<commit_before><!DOCTYPE html>
<html>
  <head>
    <meta charset="utf-8">
    <title>Cepat Sembuh</title>
    <link rel="stylesheet" href="css/bootstrap.css">
    <link rel="stylesheet" href="css/material.css">
    <link rel="stylesheet" href="css/style.css">
    <link rel="stylesheet" href="css/theme.css">
    <link rel="stylesheet" href="bower_components/font-awesome/css/font-awesome.css">
  </head>
  <body align="center">
    <div class="mdl-layout mdl-js-layout mdl-layout--fixed-header
            mdl-layout--fixed-tabs">
      <header class="mdl-layout__header">
        <div class="mdl-layout__header-row">
          <!-- Tobat -->
          <span class="mdl-layout-Tobat"><h4>Cepat Sembuh</h4></span>
        </div>      
      </header>
      <div class="mdl-layout__drawer">
        <span class="mdl-layout-Tobat"><h5>Cepat Sembuh</h5></span>        
      </div>
      <main class="mdl-layout__content">
        <section class="mdl-layout__tab-panel is-active" id="fixed-tab-1">
          <center>
          <div class="page-content">
          <form method="get" id="form-puskesmas.html" action="state-puskesmas.html" name="puskes-form">
              <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label">
                <input class="mdl-textfield__input" type="text" id="nama">
                <label class="mdl-textfield__label" for="nama">Nama</label>
              </div><br>
              <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label">
                <input class="mdl-textfield__input" type="text" id="no-bpjs">
                <label class="mdl-textfield__label" for="title">Nomor BPJS</label>
              </div><br>
              <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label">
                <input class="mdl-textfield__input" type="text" id="nik">
                <label class="mdl-textfield__label" for="title">NIK</label>
              </div><br>
              <select class="form-control" style="width:300px;" id="sex">
                <option disabled>--Sex--</option>
                <option>Laki-laki</option>
                <option>Perempuan</option>
              </select><br>
              <input type="date" class="form-control" style="width:300px;" id="date">
              <br>
              <!-- <select class="form-control" style="width:300px;" id="province">
                <option disabled>--Province--</option>
                <option value="">DKI Jakarta</option>
              </select><br> -->
              <!-- <select class="form-control" style="width:300px;" id="state" onchange="gotoPage(this)">
                <option disabled>--State--</option>
                <option value="index_jakut.html">Jakarta Utara</option>
                <option value="index_jakbar.html">Jakarta Barat</option>
                <option value="index_jatim.html">Jakarta Timur</option>
                <option value="index_japus.html">Jakarta Pusat</option>
                <option value="index_jaksel.html">Jakarta Selatan</option>
              </select><br> -->
              <input type="submit" class="mdl-button mdl-js-button mdl-button--raised mdl-js-ripple-effect mdl-button--accent" value="Submit">
            </form>
          </div>
        </center>
        </section>
      </main>
    </div>
    <script>
      function valid() {
          var valid = true;

          // Validate Hospital
          if (document.hospital-form.no-bpjs.value == "") {
            alert("Mohon mengisi form dengan benar")
            valid = false;
          };

          // Validate Puskesmas
          if (document.puskes-form.no-bpjs.value == "") {
            alert("Mohon mengisi form dengan benar")
            valid = false;
          };<commit_msg>Puskesmas update<commit_after><!DOCTYPE html>
<html>
  <head>
    <meta charset="utf-8">
    <title>Cepat Sembuh</title>
    <link rel="stylesheet" href="css/bootstrap.css">
    <link rel="stylesheet" href="css/material.css">
    <link rel="stylesheet" href="css/style.css">
    <link rel="stylesheet" href="css/theme.css">
    <link rel="stylesheet" href="bower_components/font-awesome/css/font-awesome.css">
  </head>
  <body align="center">
    <div class="mdl-layout mdl-js-layout mdl-layout--fixed-header
            mdl-layout--fixed-tabs">
      <header class="mdl-layout__header">
        <div class="mdl-layout__header-row">
          <!-- Tobat -->
          <span class="mdl-layout-Tobat"><h4>Cepat Sembuh</h4></span>
        </div>      
      </header>
      <div class="mdl-layout__drawer">
        <span class="mdl-layout-Tobat"><h5>Cepat Sembuh</h5></span>        
      </div>
      <main class="mdl-layout__content">
        <section class="mdl-layout__tab-panel is-active" id="fixed-tab-1">
          <center>
          <div class="page-content">
          <form method="get" action="state-puskesmas.html" name="hospital-form">
              <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label">
                <input class="mdl-textfield__input" type="text" id="nama">
                <label class="mdl-textfield__label" for="nama">Nama</label>
              </div><br>
              <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label">
                <input class="mdl-textfield__input" type="text" id="no-bpjs">
                <label class="mdl-textfield__label" for="title">Nomor BPJS</label>
              </div><br>
              <div class="mdl-textfield mdl-js-textfield mdl-textfield--floating-label">
                <input class="mdl-textfield__input" type="text" id="nik">
                <label class="mdl-textfield__label" for="title">NIK</label>
              </div><br>
              <select class="form-control" style="width:300px;" id="sex">
                <option disabled>--Sex--</option>
                <option>Laki-laki</option>
                <option>Perempuan</option>
              </select><br>
              <input type="date" class="form-control" style="width:300px;" id="date">
              <br>
              <!-- <select class="form-control" style="width:300px;" id="province">
                <option disabled>--Province--</option>
                <option value="">DKI Jakarta</option>
              </select><br> -->
              <!-- <select class="form-control" style="width:300px;" id="state" onchange="gotoPage(this)">
                <option disabled>--State--</option>
                <option value="index_jakut.html">Jakarta Utara</option>
                <option value="index_jakbar.html">Jakarta Barat</option>
                <option value="index_jatim.html">Jakarta Timur</option>
                <option value="index_japus.html">Jakarta Pusat</option>
                <option value="index_jaksel.html">Jakarta Selatan</option>
              </select><br> -->
              <input type="submit" class="mdl-button mdl-js-button mdl-button--raised mdl-js-ripple-effect mdl-button--accent" value="Submit">
            </form>
          </div>
        </center>
        </section>
      </main>
    </div>
    <script>
      function valid() {
          var valid = true;

          // Validate Puskesmas
          if (document.puskes-form.no-bpjs.value == "") {
            alert("Mohon mengisi form dengan benar")
            valid = false;
          };
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