Files
FE_CPONE/train/vuex/one-fo-registration/components/patientNewFormDialog.vue
2026-04-27 10:08:27 +07:00

208 lines
6.3 KiB
Vue

<template>
<v-layout row>
<v-flex xs6 pr-3>
<v-layout column>
<v-flex>
<v-text-field
model="mr"
label="No RM"
readonly
></v-text-field>
</v-flex>
<v-flex>
<v-layout row>
<v-flex xs2>
<v-select
:items="d_pretitle"
item-text="text"
item-value="value"
label="Titel"
model="pretitle"
>
</v-select>
</v-flex>
<v-flex xs8 pl-2 pr-2>
<v-text-field
label="Nama Lengkap"
model="name"
></v-text-field>
</v-flex>
<v-flex xs2>
<v-text-field
label="Gelar"
model="posttitle"
></v-text-field>
</v-flex>
</v-layout>
</v-flex>
<v-flex>
<v-flex xs2>
<v-select
:items="d_sex"
item-text="text"
item-value="value"
label="Jenis Kelamin"
model="sex"
>
</v-select>
</v-flex>
</v-flex>
<v-flex>
<v-layout row>
<v-flex xs10 pr-2>
<v-text-field
label="Tempat Lahir"
model="pob"
>
</v-text-field>
</v-flex>
<v-flex xs2>
<one-date-picker
label="Tanggal Lahir"
></one-date-picker>
</v-flex>
</v-layout>
</v-flex>
<v-flex>
<v-flex xs12>
<v-select
:items="d_religion"
item-text="text"
item-value="value"
label="Agama"
model="religion"
>
</v-select>
</v-flex>
</v-flex>
</v-layout>
</v-flex>
<v-flex xs6 pl-3>
<v-layout column>
<v-flex>
<v-textarea
label="Alamat lengkap"
model="address"
row="2"
></v-textarea>
</v-flex>
<v-flex>
<v-select
label="Propinsi"
model="province"
:items="d_province"
item-text="text"
item-value="value"
></v-select>
</v-flex>
<v-flex>
<v-select
label="Kota"
model="city"
:items="d_city"
item-text="text"
item-value="value"
></v-select>
</v-flex>
<v-flex>
<v-select
label="Kecamatan"
model="subdistrict"
:items="d_subdistrict"
item-text="text"
item-value="value"
></v-select>
</v-flex>
<v-flex>
<v-select
label="Desa / Kelurahan"
model="village"
:items="d_village"
item-text="text"
item-value="value"
></v-select>
</v-flex>
</v-layout>
</v-flex>
</v-layout>
</template>
<script>
module.exports = {
components : {
'one-date-picker': httpVueLoader('./oneDatePicker2.vue')
},
data () {
return {
pretitle: {text:'', value:'0'},
name: '',
posttitle: '',
sex: {text:'', value:'0'},
pob: '',
dob: '',
religion: {text:'', value:'0'},
address: '',
province: {text:'', value:'0'},
city: {text:'', value:'0'},
subdistrict: {text:'', value:'0'},
village: {text:'', value:'0'},
d_pretitle: [
{ text: 'Bpk', value: '1' },
{ text: 'Tn', value: '2' },
{ text: 'Ibu', value: '3' },
{ text: 'Ny', value: '4' },
{ text: 'Nn', value: '5' },
{ text: 'Anak', value: '6' },
{ text: 'Lainnya', value: '7' }
],
d_sex: [
{ text: 'Laki - laki', value: '1' },
{ text: 'Perempuan', value: '2' }
],
d_religion: [
{ text: 'Islam', value: '1' },
{ text: 'Kristen', value: '2' },
{ text: 'Katolik', value: '3' },
{ text: 'Hindu', value: '4' },
{ text: 'Buddha', value: '5' },
{ text: 'Lainnya', value: '6' }
],
d_province: [
{ text: 'Jawa Barat', value: '1' },
{ text: 'Jawa Tengah', value: '1' },
{ text: 'Jawa Timur', value: '1' }
],
d_city: [],
d_subdistrict: [],
d_village: []
}
}
}
</script>