75 lines
3.5 KiB
PHP
75 lines
3.5 KiB
PHP
@extends('Backend.layouts.main')
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@section('content-wrapper')
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<div class="container-fluid">
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<!-- Page Heading -->
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<div class="d-sm-flex align-items-center justify-content-between mb-4">
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<h1 class="h3 mb-0 text-custom-2-800">
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<i class="fas fa-notes-medical mr-1"></i>
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{{ $titlePage }}
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</h1>
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</div>
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<!-- Content Row -->
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<div class="card kartu-custom mb-5">
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<div class="card-header">
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<p class="m-0 p-0 text-custom"><b>Tambah Data Gejala</b></p>
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</div>
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<div class="card-body">
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<form action="{{ URL::to('data-gejala') }}" method="POST">
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@csrf
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<div class="mb-3 row">
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<label for="kode_gejala" class="col-sm-2 col-form-label text-custom">Kode Gejala</label>
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<div class="col-sm-2">
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<input type="text" class="form-control @error('kode_gejala') is-invalid @enderror"
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id="kode_gejala" name="kode_gejala" value="{{ old('kode_gejala') }}">
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@error('kode_gejala')
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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>
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<div class="mb-3 row">
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<label for="gejala" class="col-sm-2 col-form-label text-custom">Nama Gejala</label>
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<div class="col-sm-5">
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<input type="text" class="form-control @error('gejala') is-invalid @enderror" id="gejala"
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name="gejala" value="{{ old('gejala') }}">
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@error('gejala')
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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>
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<div class="mb-3 row">
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<label for="nilai_densitas" class="col-sm-2 col-form-label text-custom">Nilai Densitas</label>
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<div class="col-sm-2">
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<input type="number" class="form-control @error('nilai_densitas') is-invalid @enderror"
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id="nilai_densitas" name="nilai_densitas" value="{{ old('nilai_densitas') }}" step="0.01">
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@error('nilai_densitas')
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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>
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<div class="mb-3 row">
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<div class="d-grid gap-2 d-md-flex justify-content-md-end">
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<button class="btn btn-custom-2 me-md-2" type="submit">
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<i class="fas fa-save me-1"></i>
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Simpan Data
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</button>
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<button class="btn btn-secondary" type="reset">
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<i class="fas fa-ban me-1"></i>
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Cancel
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</button>
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</div>
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</div>
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</form>
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</div>
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</div>
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</div>
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@endsection
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