70 lines
2.4 KiB
PHP
70 lines
2.4 KiB
PHP
@extends('layouts.dashboard')
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@section('title', 'Form Data Ibu hamil')
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@section('content')
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<div class="pagetitle mb-4">
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<h1 style="color: #9c3a5b;">Form Data Ibu Hamil</h1>
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</div>
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<section class="section">
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<div class="row">
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<div class="col-lg-18">
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<div class="card">
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<div class="card-body">
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<h5 class="card-title">Tambah Data Ibu Hamil</h5>
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<!-- General Form Elements -->
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<form action="{{ route('ibu_hamil.store') }}" method="POST">
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@csrf
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<div class="row mb-3">
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<label for="nik" class="col-sm-2 col-form-label">NIK</label>
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<div class="col-sm-10">
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<input type="text" class="form-control" name="nik" required>
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</div>
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</div>
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<div class="row mb-3">
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<label for="nama" class="col-sm-2 col-form-label">Nama Ibu Hamil</label>
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<div class="col-sm-10">
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<input type="text" class="form-control" name="nama" id="nama" required>
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</div>
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</div>
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<div class="row mb-3">
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<label for="tgl_lahir" class="col-sm-2 col-form-label">Tanggal Lahir</label>
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<div class="col-sm-10">
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<input type="date" class="form-control" name="tgl_lahir" required>
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</div>
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</div>
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<div class="row mb-3">
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<label for="alamat" class="col-sm-2 col-form-label">Alamat</label>
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<div class="col-sm-10">
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<input type="text" class="form-control" name="alamat" required>
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</div>
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</div>
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<div class="row mb-3">
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<label for="no_hp" class="col-sm-2 col-form-label">No HP</label>
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<div class="col-sm-10">
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<input type="number" class="form-control" name="no_hp" required>
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</div>
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</div>
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<div class="row mb-3">
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<div class="col-sm-10">
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<button type="submit" class="btn btn-primary">Submit Form</button>
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</div>
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</div>
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</form><!-- End General Form Elements -->
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</div>
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</div>
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</div>
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</div>
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</section>
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@endsection
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