diff --git a/assets/hanan/fisik-2.html b/assets/hanan/fisik-2.html
index 30813c0..851f01e 100644
--- a/assets/hanan/fisik-2.html
+++ b/assets/hanan/fisik-2.html
@@ -230,18 +230,6 @@
         justify-content: center;
         flex: 1;
       }
-
-      .label-keterangan {
-        display: flex;
-        width: 40px;
-        padding: 4px 12px;
-        flex-direction: column;
-        justify-content: center;
-        align-items: center;
-        gap: 10px;
-        border-radius: 4px;
-        background-color: #f5f8fa;
-      }
     </style>
   </head>
 
@@ -1388,7 +1376,12 @@
               </span>
               <div class="card-label pl-4">VISUS JAUH</div>
               <div>
-                <a href="#" class="btn btn-secondary btn-sm">
+                <a
+                  class="btn btn-secondary btn-sm"
+                  onclick="resetSubForm('accordionVisusJauh')"
+                  data-toggle="collapse"
+                  data-target="#collapseVJ"
+                >
                   <i class="ki ki-bold-close icon-md"></i> TIDAK ADA RIWAYAT
                   PENYAKIT
                 </a>
@@ -1843,7 +1836,12 @@
               </span>
               <div class="card-label pl-4">GIGI</div>
               <div>
-                <a href="#" class="btn btn-secondary btn-sm">
+                <a
+                  class="btn btn-secondary btn-sm"
+                  onclick="resetSubForm('accordionGigi')"
+                  data-toggle="collapse"
+                  data-target="#collapseGigi"
+                >
                   <i class="ki ki-bold-close icon-md"></i> TIDAK DIPERIKSA
                 </a>
               </div>
@@ -2064,10 +2062,2182 @@
               <div class="row mt-4 align-items-start font-weight-bold">
                 KETERANGAN KODE :
               </div>
-              <div class="row mt-4">
-                <div class="label-gigi col-3">
-                  <div class="label-keterangan">X</div>
-                  <div>Berlubang</div>
+              <div class="container p-0">
+                <div class="row">
+                  <div class="col-3 mt-4 pl-0">
+                    <span
+                      class="label label-xl font-weight-bolder label-rounded"
+                      >X</span
+                    >
+                    Berlubang
+                  </div>
+                  <div class="col-3 mt-4 pl-0">
+                    <span
+                      class="label label-xl font-weight-bolder label-rounded"
+                      >C</span
+                    >
+                    Tambalan
+                  </div>
+                  <div class="col-3 mt-4 pl-0">
+                    <span
+                      class="label label-xl font-weight-bolder label-rounded"
+                      >O</span
+                    >
+                    Tanggal
+                  </div>
+                  <div class="col-3 mt-4 pl-0">
+                    <span
+                      class="label label-xl font-weight-bolder label-rounded"
+                      >R</span
+                    >
+                    Sisa akar
+                  </div>
+                  <div class="col-3 mt-4 pl-0">
+                    <span
+                      class="label label-xl font-weight-bolder label-rounded"
+                      >A</span
+                    >
+                    Gigi Palsu
+                  </div>
+                  <div class="col-3 mt-4 pl-0">
+                    <span
+                      class="label label-xl font-weight-bolder label-rounded"
+                      >K</span
+                    >
+                    Karang Gigi
+                  </div>
+                  <div class="col-3 mt-4 pl-0">
+                    <span
+                      class="label label-xl font-weight-bolder label-rounded"
+                      >I</span
+                    >
+                    Impaksi
+                  </div>
+                </div>
+              </div>
+            </div>
+          </div>
+        </div>
+      </div>
+      <!-- end gigi -->
+
+      <!-- MULUT -->
+      <div
+        class="accordion accordion-light accordion-light-borderless accordion-svg-toggle"
+        id="accordionMulut"
+      >
+        <div class="card mt-5">
+          <div class="card-header" id="headingMulut">
+            <div
+              class="card-title"
+              data-toggle="collapse"
+              data-target="#collapseMulut"
+            >
+              <span class="svg-icon svg-icon-primary">
+                <svg
+                  xmlns="http://www.w3.org/2000/svg"
+                  xmlns:xlink="http://www.w3.org/1999/xlink"
+                  width="24px"
+                  height="24px"
+                  viewBox="0 0 24 24"
+                  version="1.1"
+                >
+                  <g
+                    stroke="none"
+                    stroke-width="1"
+                    fill="none"
+                    fill-rule="evenodd"
+                  >
+                    <polygon points="0 0 24 0 24 24 0 24"></polygon>
+                    <path
+                      d="M12.2928955,6.70710318 C11.9023712,6.31657888 11.9023712,5.68341391 12.2928955,5.29288961 C12.6834198,4.90236532 13.3165848,4.90236532 13.7071091,5.29288961 L19.7071091,11.2928896 C20.085688,11.6714686 20.0989336,12.281055 19.7371564,12.675721 L14.2371564,18.675721 C13.863964,19.08284 13.2313966,19.1103429 12.8242777,18.7371505 C12.4171587,18.3639581 12.3896557,17.7313908 12.7628481,17.3242718 L17.6158645,12.0300721 L12.2928955,6.70710318 Z"
+                      fill="#000000"
+                      fill-rule="nonzero"
+                    ></path>
+                    <!-- <path
+                    d="M3.70710678,15.7071068 C3.31658249,16.0976311 2.68341751,16.0976311 2.29289322,15.7071068 C1.90236893,15.3165825 1.90236893,14.6834175 2.29289322,14.2928932 L8.29289322,8.29289322 C8.67147216,7.91431428 9.28105859,7.90106866 9.67572463,8.26284586 L15.6757246,13.7628459 C16.0828436,14.1360383 16.1103465,14.7686056 15.7371541,15.1757246 C15.3639617,15.5828436 14.7313944,15.6103465 14.3242754,15.2371541 L9.03007575,10.3841378 L3.70710678,15.7071068 Z"
+                    fill="#000000"
+                    fill-rule="nonzero"
+                    opacity="0.3"
+                    transform="translate(9.000003, 11.999999) rotate(-270.000000) translate(-9.000003, -11.999999) "
+                  ></path> -->
+                  </g>
+                </svg>
+              </span>
+              <div class="card-label pl-4 font-size-h4 font-weight-bold">
+                MULUT
+              </div>
+            </div>
+          </div>
+          <div
+            id="collapseMulut"
+            class="collapse show"
+            data-parent="#accordionMulut"
+          >
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Mukosa rongga mulut</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tidak Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Tenggorokan</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Hiperemis
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+
+              <div class="row">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tonsil hipertrofi
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Deviasi Uvula
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+
+              <div class="row">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Lain-lain
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+          </div>
+        </div>
+      </div>
+      <!-- end MULUT -->
+      <!-- LEHER -->
+      <div
+        class="accordion accordion-light accordion-light-borderless accordion-svg-toggle"
+        id="accordionLeher"
+      >
+        <div class="card mt-5">
+          <div class="card-header" id="headingLeher">
+            <div
+              class="card-title"
+              data-toggle="collapse"
+              data-target="#collapseLeher"
+            >
+              <span class="svg-icon svg-icon-primary">
+                <svg
+                  xmlns="http://www.w3.org/2000/svg"
+                  xmlns:xlink="http://www.w3.org/1999/xlink"
+                  width="24px"
+                  height="24px"
+                  viewBox="0 0 24 24"
+                  version="1.1"
+                >
+                  <g
+                    stroke="none"
+                    stroke-width="1"
+                    fill="none"
+                    fill-rule="evenodd"
+                  >
+                    <polygon points="0 0 24 0 24 24 0 24"></polygon>
+                    <path
+                      d="M12.2928955,6.70710318 C11.9023712,6.31657888 11.9023712,5.68341391 12.2928955,5.29288961 C12.6834198,4.90236532 13.3165848,4.90236532 13.7071091,5.29288961 L19.7071091,11.2928896 C20.085688,11.6714686 20.0989336,12.281055 19.7371564,12.675721 L14.2371564,18.675721 C13.863964,19.08284 13.2313966,19.1103429 12.8242777,18.7371505 C12.4171587,18.3639581 12.3896557,17.7313908 12.7628481,17.3242718 L17.6158645,12.0300721 L12.2928955,6.70710318 Z"
+                      fill="#000000"
+                      fill-rule="nonzero"
+                    ></path>
+                    <!-- <path
+                    d="M3.70710678,15.7071068 C3.31658249,16.0976311 2.68341751,16.0976311 2.29289322,15.7071068 C1.90236893,15.3165825 1.90236893,14.6834175 2.29289322,14.2928932 L8.29289322,8.29289322 C8.67147216,7.91431428 9.28105859,7.90106866 9.67572463,8.26284586 L15.6757246,13.7628459 C16.0828436,14.1360383 16.1103465,14.7686056 15.7371541,15.1757246 C15.3639617,15.5828436 14.7313944,15.6103465 14.3242754,15.2371541 L9.03007575,10.3841378 L3.70710678,15.7071068 Z"
+                    fill="#000000"
+                    fill-rule="nonzero"
+                    opacity="0.3"
+                    transform="translate(9.000003, 11.999999) rotate(-270.000000) translate(-9.000003, -11.999999) "
+                  ></path> -->
+                  </g>
+                </svg>
+              </span>
+              <div class="card-label pl-4 font-size-h4 font-weight-bold">
+                LEHER
+              </div>
+            </div>
+          </div>
+          <div
+            id="collapseLeher"
+            class="collapse show"
+            data-parent="#accordionLeher"
+          >
+            <div class="card-body px-12">
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Obat anti hypertensi
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+
+              <div class="row">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Pembesaran tiroid
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Statins
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+
+              <div class="row">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        JVP Meningkat
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        NSAIDs
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+          </div>
+        </div>
+      </div>
+      <!-- end LEHER -->
+      <!-- THORAX/DADA -->
+      <div
+        class="accordion accordion-light accordion-light-borderless accordion-svg-toggle"
+        id="accordionThorax"
+      >
+        <div class="card mt-5">
+          <div class="card-header" id="headingThorax">
+            <div
+              class="card-title"
+              data-toggle="collapse"
+              data-target="#collapseThorax"
+            >
+              <span class="svg-icon svg-icon-primary">
+                <svg
+                  xmlns="http://www.w3.org/2000/svg"
+                  xmlns:xlink="http://www.w3.org/1999/xlink"
+                  width="24px"
+                  height="24px"
+                  viewBox="0 0 24 24"
+                  version="1.1"
+                >
+                  <g
+                    stroke="none"
+                    stroke-width="1"
+                    fill="none"
+                    fill-rule="evenodd"
+                  >
+                    <polygon points="0 0 24 0 24 24 0 24"></polygon>
+                    <path
+                      d="M12.2928955,6.70710318 C11.9023712,6.31657888 11.9023712,5.68341391 12.2928955,5.29288961 C12.6834198,4.90236532 13.3165848,4.90236532 13.7071091,5.29288961 L19.7071091,11.2928896 C20.085688,11.6714686 20.0989336,12.281055 19.7371564,12.675721 L14.2371564,18.675721 C13.863964,19.08284 13.2313966,19.1103429 12.8242777,18.7371505 C12.4171587,18.3639581 12.3896557,17.7313908 12.7628481,17.3242718 L17.6158645,12.0300721 L12.2928955,6.70710318 Z"
+                      fill="#000000"
+                      fill-rule="nonzero"
+                    ></path>
+                    <!-- <path
+                    d="M3.70710678,15.7071068 C3.31658249,16.0976311 2.68341751,16.0976311 2.29289322,15.7071068 C1.90236893,15.3165825 1.90236893,14.6834175 2.29289322,14.2928932 L8.29289322,8.29289322 C8.67147216,7.91431428 9.28105859,7.90106866 9.67572463,8.26284586 L15.6757246,13.7628459 C16.0828436,14.1360383 16.1103465,14.7686056 15.7371541,15.1757246 C15.3639617,15.5828436 14.7313944,15.6103465 14.3242754,15.2371541 L9.03007575,10.3841378 L3.70710678,15.7071068 Z"
+                    fill="#000000"
+                    fill-rule="nonzero"
+                    opacity="0.3"
+                    transform="translate(9.000003, 11.999999) rotate(-270.000000) translate(-9.000003, -11.999999) "
+                  ></path> -->
+                  </g>
+                </svg>
+              </span>
+              <div class="card-label pl-4 font-size-h4 font-weight-bold">
+                THORAX/DADA
+              </div>
+            </div>
+          </div>
+          <div
+            id="collapseThorax"
+            class="collapse show"
+            data-parent="#accordionThorax"
+          >
+            <div class="card-body px-12">
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Deformitas
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+
+              <div class="row">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tumor mammae
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Gineko mastia
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+
+              <div class="row">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Lain-lain
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+          </div>
+        </div>
+      </div>
+      <!-- end THORAX/DADA -->
+      <!-- Paru-Paru -->
+      <div
+        class="accordion accordion-light accordion-light-borderless accordion-svg-toggle"
+        id="accordionParu"
+      >
+        <div class="card mt-5">
+          <div class="card-header" id="headingParu">
+            <div
+              class="card-title"
+              data-toggle="collapse"
+              data-target="#collapseParu"
+            >
+              <span class="svg-icon svg-icon-primary">
+                <svg
+                  xmlns="http://www.w3.org/2000/svg"
+                  xmlns:xlink="http://www.w3.org/1999/xlink"
+                  width="24px"
+                  height="24px"
+                  viewBox="0 0 24 24"
+                  version="1.1"
+                >
+                  <g
+                    stroke="none"
+                    stroke-width="1"
+                    fill="none"
+                    fill-rule="evenodd"
+                  >
+                    <polygon points="0 0 24 0 24 24 0 24"></polygon>
+                    <path
+                      d="M12.2928955,6.70710318 C11.9023712,6.31657888 11.9023712,5.68341391 12.2928955,5.29288961 C12.6834198,4.90236532 13.3165848,4.90236532 13.7071091,5.29288961 L19.7071091,11.2928896 C20.085688,11.6714686 20.0989336,12.281055 19.7371564,12.675721 L14.2371564,18.675721 C13.863964,19.08284 13.2313966,19.1103429 12.8242777,18.7371505 C12.4171587,18.3639581 12.3896557,17.7313908 12.7628481,17.3242718 L17.6158645,12.0300721 L12.2928955,6.70710318 Z"
+                      fill="#000000"
+                      fill-rule="nonzero"
+                    ></path>
+                    <!-- <path
+                    d="M3.70710678,15.7071068 C3.31658249,16.0976311 2.68341751,16.0976311 2.29289322,15.7071068 C1.90236893,15.3165825 1.90236893,14.6834175 2.29289322,14.2928932 L8.29289322,8.29289322 C8.67147216,7.91431428 9.28105859,7.90106866 9.67572463,8.26284586 L15.6757246,13.7628459 C16.0828436,14.1360383 16.1103465,14.7686056 15.7371541,15.1757246 C15.3639617,15.5828436 14.7313944,15.6103465 14.3242754,15.2371541 L9.03007575,10.3841378 L3.70710678,15.7071068 Z"
+                    fill="#000000"
+                    fill-rule="nonzero"
+                    opacity="0.3"
+                    transform="translate(9.000003, 11.999999) rotate(-270.000000) translate(-9.000003, -11.999999) "
+                  ></path> -->
+                  </g>
+                </svg>
+              </span>
+              <div class="card-label pl-4 font-size-h4 font-weight-bold">
+                Paru-paru
+              </div>
+            </div>
+          </div>
+          <div
+            id="collapseParu"
+            class="collapse show"
+            data-parent="#accordionParu"
+          >
+            <div class="card-body px-12">
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Gerak asimetris
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+
+              <div class="row">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Perkusi abnormal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Suara nafas tambahan
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+
+              <div class="row">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Lain-lain
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+          </div>
+        </div>
+      </div>
+      <!-- end Paru-Paru -->
+      <!-- Jantung -->
+      <div
+        class="accordion accordion-light accordion-light-borderless accordion-svg-toggle"
+        id="accordionJantung"
+      >
+        <div class="card mt-5">
+          <div class="card-header" id="headingJantung">
+            <div
+              class="card-title"
+              data-toggle="collapse"
+              data-target="#collapseJantung"
+            >
+              <span class="svg-icon svg-icon-primary">
+                <svg
+                  xmlns="http://www.w3.org/2000/svg"
+                  xmlns:xlink="http://www.w3.org/1999/xlink"
+                  width="24px"
+                  height="24px"
+                  viewBox="0 0 24 24"
+                  version="1.1"
+                >
+                  <g
+                    stroke="none"
+                    stroke-width="1"
+                    fill="none"
+                    fill-rule="evenodd"
+                  >
+                    <polygon points="0 0 24 0 24 24 0 24"></polygon>
+                    <path
+                      d="M12.2928955,6.70710318 C11.9023712,6.31657888 11.9023712,5.68341391 12.2928955,5.29288961 C12.6834198,4.90236532 13.3165848,4.90236532 13.7071091,5.29288961 L19.7071091,11.2928896 C20.085688,11.6714686 20.0989336,12.281055 19.7371564,12.675721 L14.2371564,18.675721 C13.863964,19.08284 13.2313966,19.1103429 12.8242777,18.7371505 C12.4171587,18.3639581 12.3896557,17.7313908 12.7628481,17.3242718 L17.6158645,12.0300721 L12.2928955,6.70710318 Z"
+                      fill="#000000"
+                      fill-rule="nonzero"
+                    ></path>
+                    <!-- <path
+                  d="M3.70710678,15.7071068 C3.31658249,16.0976311 2.68341751,16.0976311 2.29289322,15.7071068 C1.90236893,15.3165825 1.90236893,14.6834175 2.29289322,14.2928932 L8.29289322,8.29289322 C8.67147216,7.91431428 9.28105859,7.90106866 9.67572463,8.26284586 L15.6757246,13.7628459 C16.0828436,14.1360383 16.1103465,14.7686056 15.7371541,15.1757246 C15.3639617,15.5828436 14.7313944,15.6103465 14.3242754,15.2371541 L9.03007575,10.3841378 L3.70710678,15.7071068 Z"
+                  fill="#000000"
+                  fill-rule="nonzero"
+                  opacity="0.3"
+                  transform="translate(9.000003, 11.999999) rotate(-270.000000) translate(-9.000003, -11.999999) "
+                ></path> -->
+                  </g>
+                </svg>
+              </span>
+              <div class="card-label pl-4 font-size-h4 font-weight-bold">
+                JANTUNG
+              </div>
+            </div>
+          </div>
+          <div
+            id="collapseJantung"
+            class="collapse show"
+            data-parent="#accordionJantung"
+          >
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">JVP</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tidak Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Apex</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tidak Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Suara Jantung</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tidak Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Bising Jantung/Murmur</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tidak Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+          </div>
+        </div>
+      </div>
+      <!-- end Jantung -->
+      <!-- Perut/ Abdomen -->
+      <div
+        class="accordion accordion-light accordion-light-borderless accordion-svg-toggle"
+        id="accordionPerut"
+      >
+        <div class="card mt-5">
+          <div class="card-header" id="headingPerut">
+            <div
+              class="card-title"
+              data-toggle="collapse"
+              data-target="#collapsePerut"
+            >
+              <span class="svg-icon svg-icon-primary">
+                <svg
+                  xmlns="http://www.w3.org/2000/svg"
+                  xmlns:xlink="http://www.w3.org/1999/xlink"
+                  width="24px"
+                  height="24px"
+                  viewBox="0 0 24 24"
+                  version="1.1"
+                >
+                  <g
+                    stroke="none"
+                    stroke-width="1"
+                    fill="none"
+                    fill-rule="evenodd"
+                  >
+                    <polygon points="0 0 24 0 24 24 0 24"></polygon>
+                    <path
+                      d="M12.2928955,6.70710318 C11.9023712,6.31657888 11.9023712,5.68341391 12.2928955,5.29288961 C12.6834198,4.90236532 13.3165848,4.90236532 13.7071091,5.29288961 L19.7071091,11.2928896 C20.085688,11.6714686 20.0989336,12.281055 19.7371564,12.675721 L14.2371564,18.675721 C13.863964,19.08284 13.2313966,19.1103429 12.8242777,18.7371505 C12.4171587,18.3639581 12.3896557,17.7313908 12.7628481,17.3242718 L17.6158645,12.0300721 L12.2928955,6.70710318 Z"
+                      fill="#000000"
+                      fill-rule="nonzero"
+                    ></path>
+                    <!-- <path
+                  d="M3.70710678,15.7071068 C3.31658249,16.0976311 2.68341751,16.0976311 2.29289322,15.7071068 C1.90236893,15.3165825 1.90236893,14.6834175 2.29289322,14.2928932 L8.29289322,8.29289322 C8.67147216,7.91431428 9.28105859,7.90106866 9.67572463,8.26284586 L15.6757246,13.7628459 C16.0828436,14.1360383 16.1103465,14.7686056 15.7371541,15.1757246 C15.3639617,15.5828436 14.7313944,15.6103465 14.3242754,15.2371541 L9.03007575,10.3841378 L3.70710678,15.7071068 Z"
+                  fill="#000000"
+                  fill-rule="nonzero"
+                  opacity="0.3"
+                  transform="translate(9.000003, 11.999999) rotate(-270.000000) translate(-9.000003, -11.999999) "
+                ></path> -->
+                  </g>
+                </svg>
+              </span>
+              <div class="card-label pl-4 font-size-h4 font-weight-bold">
+                PERUT/ ABDOMEN
+              </div>
+            </div>
+          </div>
+          <div
+            id="collapsePerut"
+            class="collapse show"
+            data-parent="#accordionPerut"
+          >
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Abdomen</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Nyeri tekan
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Nyeri ketok ginjal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Shifting Dulness
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Lain-lain
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Bising usus</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tidak Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Hati</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tidak Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Limpa</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tidak Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Hernia</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tidak Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+          </div>
+        </div>
+      </div>
+      <!-- end Perut/ Abdomen -->
+
+      <!-- Genitourinaria -->
+      <div
+        class="accordion accordion-light accordion-light-borderless accordion-svg-toggle"
+        id="accordionGenitourinaria"
+      >
+        <div class="card mt-5">
+          <div class="card-header" id="headingGenitourinaria">
+            <div
+              class="card-title"
+              data-toggle="collapse"
+              data-target="#collapseGenitourinaria"
+            >
+              <span class="svg-icon svg-icon-primary">
+                <svg
+                  xmlns="http://www.w3.org/2000/svg"
+                  xmlns:xlink="http://www.w3.org/1999/xlink"
+                  width="24px"
+                  height="24px"
+                  viewBox="0 0 24 24"
+                  version="1.1"
+                >
+                  <g
+                    stroke="none"
+                    stroke-width="1"
+                    fill="none"
+                    fill-rule="evenodd"
+                  >
+                    <polygon points="0 0 24 0 24 24 0 24"></polygon>
+                    <path
+                      d="M12.2928955,6.70710318 C11.9023712,6.31657888 11.9023712,5.68341391 12.2928955,5.29288961 C12.6834198,4.90236532 13.3165848,4.90236532 13.7071091,5.29288961 L19.7071091,11.2928896 C20.085688,11.6714686 20.0989336,12.281055 19.7371564,12.675721 L14.2371564,18.675721 C13.863964,19.08284 13.2313966,19.1103429 12.8242777,18.7371505 C12.4171587,18.3639581 12.3896557,17.7313908 12.7628481,17.3242718 L17.6158645,12.0300721 L12.2928955,6.70710318 Z"
+                      fill="#000000"
+                      fill-rule="nonzero"
+                    ></path>
+                    <!-- <path
+                    d="M3.70710678,15.7071068 C3.31658249,16.0976311 2.68341751,16.0976311 2.29289322,15.7071068 C1.90236893,15.3165825 1.90236893,14.6834175 2.29289322,14.2928932 L8.29289322,8.29289322 C8.67147216,7.91431428 9.28105859,7.90106866 9.67572463,8.26284586 L15.6757246,13.7628459 C16.0828436,14.1360383 16.1103465,14.7686056 15.7371541,15.1757246 C15.3639617,15.5828436 14.7313944,15.6103465 14.3242754,15.2371541 L9.03007575,10.3841378 L3.70710678,15.7071068 Z"
+                    fill="#000000"
+                    fill-rule="nonzero"
+                    opacity="0.3"
+                    transform="translate(9.000003, 11.999999) rotate(-270.000000) translate(-9.000003, -11.999999) "
+                  ></path> -->
+                  </g>
+                </svg>
+              </span>
+              <div class="card-label pl-4 font-size-h4 font-weight-bold">
+                GENITOURINARIA
+              </div>
+            </div>
+          </div>
+          <div
+            id="collapseGenitourinaria"
+            class="collapse show"
+            data-parent="#accordionGenitourinaria"
+          >
+            <div class="card-body px-12">
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tidak diperiksa
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+
+              <div class="row">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Retensi Urin
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tanda infeksi
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+
+              <div class="row">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Lain-lain
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+          </div>
+        </div>
+      </div>
+      <!-- end Genitourinaria -->
+
+      <!-- Anggota Gerak -->
+      <div
+        class="accordion accordion-light accordion-light-borderless accordion-svg-toggle"
+        id="accordionAnggotaGerak"
+      >
+        <div class="card mt-5">
+          <div class="card-header" id="headingAnggotaGerak">
+            <div
+              class="card-title"
+              data-toggle="collapse"
+              data-target="#collapseAnggotaGerak"
+            >
+              <span class="svg-icon svg-icon-primary">
+                <svg
+                  xmlns="http://www.w3.org/2000/svg"
+                  xmlns:xlink="http://www.w3.org/1999/xlink"
+                  width="24px"
+                  height="24px"
+                  viewBox="0 0 24 24"
+                  version="1.1"
+                >
+                  <g
+                    stroke="none"
+                    stroke-width="1"
+                    fill="none"
+                    fill-rule="evenodd"
+                  >
+                    <polygon points="0 0 24 0 24 24 0 24"></polygon>
+                    <path
+                      d="M12.2928955,6.70710318 C11.9023712,6.31657888 11.9023712,5.68341391 12.2928955,5.29288961 C12.6834198,4.90236532 13.3165848,4.90236532 13.7071091,5.29288961 L19.7071091,11.2928896 C20.085688,11.6714686 20.0989336,12.281055 19.7371564,12.675721 L14.2371564,18.675721 C13.863964,19.08284 13.2313966,19.1103429 12.8242777,18.7371505 C12.4171587,18.3639581 12.3896557,17.7313908 12.7628481,17.3242718 L17.6158645,12.0300721 L12.2928955,6.70710318 Z"
+                      fill="#000000"
+                      fill-rule="nonzero"
+                    ></path>
+                    <!-- <path
+                  d="M3.70710678,15.7071068 C3.31658249,16.0976311 2.68341751,16.0976311 2.29289322,15.7071068 C1.90236893,15.3165825 1.90236893,14.6834175 2.29289322,14.2928932 L8.29289322,8.29289322 C8.67147216,7.91431428 9.28105859,7.90106866 9.67572463,8.26284586 L15.6757246,13.7628459 C16.0828436,14.1360383 16.1103465,14.7686056 15.7371541,15.1757246 C15.3639617,15.5828436 14.7313944,15.6103465 14.3242754,15.2371541 L9.03007575,10.3841378 L3.70710678,15.7071068 Z"
+                  fill="#000000"
+                  fill-rule="nonzero"
+                  opacity="0.3"
+                  transform="translate(9.000003, 11.999999) rotate(-270.000000) translate(-9.000003, -11.999999) "
+                ></path> -->
+                  </g>
+                </svg>
+              </span>
+              <div class="card-label pl-4 font-size-h4 font-weight-bold">
+                ANGGOTA GERAK
+              </div>
+            </div>
+          </div>
+          <div
+            id="collapseAnggotaGerak"
+            class="collapse show"
+            data-parent="#accordionAnggotaGerak"
+          >
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Ekstrimitas atas</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Deformitas
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tremor
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Oedem
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Partner eritem
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Penurunan kekuatan
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Lain-lain
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Ekstrimitas bawah</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Deformitas
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Varices
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Oedem
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Vascularisasi abnormal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Penurunan kekuatan
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Lain-lain
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Tonus/otot</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Paresis
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Paralysis
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Lain-lain
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+          </div>
+        </div>
+      </div>
+      <!-- end Anggota Gerak -->
+
+      <!-- System persyarafan -->
+      <div
+        class="accordion accordion-light accordion-light-borderless accordion-svg-toggle"
+        id="accordionSyaraf"
+      >
+        <div class="card mt-5">
+          <div class="card-header" id="headingSyaraf">
+            <div
+              class="card-title"
+              data-toggle="collapse"
+              data-target="#collapseSyaraf"
+            >
+              <span class="svg-icon svg-icon-primary">
+                <svg
+                  xmlns="http://www.w3.org/2000/svg"
+                  xmlns:xlink="http://www.w3.org/1999/xlink"
+                  width="24px"
+                  height="24px"
+                  viewBox="0 0 24 24"
+                  version="1.1"
+                >
+                  <g
+                    stroke="none"
+                    stroke-width="1"
+                    fill="none"
+                    fill-rule="evenodd"
+                  >
+                    <polygon points="0 0 24 0 24 24 0 24"></polygon>
+                    <path
+                      d="M12.2928955,6.70710318 C11.9023712,6.31657888 11.9023712,5.68341391 12.2928955,5.29288961 C12.6834198,4.90236532 13.3165848,4.90236532 13.7071091,5.29288961 L19.7071091,11.2928896 C20.085688,11.6714686 20.0989336,12.281055 19.7371564,12.675721 L14.2371564,18.675721 C13.863964,19.08284 13.2313966,19.1103429 12.8242777,18.7371505 C12.4171587,18.3639581 12.3896557,17.7313908 12.7628481,17.3242718 L17.6158645,12.0300721 L12.2928955,6.70710318 Z"
+                      fill="#000000"
+                      fill-rule="nonzero"
+                    ></path>
+                    <!-- <path
+                  d="M3.70710678,15.7071068 C3.31658249,16.0976311 2.68341751,16.0976311 2.29289322,15.7071068 C1.90236893,15.3165825 1.90236893,14.6834175 2.29289322,14.2928932 L8.29289322,8.29289322 C8.67147216,7.91431428 9.28105859,7.90106866 9.67572463,8.26284586 L15.6757246,13.7628459 C16.0828436,14.1360383 16.1103465,14.7686056 15.7371541,15.1757246 C15.3639617,15.5828436 14.7313944,15.6103465 14.3242754,15.2371541 L9.03007575,10.3841378 L3.70710678,15.7071068 Z"
+                  fill="#000000"
+                  fill-rule="nonzero"
+                  opacity="0.3"
+                  transform="translate(9.000003, 11.999999) rotate(-270.000000) translate(-9.000003, -11.999999) "
+                ></path> -->
+                  </g>
+                </svg>
+              </span>
+              <div class="card-label pl-4 font-size-h4 font-weight-bold">
+                SISTEM PERSYARAFAN
+              </div>
+            </div>
+          </div>
+          <div
+            id="collapseSyaraf"
+            class="collapse show"
+            data-parent="#accordionSyaraf"
+          >
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Refleks Fisiologis</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tidak Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Refleks Pathologis</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tidak ada
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Ada
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">
+                Keseimbangan & koordinasi
+              </div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tidak Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">
+                Refleks Neurologis Lainnya
+              </div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tidak ada
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Ada
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+              </div>
+            </div>
+          </div>
+        </div>
+      </div>
+      <!-- end System persyarafan -->
+
+      <!-- Smell Test -->
+
+      <div
+        class="accordion accordion-light accordion-light-borderless accordion-svg-toggle"
+        id="accordionSmell"
+      >
+        <div class="card mt-5">
+          <div class="card-header" id="headingSmell">
+            <div
+              class="card-title"
+              data-toggle="collapse"
+              data-target="#collapseSmell"
+            >
+              <span class="svg-icon svg-icon-primary">
+                <svg
+                  xmlns="http://www.w3.org/2000/svg"
+                  xmlns:xlink="http://www.w3.org/1999/xlink"
+                  width="24px"
+                  height="24px"
+                  viewBox="0 0 24 24"
+                  version="1.1"
+                >
+                  <g
+                    stroke="none"
+                    stroke-width="1"
+                    fill="none"
+                    fill-rule="evenodd"
+                  >
+                    <polygon points="0 0 24 0 24 24 0 24"></polygon>
+                    <path
+                      d="M12.2928955,6.70710318 C11.9023712,6.31657888 11.9023712,5.68341391 12.2928955,5.29288961 C12.6834198,4.90236532 13.3165848,4.90236532 13.7071091,5.29288961 L19.7071091,11.2928896 C20.085688,11.6714686 20.0989336,12.281055 19.7371564,12.675721 L14.2371564,18.675721 C13.863964,19.08284 13.2313966,19.1103429 12.8242777,18.7371505 C12.4171587,18.3639581 12.3896557,17.7313908 12.7628481,17.3242718 L17.6158645,12.0300721 L12.2928955,6.70710318 Z"
+                      fill="#000000"
+                      fill-rule="nonzero"
+                    ></path>
+                    <!-- <path
+                  d="M3.70710678,15.7071068 C3.31658249,16.0976311 2.68341751,16.0976311 2.29289322,15.7071068 C1.90236893,15.3165825 1.90236893,14.6834175 2.29289322,14.2928932 L8.29289322,8.29289322 C8.67147216,7.91431428 9.28105859,7.90106866 9.67572463,8.26284586 L15.6757246,13.7628459 C16.0828436,14.1360383 16.1103465,14.7686056 15.7371541,15.1757246 C15.3639617,15.5828436 14.7313944,15.6103465 14.3242754,15.2371541 L9.03007575,10.3841378 L3.70710678,15.7071068 Z"
+                  fill="#000000"
+                  fill-rule="nonzero"
+                  opacity="0.3"
+                  transform="translate(9.000003, 11.999999) rotate(-270.000000) translate(-9.000003, -11.999999) "
+                ></path> -->
+                  </g>
+                </svg>
+              </span>
+              <div class="card-label pl-4 font-size-h4 font-weight-bold">
+                SMELL TEST
+              </div>
+            </div>
+          </div>
+          <div
+            id="collapseSmell"
+            class="collapse show"
+            data-parent="#accordionSmell"
+          >
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Smell Test</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Anosmia
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Parosmia
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
                 </div>
               </div>
             </div>
@@ -2075,3679 +4245,624 @@
         </div>
       </div>
 
+      <!-- end Smell Test -->
+
+      <!-- Low back pain screning test -->
       <div
-        class="pt-10"
-        style="
-          flex-direction: column;
-          align-items: flex-start;
-          gap: 20px;
-          align-self: stretch;
-        "
+        class="accordion accordion-light accordion-light-borderless accordion-svg-toggle"
+        id="accordionBackPain"
       >
-        <div class="row" style="justify-content: space-between">
-          <div><i class="ki ki-minus mr-3"></i>GIGI</div>
-          <div>
-            <a href="#" class="btn btn-secondary btn-sm">
-              <i class="ki ki-bold-close icon-md"></i> TIDAK DIPERIKSA
-            </a>
+        <div class="card mt-5">
+          <div class="card-header" id="headingBackPain">
+            <div
+              class="card-title"
+              data-toggle="collapse"
+              data-target="#collapseBackPain"
+            >
+              <span class="svg-icon svg-icon-primary">
+                <svg
+                  xmlns="http://www.w3.org/2000/svg"
+                  xmlns:xlink="http://www.w3.org/1999/xlink"
+                  width="24px"
+                  height="24px"
+                  viewBox="0 0 24 24"
+                  version="1.1"
+                >
+                  <g
+                    stroke="none"
+                    stroke-width="1"
+                    fill="none"
+                    fill-rule="evenodd"
+                  >
+                    <polygon points="0 0 24 0 24 24 0 24"></polygon>
+                    <path
+                      d="M12.2928955,6.70710318 C11.9023712,6.31657888 11.9023712,5.68341391 12.2928955,5.29288961 C12.6834198,4.90236532 13.3165848,4.90236532 13.7071091,5.29288961 L19.7071091,11.2928896 C20.085688,11.6714686 20.0989336,12.281055 19.7371564,12.675721 L14.2371564,18.675721 C13.863964,19.08284 13.2313966,19.1103429 12.8242777,18.7371505 C12.4171587,18.3639581 12.3896557,17.7313908 12.7628481,17.3242718 L17.6158645,12.0300721 L12.2928955,6.70710318 Z"
+                      fill="#000000"
+                      fill-rule="nonzero"
+                    ></path>
+                    <!-- <path
+                  d="M3.70710678,15.7071068 C3.31658249,16.0976311 2.68341751,16.0976311 2.29289322,15.7071068 C1.90236893,15.3165825 1.90236893,14.6834175 2.29289322,14.2928932 L8.29289322,8.29289322 C8.67147216,7.91431428 9.28105859,7.90106866 9.67572463,8.26284586 L15.6757246,13.7628459 C16.0828436,14.1360383 16.1103465,14.7686056 15.7371541,15.1757246 C15.3639617,15.5828436 14.7313944,15.6103465 14.3242754,15.2371541 L9.03007575,10.3841378 L3.70710678,15.7071068 Z"
+                  fill="#000000"
+                  fill-rule="nonzero"
+                  opacity="0.3"
+                  transform="translate(9.000003, 11.999999) rotate(-270.000000) translate(-9.000003, -11.999999) "
+                ></path> -->
+                  </g>
+                </svg>
+              </span>
+              <div class="card-label pl-4 font-size-h4 font-weight-bold">
+                LOW BACK PAIN SCREENING TEST
+              </div>
+            </div>
           </div>
-        </div>
-
-        <!-- keterangan kode -->
-        <div
-          style="
-            margin-top: 16px;
-            display: flex;
-            align-items: flex-start;
-            align-self: stretch;
-          "
-        >
-          KETERANGAN KODE :
-        </div>
-
-        <div class="row">
           <div
-            class="col-md-3"
-            style="
-              display: flex;
-              justify-content: start;
-              align-items: center;
-              flex: 1 0 0;
-              gap: 20px;
-              margin-top: 16px;
-            "
+            id="collapseBackPain"
+            class="collapse show"
+            data-parent="#accordionBackPain"
           >
-            <div
-              style="
-                display: flex;
-                width: 40px;
-                padding: 4px 12px;
-                flex-direction: column;
-                justify-content: center;
-                align-items: center;
-                gap: 10px;
-                border-radius: 4px;
-                background-color: #f5f8fa;
-              "
-            >
-              X
-            </div>
-            <div>Berlubang</div>
-          </div>
-
-          <div
-            class="col-md-3"
-            style="
-              display: flex;
-              justify-content: start;
-              align-items: center;
-              flex: 1 0 0;
-              gap: 20px;
-              margin-top: 16px;
-            "
-          >
-            <div
-              style="
-                display: flex;
-                width: 40px;
-                padding: 4px 12px;
-                flex-direction: column;
-                justify-content: center;
-                align-items: center;
-                gap: 10px;
-                border-radius: 4px;
-                background-color: #f5f8fa;
-              "
-            >
-              C
-            </div>
-            <div>Tambalan</div>
-          </div>
-
-          <div
-            class="col-md-3"
-            style="
-              display: flex;
-              justify-content: start;
-              align-items: center;
-              flex: 1 0 0;
-              gap: 20px;
-              margin-top: 16px;
-            "
-          >
-            <div
-              style="
-                display: flex;
-                width: 40px;
-                padding: 4px 12px;
-                flex-direction: column;
-                justify-content: center;
-                align-items: center;
-                gap: 10px;
-                border-radius: 4px;
-                background-color: #f5f8fa;
-              "
-            >
-              O
-            </div>
-            <div>Tanggal</div>
-          </div>
-
-          <div
-            class="col-md-3"
-            style="
-              display: flex;
-              justify-content: start;
-              align-items: center;
-              flex: 1 0 0;
-              gap: 20px;
-              margin-top: 16px;
-            "
-          >
-            <div
-              style="
-                display: flex;
-                width: 40px;
-                padding: 4px 12px;
-                flex-direction: column;
-                justify-content: center;
-                align-items: center;
-                gap: 10px;
-                border-radius: 4px;
-                background-color: #f5f8fa;
-              "
-            >
-              R
-            </div>
-            <div>Sisa Akar</div>
-          </div>
-        </div>
-
-        <div class="row">
-          <div
-            class="col-md-3"
-            style="
-              display: flex;
-              justify-content: start;
-              align-items: center;
-              flex: 1 0 0;
-              gap: 20px;
-              margin-top: 16px;
-            "
-          >
-            <div
-              style="
-                display: flex;
-                width: 40px;
-                padding: 4px 12px;
-                flex-direction: column;
-                justify-content: center;
-                align-items: center;
-                gap: 10px;
-                border-radius: 4px;
-                background-color: #f5f8fa;
-              "
-            >
-              A
-            </div>
-            <div>Gigi Palsu</div>
-          </div>
-
-          <div
-            class="col-md-3"
-            style="
-              display: flex;
-              justify-content: start;
-              align-items: center;
-              flex: 1 0 0;
-              gap: 20px;
-              margin-top: 16px;
-            "
-          >
-            <div
-              style="
-                display: flex;
-                width: 40px;
-                padding: 4px 12px;
-                flex-direction: column;
-                justify-content: center;
-                align-items: center;
-                gap: 10px;
-                border-radius: 4px;
-                background-color: #f5f8fa;
-              "
-            >
-              K
-            </div>
-            <div>Karang Gigi</div>
-          </div>
-
-          <div
-            class="col-md-3"
-            style="
-              display: flex;
-              justify-content: start;
-              align-items: center;
-              flex: 1 0 0;
-              gap: 20px;
-              margin-top: 16px;
-            "
-          >
-            <div
-              style="
-                display: flex;
-                width: 40px;
-                padding: 4px 12px;
-                flex-direction: column;
-                justify-content: center;
-                align-items: center;
-                gap: 10px;
-                border-radius: 4px;
-                background-color: #f5f8fa;
-              "
-            >
-              I
-            </div>
-            <div>Impaksi</div>
-          </div>
-        </div>
-        <!-- end keterangan kode -->
-      </div>
-      <!-- end gigi -->
-
-      <!-- mulut -->
-      <div
-        class="pt-10"
-        style="
-          flex-direction: column;
-          align-items: flex-start;
-          gap: 20px;
-          align-self: stretch;
-        "
-      >
-        <div class="row" style="justify-content: space-between">
-          <div><i class="ki ki-minus mr-3"></i>MULUT</div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Mukosa rongga mulut</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Loseque Test</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Negatif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Positif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
               </div>
             </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Bragard Test</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Negatif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Positif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
               </div>
             </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Tenggorokan</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Patrict Test</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Negatif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Positif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
               </div>
             </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Hiperemis
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Kontra Patrict</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Negatif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Positif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
               </div>
             </div>
-          </div>
-
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tonsil hipertrofi
-                </label>
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">
+                Range of Motion (Punggung - Pinggang)
               </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Negatif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Positif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
               </div>
             </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Deviasi uvula
-                </label>
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">
+                Straight leg raised test
               </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Negatif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Positif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
               </div>
             </div>
-          </div>
-
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Lain-lain
-                </label>
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Neer Test</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Negatif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Positif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
               </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
+            </div>
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Speed Test</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Negatif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Positif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
               </div>
             </div>
           </div>
         </div>
       </div>
-      <!-- end mulut -->
+      <!-- end Low back pain screning test -->
 
-      <!-- leher -->
+      <!-- System Integumen -->
       <div
-        class="d-flex pt-10"
-        style="
-          flex-direction: column;
-          align-items: flex-start;
-          gap: 20px;
-          align-self: stretch;
-        "
+        class="accordion accordion-light accordion-light-borderless accordion-svg-toggle mb-10"
+        id="accordionBackPain"
       >
-        <div class="row d-flex" style="width: 554px; gap: 12px">
-          <i class="ki ki-minus"></i>HIDUNG
-        </div>
-        <div class="d-flex row container">
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Normal
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Obat anti hypertensi
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-        </div>
-
-        <div class="d-flex row container">
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Pembesaran tiroid
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Statins
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-        </div>
-
-        <div class="d-flex row container">
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                JVP meningkat
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                NSAIDs
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-        </div>
-      </div>
-      <!-- end leher -->
-
-      <!-- thorax/dada -->
-      <div
-        class="d-flex pt-10"
-        style="
-          flex-direction: column;
-          align-items: flex-start;
-          gap: 20px;
-          align-self: stretch;
-        "
-      >
-        <div class="row d-flex" style="width: 554px; gap: 12px">
-          <i class="ki ki-minus"></i>THORAX/DADA
-        </div>
-        <div class="d-flex row container">
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Normal
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Deformitas
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-        </div>
-
-        <div class="d-flex row container">
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Tumor mammae
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Gineko mastia
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-        </div>
-
-        <div class="d-flex row container">
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Lain-lain
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-        </div>
-      </div>
-      <!-- end thorax/dada -->
-
-      <!-- paru-paru -->
-      <div
-        class="d-flex pt-10"
-        style="
-          flex-direction: column;
-          align-items: flex-start;
-          gap: 20px;
-          align-self: stretch;
-        "
-      >
-        <div class="row d-flex" style="width: 554px; gap: 12px">
-          <i class="ki ki-minus"></i>PARU-PARU
-        </div>
-        <div class="d-flex row container">
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Normal
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Gerak asimetris
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-        </div>
-
-        <div class="d-flex row container">
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Perkusi abnormal
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Suara nafas tambahan
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-        </div>
-
-        <div class="d-flex row container">
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Lain-lain
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-        </div>
-      </div>
-      <!-- end paru-paru -->
-
-      <!-- jantung -->
-      <div
-        class="pt-10"
-        style="
-          flex-direction: column;
-          align-items: flex-start;
-          gap: 20px;
-          align-self: stretch;
-        "
-      >
-        <div class="row" style="justify-content: space-between">
-          <div><i class="ki ki-minus mr-3"></i>JANTUNG</div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>JVP</div>
-          <div class="d-flex row container">
+        <div class="card mt-5">
+          <div class="card-header" id="headingBackPain">
             <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
+              class="card-title"
+              data-toggle="collapse"
+              data-target="#collapseBackPain"
             >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
+              <span class="svg-icon svg-icon-primary">
+                <svg
+                  xmlns="http://www.w3.org/2000/svg"
+                  xmlns:xlink="http://www.w3.org/1999/xlink"
+                  width="24px"
+                  height="24px"
+                  viewBox="0 0 24 24"
+                  version="1.1"
+                >
+                  <g
+                    stroke="none"
+                    stroke-width="1"
+                    fill="none"
+                    fill-rule="evenodd"
+                  >
+                    <polygon points="0 0 24 0 24 24 0 24"></polygon>
+                    <path
+                      d="M12.2928955,6.70710318 C11.9023712,6.31657888 11.9023712,5.68341391 12.2928955,5.29288961 C12.6834198,4.90236532 13.3165848,4.90236532 13.7071091,5.29288961 L19.7071091,11.2928896 C20.085688,11.6714686 20.0989336,12.281055 19.7371564,12.675721 L14.2371564,18.675721 C13.863964,19.08284 13.2313966,19.1103429 12.8242777,18.7371505 C12.4171587,18.3639581 12.3896557,17.7313908 12.7628481,17.3242718 L17.6158645,12.0300721 L12.2928955,6.70710318 Z"
+                      fill="#000000"
+                      fill-rule="nonzero"
+                    ></path>
+                    <!-- <path
+                d="M3.70710678,15.7071068 C3.31658249,16.0976311 2.68341751,16.0976311 2.29289322,15.7071068 C1.90236893,15.3165825 1.90236893,14.6834175 2.29289322,14.2928932 L8.29289322,8.29289322 C8.67147216,7.91431428 9.28105859,7.90106866 9.67572463,8.26284586 L15.6757246,13.7628459 C16.0828436,14.1360383 16.1103465,14.7686056 15.7371541,15.1757246 C15.3639617,15.5828436 14.7313944,15.6103465 14.3242754,15.2371541 L9.03007575,10.3841378 L3.70710678,15.7071068 Z"
+                fill="#000000"
+                fill-rule="nonzero"
+                opacity="0.3"
+                transform="translate(9.000003, 11.999999) rotate(-270.000000) translate(-9.000003, -11.999999) "
+              ></path> -->
+                  </g>
+                </svg>
+              </span>
+              <div class="card-label pl-4 font-size-h4 font-weight-bold">
+                LOW BACK PAIN SCREENING TEST
               </div>
             </div>
           </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Apex</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
+          <div
+            id="collapseBackPain"
+            class="collapse show"
+            data-parent="#accordionBackPain"
+          >
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Kulit</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Tidak Normal
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Bekas Operasi
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Lain-lain
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
               </div>
             </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Kuku</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Negatif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Positif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
               </div>
             </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Suara Jantung</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Rambut</div>
+              <div class="row mt-5">
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Negatif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
+                <div class="col-6">
+                  <div class="form-group row">
+                    <div class="col-8 col-form-label">
+                      <label class="checkbox">
+                        <input type="checkbox" name="Checkboxes1" />
+                        <span class="mr-4"></span>
+                        Positif
+                      </label>
+                    </div>
+                    <div class="col-4">
+                      <input
+                        class="form-control form-control-solid"
+                        placeholder="Keterangan"
+                        type="text"
+                      />
+                    </div>
+                  </div>
+                </div>
               </div>
             </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
+            <div class="card-body px-12">
+              <div class="row pt-3 font-weight-bold">Saran</div>
+              <div class="row mt-5">
+                <textarea
                   class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Bising Jantung/Murmur</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
+                  rows="3"
+                  placeholder="Isikan saran"
+                ></textarea>
               </div>
             </div>
           </div>
         </div>
       </div>
-      <!-- end jantung -->
-
-      <!-- perut/adomen -->
-      <div
-        class="pt-10"
-        style="
-          flex-direction: column;
-          align-items: flex-start;
-          gap: 20px;
-          align-self: stretch;
-        "
-      >
-        <div class="row" style="justify-content: space-between">
-          <div><i class="ki ki-minus mr-3"></i>PERUT/ABDOMEN</div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Abdomen</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Nyeri tekan
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Nyeri ketok ginjal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Shifting Dulness
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Lain-lain
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Bising Usus</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Hati</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Limpa</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Hernia</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Hemorroid</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak diperiksa
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak Ada
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Ada
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-      </div>
-      <!-- end perut/adomen -->
-
-      <!-- genitourinaria -->
-      <div
-        class="d-flex pt-10"
-        style="
-          flex-direction: column;
-          align-items: flex-start;
-          gap: 20px;
-          align-self: stretch;
-        "
-      >
-        <div class="row d-flex" style="width: 554px; gap: 12px">
-          <i class="ki ki-minus"></i>GENITOURINARIA
-        </div>
-        <div class="d-flex row container">
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Tidak diperiksa
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Normal
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-        </div>
-
-        <div class="d-flex row container">
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Retensi Urin
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Tanda Infeksis
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-        </div>
-
-        <div class="d-flex row container">
-          <div
-            class="d-flex col-md-6"
-            style="
-              justify-content: space-between;
-              align-items: center;
-              align-self: stretch;
-            "
-          >
-            <div class="d-flex align-items-center col-md-6">
-              <label class="checkbox">
-                <input type="checkbox" name="Checkboxes1" />
-                <span class="mr-4"></span>
-                Lain-lain
-              </label>
-            </div>
-            <div class="d-flex align-items-center col-md-6">
-              <input
-                class="form-control form-control-solid"
-                type="text"
-                value=""
-                id="input1"
-                placeholder="Keterangan"
-                style="margin: 0 auto"
-              />
-            </div>
-          </div>
-        </div>
-      </div>
-      <!-- end genitourinaria -->
-
-      <!-- anggota gerak -->
-      <div
-        class="pt-10"
-        style="
-          flex-direction: column;
-          align-items: flex-start;
-          gap: 20px;
-          align-self: stretch;
-        "
-      >
-        <div class="row" style="justify-content: space-between">
-          <div><i class="ki ki-minus mr-3"></i>ANGGOTA GERAK</div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Ekstrimitas atas</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Deformitas
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tremor
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Oedem
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Partner eritem
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Penurunan kekuatan
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Lain-lain
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Ekstrimitas bawah</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Deformitas
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Varices
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Oedem
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Vascularisasi abnormal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Penurunan kekuatan
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Lain-lain
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Tonus/otot</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Paresis
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Paralysis
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Lain-lain
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-      </div>
-      <!-- end anggota gerak -->
-
-      <!-- sistem persyarafan -->
-      <div
-        class="pt-10"
-        style="
-          flex-direction: column;
-          align-items: flex-start;
-          gap: 20px;
-          align-self: stretch;
-        "
-      >
-        <div class="row" style="justify-content: space-between">
-          <div><i class="ki ki-minus mr-3"></i>SISTEM PERSYARAFAN</div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Refleks Fisiologis</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Refleks Pathologis</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak Ada
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Ada
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Keseimbangan & Koordinasi</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Refleks Neurologis Lainnya</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak Ada
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Ada
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-      </div>
-      <!-- end sistem persyarafan -->
-
-      <!-- smell test -->
-      <div
-        class="pt-10"
-        style="
-          flex-direction: column;
-          align-items: flex-start;
-          gap: 20px;
-          align-self: stretch;
-        "
-      >
-        <div class="row" style="justify-content: space-between">
-          <div><i class="ki ki-minus mr-3"></i>SMELL TEST</div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Smell Test</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Anosmia
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Parosmia
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-      </div>
-      <!-- end smell test -->
-
-      <!-- low back pain screening test -->
-      <div
-        class="pt-10"
-        style="
-          flex-direction: column;
-          align-items: flex-start;
-          gap: 20px;
-          align-self: stretch;
-        "
-      >
-        <div class="row" style="justify-content: space-between">
-          <div>
-            <i class="ki ki-minus mr-3"></i>LOW BACK PAIN SCREENING TEST
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Laseque Test</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Negatif
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Positif
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Bragard Test</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Negatif
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Positif
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Patrict Test</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Negatif
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Positif
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Kontra Patrict</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Negatif
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Positif
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Range of Motion (Punggung - Pinggang)</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Negatif
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Positif
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Straight leg raised test</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Negatif
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Positif
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Neer Sign</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Negatif
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Positif
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Speed Test</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Negatif
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Positif
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-      </div>
-      <!-- end low back pain screening test -->
-
-      <!-- sistem integumen -->
-      <div
-        class="pt-10"
-        style="
-          flex-direction: column;
-          align-items: flex-start;
-          gap: 20px;
-          align-self: stretch;
-        "
-      >
-        <div class="row" style="justify-content: space-between">
-          <div><i class="ki ki-minus mr-3"></i>SISTEM INTEGUMEN</div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Kulit</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Bekas Operasi
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Lain-lain
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Kuku</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <div>Rambut</div>
-          <div class="d-flex row container">
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-            <div
-              class="d-flex col-md-6"
-              style="
-                justify-content: space-between;
-                align-items: center;
-                align-self: stretch;
-              "
-            >
-              <div class="d-flex align-items-center col-md-6">
-                <label class="checkbox">
-                  <input type="checkbox" name="Checkboxes1" />
-                  <span class="mr-4"></span>
-                  Tidak Normal
-                </label>
-              </div>
-              <div class="d-flex align-items-center col-md-6">
-                <input
-                  class="form-control form-control-solid"
-                  type="text"
-                  value=""
-                  id="input1"
-                  placeholder="Keterangan"
-                  style="margin: 0 auto"
-                />
-              </div>
-            </div>
-          </div>
-        </div>
-
-        <div
-          class="d-flex mt-3"
-          style="
-            flex-direction: column;
-            align-items: flex-start;
-            gap: 20px;
-            align-self: stretch;
-          "
-        >
-          <label for="exampleTextarea">Saran</label>
-          <textarea class="form-control form-control-solid" rows="3"></textarea>
-        </div>
-      </div>
-      <!-- end sistem integumen -->
+      <!-- end System Integumen -->
     </div>
     <!--begin::end-->
 
@@ -5823,6 +4938,33 @@
     <script src="assets/js/scripts.bundle.js"></script>
     <!--end::Global Theme Bundle-->
 
+    <!-- begin::for ResetForm Button -->
+    <script>
+      function resetSubForm(subFormId) {
+        var checkboxes = document.querySelectorAll(
+          "#" + subFormId + ' input[type="checkbox"]'
+        );
+        checkboxes.forEach(function (checkbox) {
+          checkbox.checked = false;
+        });
+
+        var inputText = document.querySelectorAll(
+          "#" + subFormId + ' input[type="text"]'
+        );
+        inputText.forEach(function (inputtext) {
+          inputtext.value = "";
+        });
+
+        var datePickers = document.querySelectorAll(
+          "#" + subFormId + ' input[type="date"]'
+        );
+        datePickers.forEach(function (datePicker) {
+          datePicker.value = ""; // Reset date picker value
+        });
+      }
+    </script>
+    <!-- end::for ResetForm Button -->
+
     <!--begin::Page Vendors(used by this page)-->
     <script src="assets/plugins/custom/fullcalendar/fullcalendar.bundle.js"></script>
     <!--end::Page Vendors-->