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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>{{ username }}</title>
<!-- ======= Styles ====== -->
<link rel="stylesheet" type="text/css" href="{{ url_for('static', filename= 'css/dashboard-input-data.css') }}">
<link
rel="stylesheet"
href="{{ url_for('static', filename= 'css/input_data.css') }}"
/>
<link
href="https://cdn.jsdelivr.net/npm/[email protected]/dist/css/bootstrap.min.css"
rel="stylesheet"
integrity="sha384-GLhlTQ8iRABdZLl6O3oVMWSktQOp6b7In1Zl3/Jr59b6EGGoI1aFkw7cmDA6j6gD"
crossorigin="anonymous"
/>
</head>
<body>
<!-- =============== Navigation ================ -->
<div class="navigation">
<ul>
<li>
<a href="#">
<span class="icon">
<ion-icon name="people"></ion-icon>
</span>
<span class="title">Administrator</span>
</a>
</li>
<li>
<a href="{{ url_for('dashboard') }}">
<span class="icon">
<ion-icon name="home"></ion-icon>
</span>
<span class="title">Dashboard</span>
</a>
</li>
<li class="menu-item">
<a href="{{ url_for('dashboard_layout_kategori') }}">
<span class="icon">
<ion-icon name="people-outline"></ion-icon>
</span>
<span class="title">Data Analis</span>
</a>
</li>
<li>
<a href="{{ url_for('dashboard_layout_data_anak') }}">
<span class="icon">
<ion-icon name="accessibility"></ion-icon>
</span>
<span class="title">Data Anak</span>
</a>
</li>
<li>
<a href="{{ url_for('dashboard_input_data') }}">
<span class="icon">
<ion-icon name="person"></ion-icon>
</span>
<span class="title">Input Data</span>
</a>
</li>
<li>
<a href="{{ url_for('logout') }}">
<span class="icon">
<ion-icon name="log-out-outline"></ion-icon>
</span>
<span class="title">Sign Out</span>
</a>
</li>
</ul>
</div>
<!-- ========================= Main ==================== -->
<div class="main">
<div class="topbar">
<div class="toggle">
<ion-icon name="menu-outline"></ion-icon>
</div>
<!-- <div class="search">
<label>
<input type="text" placeholder="Search here">
<ion-icon name="search-outline"></ion-icon>
</label>
</div> -->
<div class="detailsPuskesmas">
<a
data-size="large"
data-show-count="true"
>{{ username }}</a
>
</div>
</div>
<!-- ======================= Cards ================== -->
<!-- <div class="cardBox">
<div class="card">
<div>
<div class="numbers">1,504</div>
<div class="cardName">Data Balita Laki - Laki yang masuk</div>
</div>
<div class="iconBx">
<ion-icon name="man-outline"></ion-icon>
</div>
</div>
<div class="card">
<div>
<div class="numbers">80</div>
<div class="cardName">Data Balita Perempuan yang masuk</div>
</div>
<div class="iconBx">
<ion-icon name="woman-outline"></ion-icon>
</div>
</div>
</div> -->
<div class="container">
<div class="row">
<div class="col-md-12">
<form class="data-balita-form" method="post">
<h2>Data Balita</h2>
<div class="form-group mt-3">
<label for="nama-lengkap">Nama Lengkap</label>
<input
type="text"
class="form-control mt-1"
id="nama-lengkap"
name="nama-lengkap"
placeholder="Masukkan Nama Lengkap"
required
/>
</div>
<div class="form-group mt-3">
<label for="usia-dalam-bentuk-bulan"
>Usia (Tahun)</label
>
<input
type="number"
class="form-control mt-1"
id="usia-dalam-bentuk-bulan"
name="usia-dalam-bentuk-bulan"
placeholder="Masukkan Usia"
required
/>
</div>
<div class="form-group mt-3">
<label for="tanggal-lahir">Tanggal Lahir</label>
<input
type="date"
class="form-control mt-1"
id="tanggal-lahir"
name="tanggal-lahir"
placeholder="Masukkan Tanggal Lahir"
required
/>
</div>
<div class="form-group mt-3">
<label for="jenis-kelamin"
>Pilih Jenis Kelamin Anak Anda</label
>
<div class="form-check mt-1">
<input
class="form-check-input"
type="radio"
name="jenis-kelamin"
id="jenis-kelamin-value-laki-laki"
value="Laki-Laki"
checked
/>
<label
class="form-check-label"
for="jenis-kelamin-value-laki-laki"
>
Laki-Laki
</label>
</div>
<div class="form-check">
<input
class="form-check-input"
type="radio"
name="jenis-kelamin"
id="jenis-kelamin-value-perempuan"
value="Perempuan"
/>
<label
class="form-check-label"
for="jenis-kelamin-value-perempuan"
>
Perempuan
</label>
</div>
</div>
<div class="form-group mt-3">
<label for="berat-badan-dalam-bentuk-kg"
>Berat Badan (Kg)</label
>
<input
type="number"
class="form-control mt-1"
id="berat-badan-dalam-bentuk-kg"
name="berat-badan-dalam-bentuk-kg"
placeholder="Masukkan Berat Badan (Kg)"
required
step="any"
/>
</div>
<div class="form-group mt-3">
<label for="tinggi-badan-dalam-bentuk-cm"
>Tinggi Badan (Cm)</label
>
<input
type="number"
class="form-control mt-1"
id="tinggi-badan-dalam-bentuk-cm"
name="tinggi-badan-dalam-bentuk-cm"
placeholder="Masukkan Tinggi Badan (Cm)"
required
step="any"
/>
</div>
<div class="form-group mt-3">
<label for="P01"
>Apakah anak anda memiliki penyakit atau kelainan
congenital atau kondisi lainnya?</label
>
<div class="form-check mt-1">
<input
class="form-check-input"
type="radio"
name="P01"
id="P01-value-ya"
value="ya"
checked
/>
<label class="form-check-label" for="P01-value-ya">
Ya
</label>
</div>
<div class="form-check">
<input
class="form-check-input"
type="radio"
name="P01"
id="P01-value-tidak"
value="tidak"
/>
<label class="form-check-label" for="P01-value-tidak">
Tidak
</label>
</div>
</div>
<div class="form-group mt-3">
<label for="P02"
>Apakah dikeluarga anda, yang memiliki berat badan
berlebih?</label
>
<div class="form-check mt-1">
<input
class="form-check-input"
type="radio"
name="P02"
id="P02-value-ya"
value="ya"
checked
/>
<label class="form-check-label" for="P02-value-ya">
Ya
</label>
</div>
<div class="form-check">
<input
class="form-check-input"
type="radio"
name="P02"
id="P02-value-tidak"
value="tidak"
/>
<label class="form-check-label" for="P02-value-tidak">
Tidak
</label>
</div>
</div>
<div class="form-group mt-3">
<label for="P03"
>Apakah anak anda selalu melakukan aktivitas pasif
seperti menonton tv dll?</label
>
<div class="form-check mt-1">
<input
class="form-check-input"
type="radio"
name="P03"
id="P03-value-ya"
value="ya"
checked
/>
<label class="form-check-label" for="P03-value-ya">
Ya
</label>
</div>
<div class="form-check">
<input
class="form-check-input"
type="radio"
name="P03"
id="P03-value-tidak"
value="tidak"
/>
<label class="form-check-label" for="P03-value-tidak">
Tidak
</label>
</div>
</div>
<div class="form-group mt-3">
<label for="P04"
>Apakah anda selalu memberikan makanan ketika anak anda
menangis?</label
>
<div class="form-check mt-1">
<input
class="form-check-input"
type="radio"
name="P04"
id="P04-value-ya"
value="ya"
checked
/>
<label class="form-check-label" for="P04-value-ya">
Ya
</label>
</div>
<div class="form-check">
<input
class="form-check-input"
type="radio"
name="P04"
id="P04-value-tidak"
value="tidak"
/>
<label class="form-check-label" for="P04-value-tidak">
Tidak
</label>
</div>
</div>
<div class="form-group mt-3">
<label for="P05"
>Jika ada masalah apakah anak anda selalu
melampiaskannya kepada makanan?</label
>
<div class="form-check mt-1">
<input
class="form-check-input"
type="radio"
name="P05"
id="P05-value-ya"
value="ya"
checked
/>
<label class="form-check-label" for="P05-value-ya">
Ya
</label>
</div>
<div class="form-check">
<input
class="form-check-input"
type="radio"
name="P05"
id="P05-value-tidak"
value="tidak"
/>
<label class="form-check-label" for="P05-value-tidak">
Tidak
</label>
</div>
</div>
<button type="submit" class="btn btn-primary btn-block mt-2">
Submit
</button>
{% if error %}
<div
class="mt-3 alert alert-danger d-flex align-items-center"
role="alert"
>
<div>{{ error }}</div>
</div>
{% endif %} {% if success %}
<div
class="mt-3 alert alert-success d-flex align-items-center"
role="alert"
>
<div>{{ success }}</div>
</div>
{% endif %}
</form>
</div>
</div>
</div>
<!-- =========== Scripts ========= -->
<!-- ====== ionicons ======= -->
<script type="module" src="https://unpkg.com/[email protected]/dist/ionicons/ionicons.esm.js"></script>
<script nomodule src="https://unpkg.com/[email protected]/dist/ionicons/ionicons.js"></script>
<script
src="https://cdn.jsdelivr.net/npm/[email protected]/dist/js/bootstrap.bundle.min.js"
integrity="sha384-w76AqPfDkMBDXo30jS1Sgez6pr3x5MlQ1ZAGC+nuZB+EYdgRZgiwxhTBTkF7CXvN"
crossorigin="anonymous"
></script>
<!-- chart js link -->
</body>
</html> |