<div class="box box-success b-t-non" id='panel-add'>
	<h4 class="labelYellow">
		<i class="fa fa-pencil m-r-15"></i> Form Edit
	</h4>
	<hr class="m-t-0">
	<form method='post' action="<?php echo e(route('editDtKesPas')); ?>" enctype='multipart/form-data'>
		<?php echo e(csrf_field()); ?>

		<div class="box-body">
			<div class='col-lg-12 col-md-12 col-sm-12 col-xs-12 p-0'>
				<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0 p-b-5" id='gr_nik'>
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>NIK Calon Istri</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="text" name="nik" value="<?php echo e($bumil->nik); ?>" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12" readonly>
					</div>
				</div>
				<div class="clearfix"></div>
				<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0 p-b-5" id='gr_reg'>
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>No Registrasi</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<!--<input type="hidden" name="id_identitas_pasangan" value='<?php echo e($kesPas->idenPas->id_identitas_pasangan); ?>' required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">-->
						<input type="hidden" name="id_kesehatan_pasangan" value='<?php echo e($kesPas->id_kesehatan_pasangan); ?>' required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
						<input type="text" name="no_registrasi" value='<?php if($kesPas->identitas_pasangan_id != 0){echo $kesPas->idenPas->no_registrasi;}else{echo "Pindahan / Lanjutan";} ?>' required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12" readonly>
					</div>
					<span class='col-lg-9 col-md-9 col-sm-12 col-xs-12 col-lg-offset-3 col-md-offset-3' id="cek_no_req"></span>
				</div>
				<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0 p-b-5">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Tanggal Registrasi</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12 input-group p-t-0 p-b-0 p-l-15 p-r-15">
						<div class="input-group-addon">
							<i class="fa fa-calendar"></i>
						</div>
						<input type="text" name='tgl_registrasi' value='<?php if($kesPas->identitas_pasangan_id != 0){echo date("d-m-Y", strtotime($kesPas->idenPas->tgl_registrasi));}else{echo "-";} ?>' autocomplete='off' placeholder='dd-mm-yyyy' class="form-control pull-right"  id='form_datetime_today_reg' data-date-format="dd-mm-yyyy" required='required' disabled>
					</div>
				</div>
				<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0 p-b-5">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Nama Calon Suami</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="text" name="nama_suami" value='<?php if($kesPas->identitas_pasangan_id != 0){echo $kesPas->idenPas->nama_suami;}else{echo "$bumil->nama_suami";} ?>' id='namaSuami' required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12" readonly>
					</div>
				</div>
				<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0 p-b-5">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Nama Calon Istri</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="text" name="nama_istri" value='<?php echo e($bumil->nama_bumil); ?>' id="namaIstri" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12" readonly>
					</div>
				</div>
				<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0 p-b-5">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Tanggal Pemeriksaan</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12 input-group p-t-0 p-b-0 p-l-15 p-r-15">
						<div class="input-group-addon">
							<i class="fa fa-calendar"></i>
						</div>
						<input type="text" name='tgl_periksa' value='<?php echo e(date("d-m-Y", strtotime($kesPas->tgl_periksa))); ?>' autocomplete='off' placeholder='dd-mm-yyyy' class="form-control pull-right"  id='form_datetime_today_periksa' data-date-format="dd-mm-yyyy" required='required'>
					</div>
				</div>
			</div>
			<div class="clearfix"></div>
			<h4 class="labelYellow m-0 m-b-5"><i class="fa fa-puzzle-piece m-r-15"></i> 1. POLI UMUM</h4>
			<label class="control-label col-lg-12 col-md-12 col-sm-12 col-xs-12" style="font-size: 18px">Anamnese dan Riwayat Penyakit</label>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>TBC</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="radio" class="customCheck" id="tbc1" value='1' name="tbc" <?php if($kesPas->tbc == '1'){echo "checked";} ?> required="required"><label class="labelRadio" for="tbc1">Ya</label>
					<input type="radio" class="customCheck" id="tbc2" value='2' name="tbc" <?php if($kesPas->tbc == '2'){echo "checked";} ?> required="required"><label class="labelRadio" for="tbc2">Tidak</label>
				</div>
			</div>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Diabetes Militus</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="radio" class="customCheck" id="diabetes1" value='1' name="diabetes" <?php if($kesPas->diabetes == '1'){echo "checked";} ?> required="required"><label class="labelRadio" for="diabetes1">Ya</label>
					<input type="radio" class="customCheck" id="diabetes2" value='2' name="diabetes" <?php if($kesPas->diabetes == '2'){echo "checked";} ?> required="required"><label class="labelRadio" for="diabetes2">Tidak</label>
				</div>
			</div>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Jantung</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="radio" class="customCheck" id="jantung1" value='1' name="jantung" <?php if($kesPas->jantung == '1'){echo "checked";} ?> required="required"><label class="labelRadio" for="jantung1">Ya</label>
					<input type="radio" class="customCheck" id="jantung2" value='2' name="jantung" <?php if($kesPas->jantung == '2'){echo "checked";} ?> required="required"><label class="labelRadio" for="jantung2">Tidak</label>
				</div>
			</div>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Hipertensi</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="radio" class="customCheck" id="hipertensi1" value='1' name="hipertensi" <?php if($kesPas->hipertensi == '1'){echo "checked";} ?> required="required"><label class="labelRadio" for="hipertensi1">Ya</label>
					<input type="radio" class="customCheck" id="hipertensi2" value='2' name="hipertensi" <?php if($kesPas->hipertensi == '2'){echo "checked";} ?> required="required"><label class="labelRadio" for="hipertensi2">Tidak</label>
				</div>
			</div>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Infeksi Kandungan</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="radio" class="customCheck" id="infekKand1" value='1' name="infeksi_kandungan" <?php if($kesPas->infeksi_kandungan == '1'){echo "checked";} ?> required="required"><label class="labelRadio" for="infekKand1">Ya</label>
					<input type="radio" class="customCheck" id="infekKand2" value='2' name="infeksi_kandungan" <?php if($kesPas->infeksi_kandungan == '2'){echo "checked";} ?> required="required"><label class="labelRadio" for="infekKand2">Tidak</label>
				</div>
			</div>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Penyakit Lain</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="radio" class="customCheck" id="penyakitLain1" value='1' name="penyakit_lain" <?php if($kesPas->penyakit_lain == '1'){echo "checked";} ?> required="required"><label class="labelRadio" for="penyakitLain1">Ya</label>
					<input type="radio" class="customCheck" id="penyakitLain2" value='2' name="penyakit_lain" <?php if($kesPas->penyakit_lain == '2'){echo "checked";} ?> required="required"><label class="labelRadio" for="penyakitLain2">Tidak</label>
				</div>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12 col-lg-offset-3 col-md-offset-3 m-b-5" id='namaPenyakitLain' <?php if($kesPas->penyakit_lain == '2'){echo "style='display:none'";} ?>>
					<input type="text" name="nama_penyakit" value='<?php echo e($kesPas->nama_penyakit); ?>' id='nmPenyakit' autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
				</div>
			</div>
			<label class="control-label col-lg-12 col-md-12 col-sm-12 col-xs-12" style="font-size: 18px">Pemeriksaan</label>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Tekanan Darah (mmHg)</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<div class="col-lg-6 col-md-6 col-sm-6 col-xs-6 p-0">
						<label class="control-label col-lg-4 col-md-4 col-sm-6 col-xs-6 p-0" id='label-input'>Sistole</label>
						<div class="col-lg-7 col-md-7 col-sm-5 col-xs-5 p-0">
							<input type="number" name="sistole" value='<?php echo e($kesPas->sistole); ?>' step='any' autocomplete='off' required="required" class="form-control input-sm customInput">
						</div>
					</div>
					<div class="col-lg-6 col-md-6 col-sm-6 col-xs-6 p-0">
						<label class="control-label col-lg-4 col-md-4 col-sm-6 col-xs-6 p-0" id='label-input'>Diastole</label>
						<div class="col-lg-7 col-md-7 col-sm-5 col-xs-5 p-0">
							<input type="number" name="diastole" value='<?php echo e($kesPas->diastole); ?>' step='any' autocomplete='off' required="required" class="form-control input-sm customInput col-md-7 col-xs-12">
						</div>
					</div>
				</div>
			</div>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Kesehatan Umum</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="radio" class="customCheck" id="kesehatanUmum1" value='1' name="kesehatan_umum" <?php if($kesPas->kesehatan_umum == '1'){echo "checked";} ?> required="required"><label class="labelRadio" for="kesehatanUmum1">Baik</label>
					<input type="radio" class="customCheck" id="kesehatanUmum2" value='2' name="kesehatan_umum" <?php if($kesPas->kesehatan_umum == '2'){echo "checked";} ?> required="required"><label class="labelRadio" for="kesehatanUmum2">Kurang</label>
				</div>
			</div>
			<div class="clearfix"></div>
			<h4 class="labelYellow m-0 m-b-5"><i class="fa fa-puzzle-piece m-r-15"></i> 2. POLI KIA</h4>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Imunisasi TT</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="radio" class="customCheck" id="imunTT1" value='1' name="imunisasi_tt" <?php if($kesPas->imunisasi_tt == '1'){echo "checked";} ?> required="required"><label class="labelRadio" for="imunTT1">Ya</label>
					<input type="radio" class="customCheck" id="imunTT2" value='2' name="imunisasi_tt" <?php if($kesPas->imunisasi_tt == '2'){echo "checked";} ?> required="required"><label class="labelRadio" for="imunTT2">Tidak</label>
				</div>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12 col-lg-offset-3 col-md-offset-3 m-b-5" id='inKetImunTT' <?php if($kesPas->imunisasi_tt == '2'){echo "style='display:none'";} ?>>
					<input type="text" name="ket_imun_tt" value='<?php echo e($kesPas->ket_imun_tt); ?>' id='ketImunTT' autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
				</div>
			</div>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Menggunakan Kontrasepsi</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="radio" class="customCheck" id="kontrasepsi1" value='1' name="kontrasepsi" <?php if($kesPas->kontrasepsi == '1'){echo "checked";} ?> required="required"><label class="labelRadio" for="kontrasepsi1">Ya</label>
					<input type="radio" class="customCheck" id="kontrasepsi2" value='2' name="kontrasepsi" <?php if($kesPas->kontrasepsi == '2'){echo "checked";} ?> required="required"><label class="labelRadio" for="kontrasepsi2">Tidak</label>
				</div>
				<div class='col-lg-12 p-0 m-0' id='inkontrasepsi' <?php if($kesPas->kontrasepsi == '2'){echo "style='display:none'";} ?>>
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Jenis</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12 m-b-5">
						<input type="text" name="jenis_kontrasepsi" value='<?php echo e($kesPas->jenis_kontrasepsi); ?>' id='jnsKontrasepsi' autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
					</div>
				</div>
			</div>
			<div class='clearfix'></div>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Ingin punya anak dalam waktu 1 tahun</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="radio" class="customCheck" id="inginAnak1" value='1' name="ingin_anak_batuta" <?php if($kesPas->ingin_anak_batuta == '1'){echo "checked";} ?> required="required"><label class="labelRadio" for="inginAnak1">Ya</label>
					<input type="radio" class="customCheck" id="inginAnak2" value='2' name="ingin_anak_batuta" <?php if($kesPas->ingin_anak_batuta == '2'){echo "checked";} ?> required="required"><label class="labelRadio" for="inginAnak2">Tidak</label>
				</div>
			</div>
			<div class="clearfix"></div>
			<h4 class="labelYellow m-0 m-b-15"><i class="fa fa-puzzle-piece m-r-15"></i> 3. LABORATORIUM</h4>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Hemoglobin (Hb)</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="text" name="hb" value='<?php echo e($kesPas->hb); ?>' required='required' autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
				</div>
			</div>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Tes kehamilan</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="radio" class="customCheck" id="testKehamilan1" value='1' name="test_kehamilan" <?php if($kesPas->test_kehamilan == '1'){echo "checked";} ?> required="required"><label class="labelRadio" for="testKehamilan1">Positif</label>
					<input type="radio" class="customCheck" id="testKehamilan2" value='2' name="test_kehamilan" <?php if($kesPas->test_kehamilan == '2'){echo "checked";} ?> required="required"><label class="labelRadio" for="testKehamilan2">Negatif</label>
				</div>
			</div>
			<div class='clearfix m-b-5'></div>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-5">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Tes lain</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="text" name="test_lain" value='<?php echo e($kesPas->test_lain); ?>' required='required' autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
				</div>
			</div>
			<div class="clearfix"></div>
			<h4 class="labelYellow m-0 m-b-15"><i class="fa fa-puzzle-piece m-r-15"></i> 4. POJOK GIZI</h4>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-5">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Berat badan (Kg)</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="number" name="berat_badan" value='<?php echo e($kesPas->berat_badan); ?>' step='any' required='required' autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
				</div>
			</div>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-5">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Tinggi badan (Cm)</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="number" name="tinggi_badan" value='<?php echo e($kesPas->tinggi_badan); ?>' step='any' required='required' autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
				</div>
			</div>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-5">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Lingkar lengan atas (Cm)</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="number" name="lingkar_lengan_atas" value='<?php echo e($kesPas->lingkar_lengan_atas); ?>' step='any' required='required' autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
				</div>
			</div>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-5">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Lingkar pinggang (Cm)</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="number" name="lingkar_pinggang" value='<?php echo e($kesPas->lingkar_pinggang); ?>' step='any' required='required' autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
				</div>
			</div>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-5">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Lingkar panggul (Cm)</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="number" name="lingkar_panggul" value='<?php echo e($kesPas->lingkar_panggul); ?>' step='any' required='required' autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
				</div>
			</div>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Menerima vitamin pengantin</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="radio" class="customCheck" id="vitPengantin1" value='1' name="vitamin_pengantin" <?php if($kesPas->vitamin_pengantin == '1'){echo "checked";} ?> required="required"><label class="labelRadio" for="vitPengantin1">Ya</label>
					<input type="radio" class="customCheck" id="vitPengantin2" value='2' name="vitamin_pengantin" <?php if($kesPas->vitamin_pengantin == '2'){echo "checked";} ?> required="required"><label class="labelRadio" for="vitPengantin2">Tidak</label>
				</div>
			</div>
			<div class="clearfix m-b-5"></div>
			<div class="col-lg-6 col-md-6 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Menerima buku saku</label>
				<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
					<input type="radio" class="customCheck" id="bukuSaku1" value='1' name="buku_saku" <?php if($kesPas->buku_saku == '1'){echo "checked";} ?> required="required"><label class="labelRadio" for="bukuSaku1">Ya</label>
					<input type="radio" class="customCheck" id="bukuSaku2" value='2' name="buku_saku" <?php if($kesPas->buku_saku == '2'){echo "checked";} ?> required="required"><label class="labelRadio" for="bukuSaku2">Tidak</label>
				</div>
			</div>
			<div class='clearfix p-b-5'></div>
		</div>
		<div class="box-footer">
			<span id='tombol'>
				<button type="submit" class="btn btn-primary pull-right m-l-15">Simpan <span class="fa fa-save"></span></button>
			</span>
			<button type="button" class="btn btn-warning btn-cancel pull-right"><span class="fa fa-chevron-left"></span> Kembali</button>
		</div>
	</form>
</div>
<script type="text/javascript">
	var onLoad = (function() {
		$('#panel-add').animateCss('bounceInUp');
	})();

	$('.btn-cancel').click(function(e){
    	e.preventDefault();
    	$('#panel-add').animateCss('bounceOutDown');
    	$('.other-page').fadeOut(function(){
    		$('.other-page').empty();
            $('.main-layer').fadeIn();
        });
    });

    $('#form_datetime_today_periksa').datetimepicker({
        weekStart: 2,
        todayBtn:  1,
        autoclose: 1,
        todayHighlight: 1,
        startView: 2,
        minView: 2,
        forceParse: 0,
    });

	$('#penyakitLain1').click(function(){
		$('#namaPenyakitLain').show();
		$('#nmPenyakit').attr('required',true);
	});
	$('#penyakitLain2').click(function(){
		$('#namaPenyakitLain').hide();
		$('#nmPenyakit').attr('required',false);
	});	

	$('#imunTT1').click(function(){
		$('#inKetImunTT').show();
		$('#ketImunTT').attr('required',true);
	});
	$('#imunTT2').click(function(){
		$('#inKetImunTT').hide();
		$('#ketImunTT').attr('required',false);
	});

	$('#kontrasepsi1').click(function(){
		$('#inkontrasepsi').show();
		$('#jnsKontrasepsi').attr('required',true);
	});
	$('#kontrasepsi2').click(function(){
		$('#inkontrasepsi').hide();
		$('#jnsKontrasepsi').attr('required',false);
	});	
</script>