<div class="content-wrapper">
    <!-- Content Header (Page header) -->
    <section class="content-header">
        <h1>
            Komunikasi dan Edukasi Poliklinik Rawat Jalan
        </h1>
        <ol class="breadcrumb">
        </ol>
    </section>

    <!-- Main content -->
    <section class="content">
        <div class="card" style="padding: 15px; background-color: white;border-radius: 5px;">
            <div class="card-body">
                <?php
                // Session 
                if ($this->session->flashdata('message')) {
                    echo $this->session->flashdata('message');
                }
                ?>
                <div class="row text-center">
                    <div class="col-md-2"></div>
                    <div class="col-md-2">
                        <img src="<?= base_url('images/logo.png'); ?>" height="80px">
                    </div>
                    <div class="col-md-6">
                        <h4 style="font-weight: bold;">
                            YAYASAN PELAYANAN KESEHATAN ABDUL RADJAK
                            <?= $unit['NamaPerusahaan']; ?><br>
                        </h4>
                    </div>
                    <div class="col-md-2"></div>
                </div>
                <div class="row">
                    <div class="col-md-1"></div>
                    <div class="col-md-10">
                        <hr>
                    </div>
                    <div class="col-md-1"></div>
                </div>

                <?php
                if ($cekform > 0) {
                    $url = base_url('form/updateKomunikasiEdukasi/' . $cases['Case ID']);
                } else {
                    $url = base_url('form/prosesKomunikasiEdukasi/' . $cases['Case ID']);
                }
                ?>

                <form action="<?= $url; ?>" method="post">
                    <div class="row">
                        <div class="col-md-1"></div>
                        <div class="col-md-10">

                            <div class="row">
                                <div class="col-md-6"><b>Nama Pasien : <input readonly type="text" name="nama" value="<?= $cases['Description']; ?>"></b></div>
                                <div class="col-md-6"><b>No.RM : <input readonly type="text" name="norm" value="<?= $cases['PatientCode']; ?>"></b></div>
                            </div>

                            <table class="table table-bordered table-striped" style="margin-top: 20px;">
                                <tr>
                                    <th width="25%">Materi Edukasi</th>
                                    <th width="15%">Tanggal</th>
                                    <th width="20%">Metode</th>
                                    <th width="20%">Evaluasi</th>
                                    <th width="10%">Paraf / Nama Edukator</th>
                                    <th width="10%">Paraf / Nama Pasien / Keluarga</th>
                                </tr>
                                <tr>
                                    <td>
                                        Dokter ... <br>
                                        <ol type="a">
                                            <li>
                                                Penjelasan penyakit, penyebab, tanda, gejala dan diagnose
                                            </li>
                                            <li>
                                                Hasil pemeriksaan
                                            </li>
                                            <li>
                                                Tindakan medis
                                            </li>
                                            <li>
                                                Perkiraan Hari Rawat
                                            </li>
                                            <li>
                                                Penjelasan komplikasi
                                            </li>
                                            <li>
                                                Rencana asuhan
                                            </li>
                                        </ol>
                                    </td>
                                    <td>
                                        <input type="date" name="tanggal1" class="form-control" value="<?= $form['tanggal1']; ?>">
                                    </td>
                                    <td>
                                        <input type="text" name="metode1" class="form-control" value="<?= $form['metode1']; ?>">
                                    </td>
                                    <td>
                                        <input type="checkbox" name="mengerti1" id="1"> <label for="1" style="font-weight: normal;">Sudah mengerti</label> <br>
                                        <input type="checkbox" name="ulang1" id="2"> <label for="2" style="font-weight: normal;">Edukasi ulang</label> <br>
                                    </td>
                                    <td>
                                        <button type="button" style="width: 100%;" class="btn btn-sm btn-default">
                                            <i class="fa fa-pencil fa-fw"></i> Paraf
                                        </button>
                                    </td>
                                    <td>
                                        <button type="button" style="width: 100%;" class="btn btn-sm btn-default">
                                            <i class="fa fa-pencil fa-fw"></i> Paraf
                                        </button>
                                    </td>
                                </tr>
                                <tr>
                                    <td>
                                        Farmasi <br>
                                        <ol type="a">
                                            <li>
                                                Nama obat dan kegunaan
                                            </li>
                                            <li>
                                                Aturan pemakaian dan dosis
                                            </li>
                                            <li>
                                                Jumlah yang diberikan
                                            </li>
                                            <li>
                                                Cara penyimpanan obat
                                            </li>
                                            <li>
                                                Efek samping obat
                                            </li>
                                            <li>
                                                Kontraindaksi obat
                                            </li>
                                        </ol>
                                    </td>
                                    <td>
                                        <input type="date" name="tanggal2" class="form-control" value="<?= $form['tanggal2']; ?>">
                                    </td>
                                    <td>
                                        <input type="text" name="metode2" class="form-control" value="<?= $form['metode2']; ?>">
                                    </td>
                                    <td>
                                        <input type="checkbox" name="mengerti2" id="3"> <label for="3" style="font-weight: normal;">Sudah mengerti</label> <br>
                                        <input type="checkbox" name="ulang2" id="4"> <label for="4" style="font-weight: normal;">Edukasi ulang</label> <br>
                                    </td>
                                    <td>
                                        <button type="button" style="width: 100%;" class="btn btn-sm btn-default">
                                            <i class="fa fa-pencil fa-fw"></i> Paraf
                                        </button>
                                    </td>
                                    <td>
                                        <button type="button" style="width: 100%;" class="btn btn-sm btn-default">
                                            <i class="fa fa-pencil fa-fw"></i> Paraf
                                        </button>
                                    </td>
                                </tr>
                                <tr>
                                    <td>
                                        Perawat <br>
                                        <ol type="a">
                                            <li>
                                                Rencana asuhan dan perawatan
                                            </li>
                                            <li>
                                                Cara perawatan di rumah
                                            </li>
                                            <li>
                                                Perawatan luka
                                            </li>
                                            <li>
                                                Alat yang perlu disiapkan di rumah
                                            </li>
                                            <li>
                                                Keamanan penggunaan alkes
                                            </li>
                                            <li>
                                                Keamanan lingkunan perawatan di rumah
                                            </li>
                                            <li>
                                                Lain-lain <br>
                                                <textarea name="lainlain2" placeholder="...." class="form-control"><?= $form['lainlain2']; ?></textarea>
                                            </li>
                                        </ol>
                                    </td>
                                    <td>
                                        <input type="date" name="tanggal3" class="form-control" value="<?= $form['tanggal3']; ?>">
                                    </td>
                                    <td>
                                        <input type="text" name="metode3" class="form-control" value="<?= $form['metode3']; ?>">
                                    </td>
                                    <td>
                                        <input type="checkbox" name="mengerti3" id="5"> <label for="5" style="font-weight: normal;">Sudah mengerti</label> <br>
                                        <input type="checkbox" name="ulang3" id="6"> <label for="6" style="font-weight: normal;">Edukasi ulang</label> <br>
                                    </td>
                                    <td>
                                        <button type="button" style="width: 100%;" class="btn btn-sm btn-default">
                                            <i class="fa fa-pencil fa-fw"></i> Paraf
                                        </button>
                                    </td>
                                    <td>
                                        <button type="button" style="width: 100%;" class="btn btn-sm btn-default">
                                            <i class="fa fa-pencil fa-fw"></i> Paraf
                                        </button>
                                    </td>
                                </tr>
                            </table>
                            <button style="width: 100%;" type="submit" class="btn btn-sm btn-primary"><i class="fa fa-fw fa-save"></i> Simpan</button>
                        </div>
                        <div class="col-md-1"></div>
                    </div>
                </form>
            </div>
        </div>
    </section>
</div>