@section('optional_css') @endsection @section('optional_js') @endsection

{{ __('Pasien') }}

@if(session('success')) {{ session('success') }} @endif
{{ __('Edit') }} {{ __('Pasien') }} @csrf @method('PUT')

Identitas

{{ __('Jenis Identitas') }} *
@if ($errors->has('jenis_identitas')) {{ $errors->first('jenis_identitas') }} @endif
{{ __('Nomor Identitas') }} *
@if ($errors->has('nomor_identitas')) {{ $errors->first('nomor_identitas') }} @endif
{{ __('Foto Identitas') }} *
@if(!empty($patient->foto_identitas)) @else @endif
Select Image Remove

Upload image if edit image

{{ __('Nama lengkap') }} *
@if ($errors->has('nama_lengkap')) {{ $errors->first('nama_lengkap') }} @endif
{{ __('Foto Pasien') }}
@if(!empty($patient->foto_pasien)) @else @endif
Select Image Remove

Upload image if edit image

{{ __('Ibu Kandung') }}
@if ($errors->has('ibu_kandung')) {{ $errors->first('ibu_kandung') }} @endif

Info Pasien

{{ __('Nomor Telepon') }} *
@if ($errors->has('nomor_telepon')) {{ $errors->first('nomor_telepon') }} @endif
{{ __('Email') }}
@if ($errors->has('email')) {{ $errors->first('email') }} @endif
{{ __('Agama') }}
@if ($errors->has('agama')) {{ $errors->first('agama') }} @endif
{{ __('Jenis Kelamin') }}
@if ($errors->has('jenis_kelamin')) {{ $errors->first('jenis_kelamin') }} @endif
{{ __('Tanggal Lahir') }}
@if ($errors->has('tanggal_lahir')) {{ $errors->first('tanggal_lahir') }} @endif
{{ __('Tempat Lahir') }}
@if ($errors->has('tempat_lahir')) {{ $errors->first('tempat_lahir') }} @endif
{{ __('keterangan') }}
@if ($errors->has('keterangan')) {{ $errors->first('keterangan') }} @endif

Alamat

{{ __('Negara Asal') }} *
@if ($errors->has('negara_asal')) {{ $errors->first('negara_asal') }} @endif
{{ __('Alamat') }} *
@if ($errors->has('alamat')) {{ $errors->first('alamat') }} @endif
{{ __('Kelurahan') }}
@if ($errors->has('kelurahan')) {{ $errors->first('kelurahan') }} @endif
{{ __('Kecamatan') }}
@if ($errors->has('kecamatan')) {{ $errors->first('kecamatan') }} @endif
{{ __('Kota') }}
@if ($errors->has('kota')) {{ $errors->first('kota') }} @endif
{{ __('RT') }}
@if ($errors->has('rt')) {{ $errors->first('rt') }} @endif
{{ __('RW') }}
@if ($errors->has('rw')) {{ $errors->first('rw') }} @endif
{{ __('Save') }}