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2026-06-12 22:44:23 +07:00
parent 4949c84feb
commit d7dd18ddba
9 changed files with 1069 additions and 15 deletions
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01/dashboard.html
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@@ -611,7 +611,7 @@
</div>
<div class="form-group">
<label>Status BPJS *</label>
<select name="status_bpjs" required>
<select name="status_bpjs" id="form-status-bpjs" required>
<option value="Tidak">Tidak Memiliki</option>
<option value="Ya">Sudah Memiliki</option>
<option value="Proses">Proses Pendaftaran</option>
@@ -619,6 +619,54 @@
</div>
</div>
<!-- BPJS Detail Fields (Hanya muncul jika Status BPJS = Ya) -->
<div id="bpjs-detail-fields" style="display: none; background: #f0fdf4; border: 1px dashed #4caf50; padding: 15px; border-radius: 8px; margin-bottom: 15px;">
<h4 style="margin: 0 0 10px 0; color: #1e3c72; font-size: 13px;">🏥 Informasi Kepesertaan BPJS</h4>
<div class="form-row">
<div class="form-group">
<label>No. Peserta BPJS *</label>
<input type="text" name="bpjs_no_peserta" placeholder="Cth: 0001234567890">
</div>
<div class="form-group">
<label>Jenis BPJS</label>
<select name="bpjs_jenis_bpjs">
<option value="Kesehatan">Kesehatan</option>
<option value="Ketenagakerjaan">Ketenagakerjaan</option>
<option value="Jaminan Hari Tua">Jaminan Hari Tua</option>
</select>
</div>
</div>
<div class="form-row">
<div class="form-group">
<label>Tingkat</label>
<select name="bpjs_tingkat">
<option value="Penerima Bantuan Iuran (PBI)">Penerima Bantuan Iuran (PBI)</option>
<option value="Pekerja Penerima Upah">Pekerja Penerima Upah</option>
<option value="Pekerja Bukan Penerima Upah">Pekerja Bukan Penerima Upah</option>
<option value="Peserta Mandiri">Peserta Mandiri</option>
</select>
</div>
<div class="form-group">
<label>Status Aktif</label>
<select name="bpjs_status_aktif">
<option value="Aktif">Aktif</option>
<option value="Nonaktif">Nonaktif</option>
<option value="Suspended">Suspended</option>
</select>
</div>
</div>
<div class="form-row">
<div class="form-group">
<label>Tanggal Daftar *</label>
<input type="date" name="bpjs_tanggal_daftar">
</div>
<div class="form-group">
<label>Faskes Tingkat 1</label>
<input type="text" name="bpjs_faskes_tingkat_1" placeholder="Cth: Puskesmas Pontianak Kota">
</div>
</div>
</div>
<div class="form-row">
<div class="form-group">
<label>Pekerjaan</label>
@@ -859,6 +907,57 @@
</div>
</div>
<!-- MODAL: FORM INPUT BANTUAN -->
<div id="modal-form-bantuan" class="modal">
<div class="modal-content">
<div class="modal-header">
<h2>Tambah Riwayat Bantuan</h2>
<button class="close-btn" onclick="closeModal('modal-form-bantuan')">&times;</button>
</div>
<div id="alert-form-bantuan" class="alert"></div>
<form id="form-bantuan">
<input type="hidden" name="id_masyarakat" id="bantuan-id-masyarakat">
<div class="form-group">
<label>Jenis Bantuan *</label>
<input type="text" name="jenis_bantuan" required placeholder="Cth: PKH, BPNT, Bantuan Beras, dll">
</div>
<div class="form-row">
<div class="form-group">
<label>Tanggal Menerima *</label>
<input type="date" name="tanggal_bantuan" required>
</div>
<div class="form-group">
<label>Nilai Bantuan (Rp) *</label>
<input type="number" name="nilai" required placeholder="Cth: 200000">
</div>
</div>
<div class="form-row">
<div class="form-group">
<label>Satuan</label>
<input type="text" name="satuan" value="Rupiah" placeholder="Cth: Rupiah, Paket, dll">
</div>
<div class="form-group">
<label>Nama Pemberi Bantuan</label>
<input type="text" name="nama_pemberi" placeholder="Cth: Dinas Sosial, Baznas, dll">
</div>
</div>
<div class="form-group">
<label>Keterangan</label>
<textarea name="keterangan" placeholder="Keterangan tambahan bantuan..."></textarea>
</div>
<div class="button-group">
<button type="submit" class="btn-primary">Simpan Bantuan</button>
<button type="button" class="btn-secondary" onclick="closeModal('modal-form-bantuan')">Batal</button>
</div>
</form>
</div>
</div>
<script src="js/main.js"></script>
</body>