277 lines
14 KiB
PHP
277 lines
14 KiB
PHP
@extends('layouts.main')
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@section('container')
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<div class="card shadow mb-4">
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<div class="card-header py-3 text-center">
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<h5 class="m-0 font-weight-bold text-primary">{{ $heading }}</h5>
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</div>
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<div class="card-body">
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<form id="formTambahBalita" action="/tambah_pasien/create" method="post">
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@csrf
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<div class="form-group">
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<label>NIK Ibu</label>
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<input type="number" name="nik_ibu" class="form-control @error('nik_ibu')is-invalid @enderror"
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value="{{ old('nik_ibu') }}">
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@error('nik_ibu')
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<div class="invalid-feedback">
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{{ $message }}
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</div>
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@enderror
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</div>
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<div class="form-group">
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<label>Tanggal Lahir Ibu</label>
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<input type="date" name="tanggal_lahir_ibu"
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class="form-control @error('tanggal_lahir_ibu')is-invalid @enderror"
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value="{{ old('tanggal_lahir_ibu') }}">
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@error('tanggal_lahir_ibu')
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<div class="invalid-feedback">
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{{ $message }}
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</div>
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@enderror
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</div>
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<div class="form-group">
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<label>Nama Ibu</label>
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<input type="text" name="nama_ibu" class="form-control @error('nama_ibu')is-invalid @enderror"
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value="{{ old('nama_ibu') }}">
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@error('nama_ibu')
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<div class="invalid-feedback">
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{{ $message }}
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</div>
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@enderror
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</div>
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{{-- <div class="form-group">
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<label>Umur Ibu</label>
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<input type="number" name="umur_ibu" class="form-control @error('umur_ibu')is-invalid @enderror"
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value="{{ old('umur_ibu') }}">
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@error('umur_ibu')
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<div class="invalid-feedback">
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{{ $message }}
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</div>
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@enderror
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</div> --}}
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<div class="form-group">
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<label>Tanggal Lahir Ayah</label>
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<input type="date" name="tanggal_lahir_ayah"
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class="form-control @error('tanggal_lahir_ayah')is-invalid @enderror"
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value="{{ old('tanggal_lahir_ayah') }}">
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@error('tanggal_lahir_ayah')
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<div class="invalid-feedback">
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{{ $message }}
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</div>
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@enderror
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</div>
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<div class="form-group">
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<label>Nama Ayah</label>
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<input type="text" name="nama_ayah" class="form-control @error('nama_ayah')is-invalid @enderror"
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value="{{ old('nama_ayah') }}">
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@error('nama_ayah')
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<div class="invalid-feedback">
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{{ $message }}
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</div>
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@enderror
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</div>
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{{-- <div class="form-group">
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<label>Umur Ayah</label>
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<input type="number" name="umur_ayah" class="form-control @error('umur_ayah')is-invalid @enderror"
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value="{{ old('umur_ayah') }}">
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@error('umur_ayah')
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<div class="invalid-feedback">
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{{ $message }}
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</div>
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@enderror
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</div> --}}
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<div class="form-group">
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<label>Alamat</label>
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<input type="text" name="alamat" class="form-control @error('alamat')is-invalid @enderror"
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value="{{ old('alamat') }}">
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@error('alamat')
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<div class="invalid-feedback">
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{{ $message }}
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</div>
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@enderror
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</div>
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<div class="form-group">
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<label>Anak Ke</label>
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<input type="number" name="anak_ke" class="form-control @error('anak_ke')is-invalid @enderror"
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value="{{ old('anak_ke') }}">
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@error('anak_ke')
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<div class="invalid-feedback">
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{{ $message }}
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</div>
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@enderror
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</div>
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<div class="form-group">
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<label for="status_ayah">Status Ayah</label>
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<select class="form-control @error('status_ayah') is-invalid @enderror" name="status_ayah"
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id="status_ayah">
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<option value="" {{ old('status_ayah') == '' ? 'selected' : '' }}>--- Pilih ---</option>
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<option value="Masih Hidup" {{ old('status_ayah') == 'Masih Hidup' ? 'selected' : '' }}>Masih Hidup
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</option>
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<option value="Cerai" {{ old('status_ayah') == 'Cerai' ? 'selected' : '' }}>Cerai</option>
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<option value="Meninggal" {{ old('status_ayah') == 'Meninggal' ? 'selected' : '' }}>Meninggal
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</option>
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</select>
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@error('status_ayah')
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<div class="invalid-feedback">{{ $message }}</div>
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@enderror
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</div>
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<div class="form-group">
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<label for="status_ibu">Status Ibu</label>
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<select class="form-control @error('status_ibu') is-invalid @enderror" name="status_ibu"
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id="status_ibu">
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<option value="" {{ old('status_ibu') == '' ? 'selected' : '' }}>--- Pilih ---</option>
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<option value="Sudah Melahirkan" {{ old('status_ibu') == 'Sudah Melahirkan' ? 'selected' : '' }}>
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Sudah Melahirkan</option>
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<option value="Hamil" {{ old('status_ibu') == 'Hamil' ? 'selected' : '' }}>Hamil</option>
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</select>
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@error('status_ibu')
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<div class="invalid-feedback">{{ $message }}</div>
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@enderror
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</div>
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<div class="form-group" id="nikBayiSection" style="display: none;">
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<label for="status_nik_balita">Keterangan NIK Balita</label>
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<select class="form-control @error('status_nik_balita') is-invalid @enderror" name="status_nik_balita"
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id="status_nik_balita">
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<option value="" {{ old('status_nik_balita') == '' ? 'selected' : '' }}>--- Pilih ---
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</option>
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<option value="Memiliki NIK" {{ old('status_nik_balita') == 'Memiliki NIK' ? 'selected' : '' }}>
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Memiliki NIK</option>
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<option value="Belum Memiliki NIK"
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{{ old('status_nik_balita') == 'Belum Memiliki NIK' ? 'selected' : '' }}>Belum Memiliki NIK
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</option>
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</select>
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@error('status_nik_balita')
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<div class="invalid-feedback">{{ $message }}</div>
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@enderror
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</div>
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<div id="BayiSection" class="form-group" style="display: none;">
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<label>NIK Balita</label>
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<input type="number" name="nik_balita" class="form-control @error('nik_balita') is-invalid @enderror"
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value="{{ old('nik_balita') }}">
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@error('nik_balita')
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<div class="invalid-feedback">{{ $message }}</div>
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@enderror
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</div>
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<div id="namaBayiSection" class="form-group" style="display: none;">
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<label>Nama Balita</label>
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<input type="text" name="nama_balita"
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class="form-control @error('nama_balita') is-invalid @enderror" value="{{ old('nama_balita') }}">
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@error('nama_balita')
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<div class="invalid-feedback">{{ $message }}</div>
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@enderror
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</div>
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<div id="jkSection" class="form-group" style="display: none;">
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<label for="jenis_kelamin">Jenis Kelamin</label>
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<select class="form-control @error('jenis_kelamin') is-invalid @enderror" name="jenis_kelamin"
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id="jenis_kelamin">
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<option value="" {{ old('jenis_kelamin') == '' ? 'selected' : '' }}>--- Pilih ---</option>
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<option value="Laki Laki" {{ old('jenis_kelamin') == 'Laki Laki' ? 'selected' : '' }}>Laki Laki
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</option>
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<option value="Perempuan" {{ old('jenis_kelamin') == 'Perempuan' ? 'selected' : '' }}>Perempuan
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</option>
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</select>
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@error('jenis_kelamin')
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<div class="invalid-feedback">{{ $message }}</div>
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@enderror
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</div>
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<div id="tglSection" class="form-group" style="display: none;">
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<label>Tanggal Lahir</label>
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<input type="date" name="tanggal_lahir"
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class="form-control @error('tanggal_lahir')is-invalid @enderror"
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value="{{ old('tanggal_lahir') }}">
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@error('tanggal_lahir')
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<div class="invalid-feedback">{{ $message }}</div>
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@enderror
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</div>
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<div id="jamSection" class="form-group" style="display: none;">
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<label>Jam Lahir</label>
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<input type="time" name="jam_lahir" class="form-control @error('jam_lahir')is-invalid @enderror"
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value="{{ old('jam_lahir') }}">
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@error('jam_lahir')
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<div class="invalid-feedback">{{ $message }}</div>
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@enderror
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</div>
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<div class="form-group">
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<button type="submit" class="btn btn-primary btn-block">Simpan</button>
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</div>
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</form>
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</div>
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</div>
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<script>
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document.addEventListener("DOMContentLoaded", function() {
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var statusSelect = document.getElementById("status_ibu");
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var nikBayiSection = document.getElementById("nikBayiSection");
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var namaBayiSection = document.getElementById("namaBayiSection");
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var jkSection = document.getElementById("jkSection");
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var tglSection = document.getElementById("tglSection");
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var jamSection = document.getElementById("jamSection");
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var BayiSection = document.getElementById("BayiSection");
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var statusSelectBayi = document.getElementById("status_nik_balita");
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function updateVisibility() {
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console.log("Status Ibu:", statusSelect.value);
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console.log("Status NIK Balita:", statusSelectBayi.value);
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if (statusSelect.value === "Sudah Melahirkan") {
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nikBayiSection.style.display = "block";
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namaBayiSection.style.display = "block";
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jkSection.style.display = "block";
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tglSection.style.display = "block";
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jamSection.style.display = "block";
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} else {
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nikBayiSection.style.display = "none";
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namaBayiSection.style.display = "none";
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jkSection.style.display = "none";
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tglSection.style.display = "none";
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jamSection.style.display = "none";
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}
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if (statusSelect.value === "Sudah Melahirkan" && statusSelectBayi.value === "Memiliki NIK") {
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BayiSection.style.display = "block";
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} else {
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BayiSection.style.display = "none";
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}
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}
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// Membuat pengecekan awal saat halaman dimuat
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updateVisibility();
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// Menambahkan event listener ke dropdown
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statusSelect.addEventListener("change", updateVisibility);
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statusSelectBayi.addEventListener("change", updateVisibility);
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// Menghapus class is-invalid saat input mendapat fokus
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var inputs = document.querySelectorAll('.form-control');
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inputs.forEach(function(input) {
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input.addEventListener('focus', function() {
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this.classList.remove('is-invalid');
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var feedback = this.parentNode.querySelector('.invalid-feedback');
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if (feedback) {
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feedback.style.display = 'none';
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}
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});
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});
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var formCheckInputs = document.querySelectorAll('.form-check-input');
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formCheckInputs.forEach(function(formCheckInput) {
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formCheckInput.addEventListener('change', function() {
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var errorFeedback = this.parentNode.parentNode.querySelector(
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'.invalid-feedback');
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if (errorFeedback) {
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errorFeedback.style.display = 'none';
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}
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});
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});
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});
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</script>
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@endsection
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