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

{{ __('Pasien') }}

{{ __('Create') }} {{ __('Pasien') }} @csrf

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') }} *
Select Image Remove

Upload image if add image

{{ __('Nama Lengkap Sesuai KTP') }} *
@if ($errors->has('nama_lengkap')) {{ $errors->first('nama_lengkap') }} @endif
{{ __('Foto Pasien') }} *
Select Image Remove

Upload image if add image

Info Pasien

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

Alamat

{{ __('Negara Asal') }} *
@if ($errors->has('negara_asal')) {{ $errors->first('negara_asal') }} @endif
{{ __('Alamat Domisili') }} *
@if ($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') }}