>
</p>
<label for="bukti" class="merah">Alamat /Kepala/instansi/ Kepada Rekom </label>
<input name="alamatrek" class="form-control" type="text" value="<?php echo $d['alamatrek'] ?>" size="11">
</p>
<label for="bukti" class="merah">Sudah/belum (Praktek)</label>
<input name="praktek" class="form-control" type="text" value="<?php echo $d['praktek'] ?>" size="11">
</p>
<label for="bukti" class="merah">Administrasi</label>
<input name="adm" class="form-control" type="text" value="<?php echo $d['adm'] ?>" size="11">
</p>
<label for="bukti" class="merah">Nominal </label>
<input name="nominal" class="form-control" type="text" value="<?php echo $d['nominal'] ?>" size="11">
</p>
<label for="bukti">Tujuan Alamat Mutasi </label>
</p>
<textarea name="alamatmt" class="form-control" placeholder="Isi Alamat" ><?php echo $d['alamatmt'] ?></textarea>
</p>
<label for="bukti">Tujuan Kota Mutasi </label>
</p>
<input name="kotamt" class="form-control" placeholder="Isi Tujuan kota" value="<?php echo $d['kotamt'] ?>">
</p>
<label for="bukti">NO Registrasi PKHI </label>
</p>
<input name="nopkhi" class="form-control" placeholder="Isi Noreg PKHI" value="<?php echo $d['nopkhi'] ?>">
</p>
<label for="bukti">Unit Kerja </label>
</p>
<input name="unitkerja" class="form-control" placeholder="Isi Unit kerja"value="<?php echo $d['unitkerja'] ?>" >
</p>
<strong>Jenis Pengajuan Rekomendasi :</strong><br>
</P>
<input type="radio" name="perihal" value="rekomendasi_SIP_dr_umum"<?php if($perihal=='rekomendasi_SIP_dr_umum') echo 'checked'?> > Rekomendasi SIP dr Umum (Pengantar IDI Luar kota Bandung) <br>
<input type="radio" name="perihal" value="rekomendasi_SIP_dr_spesialis"<?php if($perihal=='rekomendasi_SIP_dr_spesialis') echo 'checked'?> > Rekomendasi SIP dr Spesialis (Pengantar IDI Luar kota Bandung)<br>
<input type="radio" name="perihal" value="rekomendasi_PPDS"<?php if($perihal=='rekomendasi_PPDS') echo 'checked'?> > Rekomendasi Daftar PPDS <br>
<input type="radio" name="perihal" value="rekomendasi_SIP_PPDS_I"<?php if($perihal=='rekomendasi_SIP_PPDS_I') echo 'checked'?> > Rekomendasi SIP PPDS I<br>
<input type="radio" name="perihal" value="rekomendasi_PPDS_II"<?php if($perihal=='rekomendasi_PPDS_II') echo 'checked'?> > Rekomendasi Daftar PPDS II<br>
<input type="radio" name="perihal" value="rekomendasi_SIP_PPDS_II"<?php if($perihal=='rekomendasi_SIP_PPDS_II') echo 'checked'?> > Rekomendasi SIP PPDS II <br>
<input type="radio" name="perihal" value="rekomendasi_fellowship"<?php if($perihal=='rekomendasi_fellowship') echo 'checked'?> > Rekomendasi Fellowship<br>
<input type="radio" name="perihal" value="rekomendasi_COGS"<?php if($perihal=='rekomendasi_COGS') echo 'checked'?> > Rekomendasi Certificate Of Good Standing<br>
<input type="radio" name="perihal" value="rekomendasi_UKDI"<?php if($perihal=='rekomendasi_UKDI') echo 'checked'?> > Rekomendasi UKDI<br>
<input type="radio" name="perihal" value="rekomendasi_PKHI_um"<?php if($perihal=='rekomendasi_PKHI_um') echo 'checked'?> > Rekomendasi PKHI Dokter Umum<br>
<input type="radio" name="perihal" value="rekomendasi_PKHI_sp"<?php if($perihal=='rekomendasi_PKHI_sp') echo 'checked'?> > Rekomendasi PKHI Dokter Spesial<br>
<input type="radio" name="perihal" value="rekomendasi_internsip"<?php if($perihal=='rekomendasi_internsip') echo 'checked'?> > Rekomendasi Internsip<br>
<input type="radio" name="perihal" value="mutasi"<?php if($perihal=='mutasi') echo 'checked'?> > Rekomendasi Mutasi<br>
<input type="radio" name="perihal" value="kehilangan"<?php if($perihal=='kehilangan') echo 'checked'?> > Rekomendasi Kehilangan<br>
<input type="radio" name="perihal" value="Rekomendasi_Pengantar_SIP"<?php if($perihal=='Pengantar_Puskesmas') echo 'checked'?> > Rekomendasi Pengantar Puskesmas<br>
<br><br>
<label for="bukti">Nomor hilang Kepolisian </label>
</p>
<input name="nopol" class="form-control" placeholder="Isi Nomor dr Kepolisian"value="<?php echo $d['nopol'] ?>" >
</p>
<label for="bukti"><b>Tanggal hilang dari kepolisian </b></label>
<input name="tglpol" class="form-control" placeholder="Isi Tanggal dari Polisi"value="<?php echo $d['tglpol'] ?>" >
</p>
<label for="bukti"><b>Lampiran Kehilangan/Kepolisian</b> </label>
<input name="lampiran" class="form-control" placeholder="Isi Lampiran"value="<?php echo $d['lampiran'] ?>" >
</p>
<label for="bukti"><b>wilayah kerja PKM</b> </label>
<input name="wil_kerja" class="form-control" placeholder="Isi Wilayah Kerja PKM"value="<?php echo $d['wil_kerja'] ?>" >
</p>
<label for="bukti"><b>wilayah kerja PKM/Kota Kabupaten</b> </label>
<input name="kota_kab" class="form-control" placeholder="Isi Wilayah Kota/kabupaten"value="<?php echo $d['kota_kab'] ?>" >
</p>
<br><br>
<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 -->