@extends('layouts.template')

@section('title')
Cari Data File Keluar | SIMRS
@endsection

@section('pagetitle')
Cari Data File Keluar
@endsection

@section('breadcumb')
<nav aria-label="breadcrumb" role="navigation" class="breadcrumb">
    <ol class="breadcrumb">
        <li class="breadcrumb-item"><a href="#">Beranda</a></li>
        <li class="breadcrumb-item"><a href="#">Rekam Medis</a></li>
        <li class="breadcrumb-item active" aria-current="page">Cari Data File Keluar</li>
    </ol>
</nav>
@endsection

@section('content')
<div class="container-fluid">
    <div class="row">
        <div class="col-md-4">
            <h4 class="title">Cari Data File Keluar </h4>
            <!-- <p class="category">A powerful jQuery plugin handcrafted by our friends from <a href="https://datatables.net/" target="_blank">dataTables.net</a>. It is a highly flexible tool, based upon the foundations of progressive enhancement and will add advanced interaction controls to any HTML table. Please check out the <a href="https://datatables.net/manual/index" target="_blank">full documentation.</a></p> -->
            <div class="card">
                <form id="allInputsFormValidation" class="form-horizontal" action="" method="post" novalidate="">
                    <div class="card-content">
                        <h4 class="card-title">Pencarian Pasien</h4>
                        <fieldset>
                            <div class="form-group">
                                <label class="col-sm-6 control-label">
                                    No. Rekam Medis
                                </label>
                                <div class="col-sm-6">
                                    <input class="form-control" type="text" name="required" required="required" />
                                </div>
                            </div>
                        </fieldset>

                        <fieldset>
                            <div class="form-group">
                                <label class="col-sm-6 control-label">
                                    Nama
                                </label>
                                <div class="col-sm-6">
                                    <input class="form-control" type="text" name="email" email="true" />
                                </div>
                            </div>
                        </fieldset>

                        <fieldset>
                            <div class="form-group">
                                <label class="col-sm-6 control-label">
                                    Tanggal Lahir
                                </label>
                                <div class="col-sm-6">
                                    <input class="form-control" type="text" name="number" number="true" />
                                </div>
                            </div>
                        </fieldset>
                    </div>
                </form> <!-- turunkan ke bawah card-footer jika data sudah ada -->
                    <div class="card-footer text-center">
                        <a href="{{ route('hpfk') }}">
                        <button type="submit" class="btn btn-info btn-fill">Cari</button>
                        </a>
                        <button type="submit" class="btn btn-danger btn-fill">Batal</button>
                    </div>
            </div><!--  end card  -->
        </div> <!-- end col-md-12 -->
    </div> <!-- end row -->
</div>

@endsection

@section('script')
<!-- jika ada script tambahan letakkan disini -->
@endsection