diff --git a/Modules/HospitalPortal/Http/Controllers/Api/MemberController.php b/Modules/HospitalPortal/Http/Controllers/Api/MemberController.php
index 4a69d876..52af40fb 100644
--- a/Modules/HospitalPortal/Http/Controllers/Api/MemberController.php
+++ b/Modules/HospitalPortal/Http/Controllers/Api/MemberController.php
@@ -96,6 +96,16 @@ class MemberController extends Controller
 
                 $res_data['type'] = $request->type;
 
+                // Provider
+                $providers = DB::table('organizations')
+                ->select(
+                    'organizations.id',
+                    'organizations.name'
+                )
+                ->get();
+
+                $res_data['providers'] = $providers;
+
                 
                 return ApiResponse::apiResponse("Success", $res_data, trans('Message.success'), 200);
             }
diff --git a/Modules/HospitalPortal/Http/Controllers/Api/RequestLogController.php b/Modules/HospitalPortal/Http/Controllers/Api/RequestLogController.php
index db2cf4b9..a7f796ad 100644
--- a/Modules/HospitalPortal/Http/Controllers/Api/RequestLogController.php
+++ b/Modules/HospitalPortal/Http/Controllers/Api/RequestLogController.php
@@ -23,7 +23,10 @@ class RequestLogController extends Controller
     {
         $data = [
             'member_id' => $request->member_id,
-            'service_code' => $request->service_code
+            'service_code' => $request->service_code,
+            'id_provider' => $request->id_provider,
+            'name_provider' => $request->name_provider,
+            'adress_provider' => $request->address_provider
         ];
         $validator = Validator::make($request->all(), [
             'member_id' => 'required',
@@ -32,6 +35,18 @@ class RequestLogController extends Controller
             'member_id.required' => trans('Validation.required',['attribute' => 'Member ID']),
             'service_code.required' => trans('Validation.required',['attribute' => 'Service Code']),
         ]);
+        if($request->id_provider)
+        {
+            $validator = Validator::make($request->all(), [
+                'id_provider' => 'required',
+                'member_id' => 'required',
+                'service_code' => 'required'
+            ], [
+                'id_provider.required' => trans('Validation.required',['attribute' => 'Provider ID']),
+                'member_id.required' => trans('Validation.required',['attribute' => 'Member ID']),
+                'service_code.required' => trans('Validation.required',['attribute' => 'Service Code']),
+            ]);
+        }
         if ($validator->fails())
         {
             return ApiResponse::apiResponse('Bad Request', $data, $validator->errors(), 400);
diff --git a/frontend/hospital-portal/public/lang/en-US.json b/frontend/hospital-portal/public/lang/en-US.json
index c8060371..7bb9238b 100644
--- a/frontend/hospital-portal/public/lang/en-US.json
+++ b/frontend/hospital-portal/public/lang/en-US.json
@@ -34,5 +34,9 @@
   "txtSupportingResultDocument" : "Supporting Result Document",
   "txtAddResult" : "Add Result",
   "txtServiceType" : "Service Type",
-  "txtAdditionalDocuments" : "Additional Documents"
+  "txtAdditionalDocuments" : "Additional Documents",
+  "txtAddNew" : "Add New",
+  "txtAddress" : "Address",
+  "txtProvider": "Provider",
+  "txtAlertProvider" : "Please enter provider"
 }
diff --git a/frontend/hospital-portal/public/lang/id-ID.json b/frontend/hospital-portal/public/lang/id-ID.json
index 5ca6e767..29798776 100644
--- a/frontend/hospital-portal/public/lang/id-ID.json
+++ b/frontend/hospital-portal/public/lang/id-ID.json
@@ -34,5 +34,9 @@
   "txtSupportingResultDocument" : "Dokumen Hasil Pendukung",
   "txtAddResult" : "Tambah Hasil",
   "txtServiceType" : "Tipe Layanan",
-  "txtAdditionalDocuments" : "Dokumen Tambahan"
+  "txtAdditionalDocuments" : "Dokumen Tambahan",
+  "txtAddNew" : "Tambah Baru",
+  "txtAddress" : "Alamat",
+  "txtProvider": "Penyedia",
+  "txtAlertProvider" : "Mohon masukan provider"
 }
diff --git a/frontend/hospital-portal/src/sections/dashboard/FormRequestLog.tsx b/frontend/hospital-portal/src/sections/dashboard/FormRequestLog.tsx
index 1f6433c2..43b6204f 100644
--- a/frontend/hospital-portal/src/sections/dashboard/FormRequestLog.tsx
+++ b/frontend/hospital-portal/src/sections/dashboard/FormRequestLog.tsx
@@ -16,10 +16,14 @@ import { useRef, useState, useContext } from 'react';
 import { makeFormData } from '@/utils/jsonToFormData';
 import { format } from 'date-fns';
 import { LanguageContext } from '@/contexts/LanguageContext';
+import Autocomplete from '@mui/material/Autocomplete';
+import TextField from '@mui/material/TextField';
+import Button from '@mui/material/Button';
 
 interface MemberType {
     members: any;
     services: any;
+    providers:any;
 }
 interface FormRequestClaimProps {
     member: MemberType;
@@ -28,9 +32,15 @@ interface FormRequestClaimProps {
 export default function FormRequestClaim({ member, handleSubmitSuccess }: FormRequestClaimProps) {
     const { localeData }: any =  useContext(LanguageContext);
     const [serviceCode, setServiceCode] = useState<string>('');
+    const [idProvider, setIdProvider] = useState<number>(0);
 
     const [submitLoading, setSubmitLoading] = useState<boolean>(false);
     function submitRequest() {
+        if(!idProvider&& (name == '' || alamat == ''))
+        {
+            enqueueSnackbar(localeData.txtAlertProvider, { variant: 'warning' });
+            return false;
+        }
         if(serviceCode == '')
         {
             enqueueSnackbar(localeData.txtDialogMember4, { variant: 'warning' });
@@ -39,7 +49,10 @@ export default function FormRequestClaim({ member, handleSubmitSuccess }: FormRe
         setSubmitLoading(true);
         const formData = {
             member_id: member.members.id,
-            service_code: serviceCode
+            service_code: serviceCode,
+            id_provider: idProvider,
+            name_provider : name,
+            address_provider: alamat
         };
         axios
         .post('/request-log', formData)
@@ -64,8 +77,26 @@ export default function FormRequestClaim({ member, handleSubmitSuccess }: FormRe
         name: string;
     }
 
+    interface Providers {
+        id: number;
+        name: string;
+    }
+
+    const [showAddNewForm, setShowAddNewForm] = useState(false);
+    const [name, setName] = useState('');
+    const [alamat, setAlamat] = useState('');
+
+    const handleAddNewData = () => {
+        // Logika untuk menambahkan data baru ke database
+        // Pastikan untuk menyesuaikan logika ini sesuai dengan kebutuhan aplikasi Anda
+        console.log('Adding new data:', { name, alamat });
+
+        // Setelah menambahkan data baru, Anda mungkin ingin melakukan sesuatu seperti menutup formulir tambahan atau melakukan pengaturan lainnya
+        setShowAddNewForm(false);
+    };
+
     return (
-        <Stack direction="column" spacing={4}>
+        <Stack direction="column" spacing={2}>
         <Stack direction="row" justifyContent={'end'} sx={{ marginBottom: 2 }} spacing={2}>
             <Typography variant='body2' sx={{color: '#757575'}}>
             {localeData.txtDialogMember5}
@@ -74,27 +105,71 @@ export default function FormRequestClaim({ member, handleSubmitSuccess }: FormRe
         </Stack>
 
         <Stack direction="row" spacing={2}>
-            <Stack spacing={2} sx={{width:'100%'}}>
-                <Typography variant='subtitle1'>{localeData.txtDialogMember1}*</Typography>
-                <FormControl>
-                <InputLabel htmlFor="service_type">
-                {localeData.txtDialogMember1}
-                </InputLabel>
-                <Select
-                    id="service_type"
-                    value={serviceCode}
+            <Stack spacing={2} sx={{ width: '100%' }}>
+                <Typography variant='subtitle1'>{localeData.txtProvider} *</Typography>
+                <Autocomplete
+                id="provider"
+                options={[{ name: localeData.txtAddNew, id: 0 }, ...member?.providers || []]}
+                getOptionLabel={(option: Providers) => option.name || ''}
+                value={member?.providers.find((item: Providers) => item.id === idProvider) || null}
+                onChange={(event: React.ChangeEvent<{}>, newValue: Providers | null) => {
+                    if (newValue?.id === 0) {
+                    // Pengguna memilih opsi "Tambahkan Data Baru"
+                    setIdProvider(0); // Reset nilai
+                    setShowAddNewForm(true); // Menampilkan formulir tambahan
+                    } else {
+                    // Pengguna memilih opsi dari hasil pencarian
+                    setIdProvider(newValue?.id || 0);
+                    setShowAddNewForm(false); // Menyembunyikan formulir tambahan
+                    }
+                }}
+                renderInput={(params) => (
+                    <TextField
+                    {...params}
+                    label={localeData.txtProvider}
                     fullWidth
-                    label={localeData.txtDialogMember1}
-                    onChange={(e) => {
-                    setServiceCode(e.target.value);
-                    }}
-                >
-                {member && member?.services?.map((item: MemberService, index:number) => (
-                    <MenuItem key={index} value={item.service_code}>{item.name}</MenuItem>
-                ))}
-                </Select>
+                    />
+                )}
+                />
+                {showAddNewForm && (
+                    <Stack direction="column" spacing={1} padding={1}>
+                        <Typography variant='body2'>{localeData.txtAddNew} *</Typography>
+                        <TextField
+                        label={localeData.txtName}
+                        fullWidth
+                        onChange={(e) => setName(e.target.value)}
+                        />
+                        <TextField
+                        label={localeData.txtAddress}
+                        fullWidth
+                        onChange={(e) => setAlamat(e.target.value)}
+                        />
+                    </Stack>
+                )}
+                <FormHelperText style={{ color: 'red' }}></FormHelperText>
+            </Stack>
+        </Stack>
+        
+        <Stack direction="row" spacing={2}>
+            <Stack spacing={2} sx={{ width: '100%' }}>
+                <Typography variant='subtitle1'>{localeData.txtDialogMember1} *</Typography>
+                <Autocomplete
+                id="service_type"
+                options={member?.services || []}
+                getOptionLabel={(option: MemberService) => option.name || ''}
+                value={member?.services.find((item: MemberService) => item.service_code === serviceCode) || null}
+                onChange={(event: React.ChangeEvent<{}>, newValue: MemberService | null) => {
+                    setServiceCode(newValue?.service_code || '');
+                }}
+                renderInput={(params) => (
+                    <TextField
+                    {...params}
+                    label={localeData.txtDialogMember1}
+                    fullWidth
+                    />
+                )}
+                />
                 <FormHelperText style={{ color: 'red' }}></FormHelperText>
-                </FormControl>
             </Stack>
         </Stack>