entripasien.php

?html>

?head>

?title> Entri Data Pasien?/title>

?meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">

?script language="JavaScript">

?!--



function trim(str)

{

return str.replace(/^\s+|\s+$/g,'');

}



function validasipasien()

{

var cpasien, cnama, calamat, cgol_darah, cjkel, ctempat, ctanggal, ctelp;

with (window.document.formpasien)

{

cpasien = textpasien;

cnama = textnama;

calamat = textalamat;

cgol_darah = combodarah;

cjkel = combojkel;

ctempat = texttempat;

ctanggal = texttgl_lahir;

ctelp = texttelp;

}

if (trim(cpasien.value) =='')

{

alert ('silahkan isi dulu kode dengan lengkap');

cpasien.focus();

return false;

}

else

if (trim(cnama.value) =='')

{

alert ('silahkan isi dulu nama dengan lengkap');

cnama.focus();

return false;

}

else

if (trim(calamat.value) =='')

{

alert ('silahkan isi dulu alamat dengan lengkap');

calamat.focus();

return false;

}

else

if (trim(cgol_darah.value) =='')

{

alert ('silahkan isi dulu kode darah pasien');

cgol_darah.focus();

return false;

}

else

if (trim(cjkel.value) =='')

{

alert ('silahkan isi dulu jenis kelamin pasien');

cjkel.focus();

return false;

}

else

if (trim(ctempat.value) =='')

{

alert ('silahkan isi dulu tempat lahir pasien');

ctempat.focus();

return false;

}

else

if (trim(ctelp.value) =='')

{

alert ('silahkan isi dulu nomor telepon pasien');

ctelp.focus();

return false;

}

else

{

cpasien.value =trim(cpasien.value);

cnama.value =trim(cnama.value);

calamat.value =trim(calamat.value);

cgol_darah.value =trim(cgol_darah.value);

cjkel.value =trim(cjkel.value);

ctempat.value =trim(ctempat.value);

ctanggal.value =trim(ctanggal.value);

ctelp.value =trim(ctelp.value);



return true;

}

}

//-->

?/script>

?/head>



?body>

?form action = "simpanpasien.php" onsubmit= "return validasipasien();" method= "post" name= "formpasien" enctype= "multipart/form-data">



?font color = "blue"> ?h3> Entri Data Pasien ?/h3>

?hr>

?table>

?tr>?td align="right"> Kode Pasien: ?/td>

?td>?input id = "textpasien" name= "textpasien" type = "text" maxlength="8" size="8">

?/td>

?/tr>



?tr>?td align="right"> Nama Pasien: ?/td>

?td>?Input id = "textnama" name= "textnama" type = "text" maxlength="25" size="15">

?/td>

?/tr>



?tr>?td align="right"> alamat Pasien: ?/td>

?td>?Input id = "textalamat" name= "textalamat" type = "text" maxlength="8" size="8">

?/td>

?/tr>



?tr>?td align="right"> Golongan Darah: ?/td>

?td>?Select id = "combodarah" name= "combodarah">

?option value = "" selected> ?/option>

?option value = "A" > A ?/option>

?option value = "B" > B ?/option>

?option value = "AB" > AB ?/option>

?option value = "O" > O ?/option>

?/td>

?/tr>



?tr>?td align="right"> Jenis Kelamin: ?/td>

?td>?Select id = "combojk" name= "combojkel">



?option value = "L" > L ?/option>

?option value = "P" > P ?/option>



?/td>

?/tr>



?tr>?td align="right">

?font size="2" color="blue"> Tempat Lahir :?/font>

?/td>



?td>

?input id ="texttempat" name="texttempat" type="text"

maxlenght="15" size="15"

?/td>

?/tr>



?tr>?td align="right">

?font size="2" color="blue"> Tanggal Lahir :?/font>

?/td>



?td>

?input id ="texttgl_lahir" name="texttgl_lahir" type="text"

maxlenght="15" size="15"

?/td>

?/tr>



?tr>?td align="right">

?font size="2" color="blue"> Nomor Telepon:?/font>

?/td>



?td>

?input id ="texttelp" name="texttelp" type="text"

maxlenght="15" size="15"

?/td>

?/tr>



?/table>



?hr>



?input name ="tombolsimpan" type="submit" value="simpan">

?hr>

?/form>

?/body>

?/html>