71 lines
3.6 KiB
PHP
71 lines
3.6 KiB
PHP
@extends('layouts.draft')
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@section('content')
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<div class="container">
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<div class="row justify-content-center">
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<div class="col-md-8">
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<div class="card">
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<div class="card-header">Tambah Data Pengguna</div>
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<div class="card-body">
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<form method="POST" action="{{ route('pasien.store') }}">
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@csrf
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<div class="form-group">
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<label for="name">Nama </label>
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<input id="name" type="text"
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class="form-control @error('name') is-invalid @enderror" name="name"
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value="{{ old('name') }}" required autocomplete="name" autofocus>
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@error('name')
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<span class="invalid-feedback" role="alert">
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<strong>{{ $message }}</strong>
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</span>
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@enderror
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</div>
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<div class="form-group">
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<label for="age">Usia</label>
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<input id="age" type="number" class="form-control @error('age') is-invalid @enderror"
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name="age" value="{{ old('age') }}" required autocomplete="age">
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@error('age')
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<span class="invalid-feedback" role="alert">
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<strong>{{ $message }}</strong>
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</span>
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@enderror
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</div>
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<div class="form-group">
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<label for="phone">No HP</label>
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<input id="phone" type="text"
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class="form-control @error('phone') is-invalid @enderror" name="phone"
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value="{{ old('phone') }}" required autocomplete="phone">
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@error('phone')
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<span class="invalid-feedback" role="alert">
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<strong>{{ $message }}</strong>
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</span>
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@enderror
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</div>
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<div class="form-group">
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<label for="alamat">Alamat</label>
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<input id="alamat" type="text"
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class="form-control @error('alamat') is-invalid @enderror" name="alamat"
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value="{{ old('alamat') }}" required autocomplete="alamat">
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@error('alamat')
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<span class="invalid-feedback" role="alert">
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<strong>{{ $message }}</strong>
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</span>
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@enderror
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</div>
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<!-- Tambahkan input hidden untuk id_user -->
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<input type="hidden" name="id_user" value="{{ Auth::id() }}">
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<button type="submit" class="btn btn-primary">Tambah</button>
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<a href="/pasien" class="btn btn-danger"> Batal</a>
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</form>
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</div>
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</div>
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</div>
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</div>
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</div>
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@endsection
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