<!-- Content Wrapper. Contains page content -->
<div class="content-wrapper">
    <!-- Content Header (Page header) -->
    <section class="content-header">
        <h1>
            Pembatalan Kunjungan Klinik Kalideres
        </h1>
        <ol class="breadcrumb">
            <li><a href="#"><i class="fa fa-dashboard"></i> Pasien</a></li>
            <li class="active">Cancel</li>
        </ol>
    </section>

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

        <!-- Default box -->
        <div class="box">
            <div class="box-header with-border">
                <?= $this->session->flashdata('message'); ?>
                <small>Cari Pasien</small>
                <div class="box-tools pull-right">
                    <button class="btn btn-box-tool" data-widget="collapse" data-toggle="tooltip" title="Collapse"><i class="fa fa-minus"></i></button>
                    <button class="btn btn-box-tool" data-widget="remove" data-toggle="tooltip" title="Remove"><i class="fa fa-times"></i></button>
                </div>
            </div>
            <div class="box-body">
                <form method="POST" action="<?= base_url('pasien/cancelaction') ?>">
                    <div class="row">
                        <div class="col-md-6">
                            <div class="form-group">
                                <label for="case_id">No Kunjungan</label>
                                <div class="input-group input-group-sm">
                                    <input type="text" class="form-control" id="case_id" name="case_id" onkeydown="if(event.keyCode == 13) document.getElementById('btnsearch').click();" onkeypress="return justNumber(event);" placeholder="Cari Case ID">
                                    <span class="input-group-btn">
                                        <button type="button" id="btnsearch" class="btn btn-success bg-green-gradient btn-flat" onclick="searchpatientcancel();">Search!</button>
                                    </span>
                                </div>
                            </div>
                            <div class="row">
                                <div class="col-md-6">
                            <div class="form-group">
                                <label for="mr_id">MR ID</label>
                                <input type="text" class="form-control" id="mr_id" name="mr_id" readonly>
                            </div></div>
                            <div class="col-md-6">
                            <div class="form-group">
                                <label for="nama_pasien">Nama Pasien</label>
                                <input type="text" class="form-control" id="nama_pasien" name="nama_pasien" readonly>
                            </div></div>
                            </div>
                            <div class="form-group">
                                <label for="tanggal_masuk">Tanggal Masuk</label>
                                <div class="input-group date">
                                <div class="input-group-addon">
                                <i class="fa fa-calendar"></i>
                                </div>
                                <input type="text" class="form-control" id="tanggal_masuk" name="tanggal_masuk" readonly>
                            </div></div>
                            <div class="form-group">
                                <label for="status">Status</label>
                                <input type="text" class="form-control" id="status" name="status" readonly>
                            </div>
                            <div class="form-group">
                                <label for="kategori">Kategori</label>
                                <input type="text" class="form-control" id="kategori" name="kategori" readonly>
                            </div>
                            <div class="form-group">

                            </div>
                            <div class="form-group">
                                <label for="no_sep">No SEP</label>
                                <input type="text" class="form-control" id="no_sep" name="no_sep" readonly>
                                <input type="checkbox" value="1" id="sep" name="hapus_sep">
                                <label for="sep" style="font-weight: normal;"> Hapus SEP</label>
                            </div>
                            <div class="form-group">
                                <label for="note">Catatan</label>
                                <textarea id="note" name="note" class="form-control"></textarea>
                            </div>
                            <div class="form-group">
                                <button type="submit" id="btncancel" class="btn btn-primary bg-blue-gradient btn-block" disabled>OK</button>
                                <a href="<?= base_url('dashboard') ?>" class="btn bg-yellow-gradient btn-warning btn-block">Batal</a>
                            </div>
                        </div>
                    </div>
                </form>
            </div><!-- /.box-body -->
        </div><!-- /.box -->

    </section><!-- /.content -->
</div><!-- /.content-wrapper -->