<div class="content-wrapper">
    <!-- Content Header (Page header) -->
    <section class="content-header">
        <h1>
            Sistem Klinik
            <small>Rekam Medis</small>
        </h1>
        <ol class="breadcrumb">
            <li><a href="#"><i class="fa fa-dashboard"></i> Klinik</a></li>
            <li class="active">Dashboard</li>
        </ol>
    </section>

    <!-- Main content -->
    <section class="content">

        <!-- Default box -->
        <div class="box">
         <div class="box-header with-border">
            <div class="box-tools pull-right">
            <!-- Kolom Pencarian Right -->
            </div>
            <br>
            <div class="box-body">
                <div class="table-responsive">
                <form action="<?= base_url('kasir/searchVoid'); ?>" method="post">
                <table border="0" class="table table-bordered table-striped dataTable dtr-inline">
                    <tr>
                    <td>Received No</td>
                        <td>:</td>
                        <td><input type="text" name="nokwitansi" class="form-control" value="" id="" placeholder="No.Kwitansi"></td>
                        <td colspan="3"><button type="submit" class="btn btn-success" onkeypress="">Cari</button></td>
                    </tr>
                    <tr>
                    <td>Case ID</td>
                        <td>:</td>
                        <td><input type="text" name="CaseID" class="form-control cari" value=""  onkeyup="isi_otomatis()" id="cari" placeholder="Case ID"></td>

                        <td>PaymentDate</td>
                        <td>:</td>
                        <td><input type="text" name="PaymenDate" class="form-control" value="" id="" placeholder="Tanggal Transaksi"></td>
                    </tr>
                    <tr>
                        <td>MR ID</td>
                        <td>:</td>
                        <td><input type="text" name="Mr" class="form-control" value="" id="patiencode" placeholder="No Mr"></td>

                        <td>Name Patient</td>
                        <td>:</td>
                        <td><input type="text" name="Nama" class="form-control" value="" id="PatientName" placeholder="Nama Pasien"></td>
                    </tr>
                    <tr>
                        <td>Amount Paid</td>
                        <td>:</td>
                        <td><input type="text" name="Amount" class="form-control" value="" id="" placeholder="Nominal"></td>

                        <td>Reason</td>
                        <td>:</td>
                        <td><textarea name="Reson" class="form-control" value="" id="" placeholder="Keterangan"></textarea></td>
                    </tr>
                </table>
                </form>
                </div>
            </div>
         </div>
    </div>
    </section>
</div>
