Nama : Jihan Putri Yuga Pradewinta

Nim : 30519062

Prodi : D3-RMIK’19

Kelas = B

Mata Kuliah =ALGORITMA DAN PEMOGRAMAN

Dosen= Bu Anggia

Membuat Formulir Pendaftaran Pasien Rawat Jalan

Hasil Program pada chrome =

Hasil kembali ke halaman utama=
 - Hasil menuju ke website IIKBW=

 KODING SYNTAX PADA DREAMWEAVER=

<style type="text/css">

<!--

.style1 {

font-size: 24px;

font-weight: bold;

-->

</style>
 <div align="center">

<legend class="style1"><img src="Logo_IIK_BW_fix_new (1).png" width="187"

height="65" /></legend>

</div>

<div align="center">

<legend class="style1">Rumah Sakit Bhakti Wiyata Kediri</legend>

<legend> Jl. KH Wachid Hasyim No.65, Bandar Lor, Kec. Mojoroto, Kota Kediri, Jawa
Timur 64114</legend>

<legend> Website. <a href="https://www.iik.ac.id/"> iik.ac.id </a> </legend>

<p>&nbsp;</p>

</div>

<div align="center">

<legend><strong>Formulir Pendaftaran Pasien Rawat Jalan</strong></legend>

</div>

</div>

</div>

<form method="post" action="hasilformjihan.php">

<fieldset>

<legend>Identitas Pasien</legend>

<table border="0">

<style>

body {

background-color: #66CCFF

</style>

<tr>
 <td>Nomor ID.(KTP/SIM/Paspor)</td>

<td>:</td>

<td><input type="text"name="Noktp"></td>

</tr>

<tr>

<td>Nomor Rekam Medis</td>

<td>:</td>

<td><input type="text" name="norm"></td>

</tr>

<tr>

<td>Nama Pasien</td>

<td>:</td>

<td><select name="inisial" size="1">

<option value="pilih">-Pilih-</option>

<option>Tn.</option>

<option>Ny.</option>

<option>By.</option>

<option>Nn.</option>

<option>An.</option>

</select>

<input type="text" name="nama"></td>

<td>&nbsp;</td>

</tr>

<tr>

<td>Tempat Lahir</td>
 <td>:</td>

<td><input type="text" name="tempatlahir"></td>

</tr>

<tr>

<td>Tanggal Lahir</td>

<td>:</td>

<td>

<select name="tanggallahir">

<option value="Tanggal">Tanggal</option>

<?php

for ($i=1; $i<=31 ; $i++) {

?>

<option value="<?php echo $i; ?>"><?php echo $i; ?></option>

<?php

?>

</select>

<select name="bulan">

<option value="Bulan">Bulan</option>

<?php

for ($i=1; $i<=12 ; $i++) {

?>

<option value="<?php echo $i; ?>"><?php echo $i; ?></option>

<?php

}
 ?>

</select>

<select name="tahun">

<option value="Tahun">Tahun</option>

<?php

for ($i=1990; $i<=2021 ; $i++) {

?>

<option value="<?php echo $i; ?>"><?php echo $i; ?></option>

<?php

?>

</select></td>

<td>&nbsp;</td>

<td>&nbsp;</td>

</tr>

<tr>

<td>Usia</td>

<td>:</td>

<td><input type="text" name="usia"></td>

</tr>

<tr>

<td>Jenis Kelamin</td>

<td>:</td>

<td>

<input name="JK" type="radio" id="pria" value="pria" checked="checked" />

<label for="Pria">Pria</label>

<input name="JK" type="radio" id="wanita" value="wanita" />

<label for="Wanita">Wanita</label></td>

</tr>

<tr>

<td>Alamat Lengkap </td>

<td>:</td>

<td><textarea name="alamat" cols="15" rows="3"></textarea></td>

</tr>

<tr>

<td>Agama</td>

<td>:</td>

<td><select name="agama" size="1">

<option value="">Agama</option>

<option>Islam</option>

<option>Kristen</option>

<option>Katolik</option>

<option>Hindu</option>

<option>Buddha</option>

</select></td>

</tr>

<tr>

<td>Kewarganegaraan</td>

<td>:</td>

<td><select name="kewarganegaraan" size="1">

 <option value="">-Pilih-</option>

<option>WNI</option>

<option>WNA</option>

</select>

</td>

</tr>

<tr>

<td>Pendidikan</td>

<td>:</td>

<td><select name="pendidikan" size="1">

<option>SD</option>

<option>SMP</option>

<option>SLTA / Sederajat</option>

<option>D3/Sederajat</option>

<option>Sarjana/Sederajat</option>

</select>

</td>

</tr>

<tr>

<td>Pekerjaan</td>

<td>:</td>

<td><input type="text"name="pekerjaan"></td>

</tr>

<tr>

<td>Status Pernikahan</td>
 <td>:</td>

<td><select name="status" size="1">

<option value="">Status</option>

<option>Menikah</option>

<option>Belum Menikah</option>

<option>Janda</option>

<option>Duda</option>

</select></td>

</tr>

<tr>

<td>Golongan Darah</td>

<td>:</td>

<td>

<input name="Goldarah" type="radio" id="A" value="A" checked="checked" />

<label for="A">A</label>

<input name="Goldarah" type="radio" id="AB" value="AB" />

<label for="AB">AB</label>

<input name="Goldarah" type="radio" id="B" value="B" />

<label for="B">B</label>

<input name="Goldarah" type="radio" id="O" value="AB" />

<label for="O">O</label></td>

</tr>

<tr>

<td>Cara Pembayaran</td>

<td>:</td>
<td><select name="pembayaran" size="1">

<option value="pembayaran">-Pilih-</option>

<option>Asuransi/BPJS</option>

<option>Umum/Mandiri</option>

</select>

</td>

</tr>

<tr>

<td>Nama Penanggung Jawab</td>

<td>:</td>

<td><input type="text" name="Penanggungjawab"></td>

</tr>

<tr>

<td>No.Tlp/HP</td>

<td>:</td>

<td><input type="text" name="notelp"></td>

</tr>

<tr>

<td>Poli yang dituju </td>

<td>:</td>

<td><select name="poli">

<option value="">-Pilih-</option>

<option value="Umum">Umum</option>

<option value="Dalam">Dalam</option>

<option value="THT">THT</option>
 <option value="Anak">Anak</option>

<option value="Kandungan">Kandungan & Kebidanan (Obgyn)</option>

<option value="Gigi">Gigi & Mulut</option>

<option value="Mata">Mata</option>

<option value="Kulit">Kulit & Kelamin</option>

</select> </td>

</tr>

<tr>

<td>Nama Dokter</td>

<td>:</td>

<td><input type="text" name="namadokter"></td>

</tr>

<tr>

<td>Cara Kunjungan</td>

<td>:</td>

<td><select name="carakunjungan">

<option value="carakunjungan">-Pilih-</option>

<option value="Datang Sendiri">Datang sendiri</option>

<option value="Rujukan">Rujukan</option>

</select>

</td>

</tr>

<tr>

<td>Tanggal Pendaftaran</td>

<td>:</td>
 <td>

<?php

//kombinasi format tanggal dan jam

echo date('l, d-m-Y h:i:s a');

?>

</td></tr>

<td>&nbsp;</td>

<tr>

<td><div align="center"><strong>Nomor Urut Kunjungan Pasien</strong></div></td>

</tr>

<tr>

<td>Nomor Kunjungan Pasien</td>

<td>:</td>

<td><input type="text" name="inisialisasi"></td>

</tr>

<tr>

<td> Batas </td>

<td>:</td>

<td><input type="text"name="Batas"></td>

</tr>

<tr>

<td>Jenis sorting</td>

<td>:</td>

<td><select name="jenis">
<option value="">-Pilih-</option>

<option value="Ascending">Ascending</option>

<option value="Descending">Descending</option>

</select></td>

</tr>

<tr>

<td colspan="2"></td>

<td>

<input type="submit" value="Registrasi"/>

<input type="reset" value="Clear"/>

<input type="reset" value="Reset"></td>

</tr>

<td>&nbsp;</td>

</tr>

</table>

</fieldset>

</form>

</body>
  Koding Untuk Menampilkan File (.php)=

<html>

<body>

<table border="0">

<tr>

<td>Nomor ID.(KTP/SIM/Paspor)</td>

<td>:</td>

<td colspan="1"><?php echo $_POST["Noktp"];?></td>

</tr>

<tr>

<td>Nomor Rekam Medis</td>

<td>:</td>

<td colspan="1"><?php echo $_POST["norm"];?></td>

</tr>

<tr>

<td>Nama Pasien</td>

<td>:</td>

<td colspan="1"><?php echo $_POST["inisial"];?><?php echo

$_POST["nama"];?></td>

<td colspan="1">&nbsp;</td>

</tr>

<tr>

<td>Tempat Lahir</td>

<td>:</td>

<td colspan="1"><?php echo $_POST["tempatlahir"];?></td>

 <tr>

<td>Tanggal Lahir</td>

<td>:</td>

<td><?php echo $_POST["tanggallahir"];?>

-<td colspan="1"><?php echo $_POST["bulan"];?></td>

<td>-

<td colspan="1"><?php echo $_POST["tahun"];?></td>

<td><td colspan="1">&nbsp;</td>

</tr>

<tr>

<td>Jenis Kelamin</td>

<td>:</td>

<td colspan="1"><?php echo $_POST["JK"];?></td>

</tr>

<tr>

<td>Usia</td>

<td>:</td>

<td colspan="1"><?php echo $_POST["usia"];?></td>

</tr>

<tr>

<td>Alamat Lengkap </td>

<td>:</td>

<td colspan="1"><?php echo $_POST["alamat"];?></td>

</tr>
 <tr>

<td>Agama</td>

<td>:</td>

<td colspan="1"><?php echo $_POST["agama"];?></td>

</tr>

<tr>

<td>Kewarganegaraan</td>

<td>:</td>

<td colspan="1"><?php echo $_POST["kewarganegaraan"];?></td>

</tr>

<tr>

<td>Pendidikan</td>

<td>:</td>

<td colspan="1"><?php echo $_POST["pendidikan"];?></td>

</tr>

<tr>

<td>Pekerjaan</td>

<td>:</td>

<td colspan="1"><?php echo $_POST["pekerjaan"];?></td>

</tr>

<tr>

<td>Status</td>

<td>:</td>

<td colspan="1"><?php echo $_POST["status"];?></td>

</tr>
 <tr>

<td>Golongan Darah</td>

<td>:</td>

<td colspan="1"><?php echo $_POST["Goldarah"];?></td>

</tr>

<td>Cara Pembayaran</td>

<td>:</td>

<td colspan="1"><?php echo $_POST["pembayaran"];?></td>

</tr>

<tr>

<td>Nama Penanggung Jawab</td>

<td>:</td>

<td colspan="1"><?php echo $_POST["Penanggungjawab"];?></td>

</tr>

<tr>

<td>No.Tlp/HP</td>

<td>:</td>

<td colspan="1"><?php echo $_POST["notelp"];?></td>

</tr>

<tr>

<td>Poli yang dituju</td>

<td>:</td>
 <td colspan="1"><?php echo $_POST["poli"];?></td>

</tr>

<tr>

<td>Nama Dokter</td>

<td>:</td>

<td colspan="1"><?php echo $_POST["namadokter"];?></td>

</tr>

<tr>

<td>Cara Kunjungan</td>

<td>:</td>

<td colspan="1"><?php echo $_POST["carakunjungan"];?></td>

</tr>

<tr>

<td>Tanggal Pendaftaran</td>

<td>:</td>

<td>

<?php

//kombinasi format tanggal dan jam

echo date('l, d-m-Y h:i:s a');

?>

<tr>

<td>Nomor Kunjungan Pasien</td>

</tr>
 </table>

<br> <a href="formulirjihan.php">Kembali ke Halaman Utama</a>

<?php

echo "<br>";

echo "nomor urut pasien adalah:";

echo "</br>";

$a=$_POST ['inisialisasi'];

$b=$_POST ['Batas'];

$c=$_POST ['jenis'];

if($b>$a && $c=="Ascending"){

for ($i=$a; $i<=$b; $i++){

echo "$i<br>";

elseif ($b>$a && $c=="Descending") {

for ($i=$b; $a<=$i; $i--) {

echo "$i<br>";

}
?>

</body>

</html>