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i_pasien_reg.php
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<?php
sleep(1);
session_start();
//ambil nilai
require("inc/config.php");
require("inc/fungsi.php");
require("inc/koneksi.php");
nocache;
//nilai
$filenya = "$sumber/pasien_reg.php";
$filenyax = "$sumber/i_pasien_reg.php";
$judul = "Formulir Pendaftaran Online";
$juduli = $judul;
//tanggal
$dateku_now = "$tanggal/$bulan/$tahun";
$dateku = date_create(''.$tahun.'-'.$bulan.'-'.$tanggal.'');
date_add($dateku, date_interval_create_from_date_string('10 days'));
$dateku_batas = date_format($dateku, 'd/m/Y');
$dateku = date_create(''.$tahun.'-'.$bulan.'-'.$tanggal.'');
date_add($dateku, date_interval_create_from_date_string('1 days'));
$dateku_besok = date_format($dateku, 'd/m/Y');
//ambil nilai
$aksi = nosql($_GET['aksi']);
$norm = nosql($_SESSION['norm']);
$kdku = nosql($_SESSION['kdku']);
//PROSES ////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////
//jika daftar1
if ($aksi == "daftar")
{
$kdku = nosql($_SESSION['kdku']);
//jika null, bikin sesi
if (empty($kdku))
{
//bikin session
$_SESSION['kdku'] = $x;
}
$kdku = nosql($_SESSION['kdku']);
?>
<script language='javascript'>
//membuat document jquery
$(document).ready(function(){
$("#e_tgl_lahir").datepicker();
<?php
//jika selesai
if (!empty($_SESSION['selesai']))
{
?>
$("#iform").load("<?php echo $filenyax;?>?aksi=daftar4");
<?php
}
else
{
?>
$("#btnSMP").on('click', function(){
$("#formx21").submit(function(){
$.ajax({
url: "<?php echo $filenyax;?>?aksi=simpan",
type:$(this).attr("method"),
data:$(this).serialize(),
success:function(data){
$("#iproses").show();
$("#ihasil1").html(data);
setTimeout('$("#iproses").hide()',1000);
$("#iform").load("<?php echo $filenyax;?>?aksi=daftar2");
$('.myimage2').attr('src', 'img/proses21.png');
$('.myimage1').attr('src', 'img/proses1.png');
$('.myimage3').attr('src', 'img/proses3.png');
$('.myimage4').attr('src', 'img/proses4.png');
}
});
return false;
});
});
$('#provinsi').change(function() {
var provinsi = $(this).val();
$.ajax({
type: 'POST',
url: 'i_alamat.php',
data: 'id_provinsi=' + provinsi,
success: function(response) {
$('#kabupaten').html(response);
}
});
});
$('#kabupaten').change(function() {
var kabupaten = $(this).val();
$.ajax({
type: 'POST',
url: 'i_alamat.php',
data: 'id_kabupaten=' + kabupaten,
success: function(response) {
$('#kecamatan').html(response);
}
});
});
<?php
}
?>
$('#datepickerku').on('changeDate', function() {
$("#e_tglku").val($('#datepickerku').datepicker('getFormattedDate'));
});
var active_dates = [<?php echo $daku_tgl;?>];
$("#datepickerku").datepicker({
format: "dd/mm/yyyy",
startDate: "<?php echo $dateku_now;?>",
endDate: "<?php echo $dateku_batas;?>",
autoclose: true,
todayHighlight: true,
beforeShowDay: function(date){
var d = date;
var curr_date = d.getDate();
var curr_month = d.getMonth() + 1; //Months are zero based
var curr_year = d.getFullYear();
var formattedDate = curr_date + "/" + curr_month + "/" + curr_year
if ($.inArray(formattedDate, active_dates) != -1){
return {
classes: 'activeClass'
};
}
return;
}
});
});
</script>
<?php
//detail edit..
$qpok = mysqli_query($koneksi, "SELECT * FROM pasien ".
"WHERE kd = '$kdku'");
$rpok = mysqli_fetch_assoc($qpok);
$pok_nama = balikin($rpok['nama']);
$pok_alamat_jalan = balikin($rpok['alamat_jalan']);
$pok_alamat_rt = balikin($rpok['alamat_rt']);
$pok_alamat_rw = balikin($rpok['alamat_rw']);
$pok_alamat_kodepos = balikin($rpok['alamat_kodepos']);
$pok_propinsi = balikin($rpok['propinsi']);
$pok_kabupaten = balikin($rpok['kabupaten']);
$pok_kecamatan = balikin($rpok['kecamatan']);
$pok_kelurahan = balikin($rpok['kelurahan']);
$pok_tmp_lahir = balikin($rpok['tmp_lahir']);
$pok_tgl_lahir = balikin($rpok['tgl_lahir']);
$pok_title = balikin($rpok['title']);
$pok_kelamin = balikin($rpok['kelamin']);
//propinsi
$query = mysqli_query($koneksi, "SELECT * FROM provinsi ".
"WHERE id_prov = '$pok_propinsi'");
$row = mysqli_fetch_assoc($query);
$pok_propinsi = balikin($row['nama']);
//kabupaten
$query = mysqli_query($koneksi, "SELECT * FROM kabupaten ".
"WHERE id_kab = '$pok_kabupaten'");
$row = mysqli_fetch_assoc($query);
$pok_kabupaten = balikin($row['nama']);
//kecamatan
$query = mysqli_query($koneksi, "SELECT * FROM kecamatan ".
"WHERE id_kec = '$pok_kecamatan'");
$row = mysqli_fetch_assoc($query);
$pok_kecamatan = balikin($row['nama']);
//pecah
$pecahku = explode("-", $pok_tgl_lahir);
$lahir_thn = $pecahku[0];
$lahir_bln = $pecahku[1];
$lahir_tgl = $pecahku[2];
//jika null
if ($lahir_thn == "0000")
{
$pok_tgl_lahir = "$tanggal/$bulan/$tahun";
}
else
{
$pok_tgl_lahir = "$lahir_tgl/$lahir_bln/$lahir_thn";
}
//periksa
$qpok2 = mysqli_query($koneksi, "SELECT * FROM pasien_periksa ".
"WHERE kd_pasien = '$kdku'");
$rpok2 = mysqli_fetch_assoc($qpok2);
$pok2_tgl_periksa = $rpok2['tgl_periksa'];
$pok2_poli_nama = balikin($rpok2['poli_nama']);
//pecah
$pecahku = explode("-", $pok2_tgl_periksa);
$book_thn = $pecahku[0];
$book_bln = $pecahku[1];
$book_tgl = $pecahku[2];
//jika null
if ($book_thn == "0000")
{
$book_tgl2 = "$tanggal/$bulan/$tahun";
}
else
{
$book_tgl2 = "$book_tgl/$book_bln/$book_thn";
}
?>
<form name="formx21" id="formx21">
<table border="0" cellpadding="3" cellspacing="3" width="100%">
<tr valign="top" bgcolor="white">
<td width="10">
</td>
<td>
<hr>
<table border="0" cellpadding="3" cellspacing="3" width="100%">
<tr valign="top">
<td width="550" bgcolor="white">
<h3>
BOOKING PERIKSA
</h3>
<table border="0" cellpadding="3" cellspacing="3" width="100%" bgcolor="<?php echo $warna02;?>">
<tr>
<td width="100">
<p>
POLI
</p>
</td>
<td width="10">
<p>
:
</p>
</td>
<td>
<p>
<select name="e_poli" id="e_poli" class="btn btn-info">
<option value="<?php echo $pok2_poli_nama;?>" selected><?php echo $pok2_poli_nama;?></option>';
<?php
//jenis bayar
$qku = mysqli_query($koneksi, "SELECT * FROM m_poli ".
"ORDER BY nama ASC");
$rku = mysqli_fetch_assoc($qku);
do
{
//nilai
$ku_kd = nosql($rku['kd']);
$ku_nama = balikin($rku['nama']);
echo '<option value="'.$ku_nama.'">'.$ku_nama.'</option>';
}
while ($rku = mysqli_fetch_assoc($qku));
?>
</select>
</p>
</td>
</tr>
<tr>
<td width="100">
<p>
TANGGAL
</p>
</td>
<td width="10">
<p>
:
</p>
</td>
<td>
<p>
<input name="datepickerku" id="datepickerku" type="text" value="<?php echo $book_tgl2;?>" class="btn btn-info">
<input name="e_tglku" id="e_tglku" type="hidden">
</p>
</td>
</tr>
</table>
<hr>
<h3>DATA DIRI PASIEN</h3>
<p>
Title :
<br>
<select name="e_title" id="e_title" class="btn btn-info">
<option value="<?php echo $pok_title;?>" selected>- <?php echo $pok_title;?> -</option>
<option value="Bapak">Bapak</option>
<option value="Ibu">Ibu</option>
<option value="Saudara">Saudara</option>
<option value="Saudari">Saudari</option>
</select>
</p>
<p>
Nama :
<br>
<input name="e_nama" id="e_nama" type="text" size="30" value="<?php echo $pok_nama;?>" class="btn btn-info">
</p>
<p>
Tempat, Tanggal Lahir :
<br>
<input name="e_tmp_lahir" id="e_tmp_lahir" type="text" size="20" value="<?php echo $pok_tmp_lahir;?>" class="btn btn-info">,
<input name="e_tgl_lahir" id="e_tgl_lahir" type="text" size="10" value="<?php echo $pok_tgl_lahir;?>" class="btn btn-info">
</p>
<p>
Jenis Kelamin :
<br>
<select name="e_kelamin" id="e_kelamin" class="btn btn-info">
<option value="<?php echo $pok_kelamin;?>" selected>- <?php echo $pok_kelamin;?> -</option>
<option value="L">Laki - Laki</option>
<option value="P">Perempuan</option>
</select>
</p>
</td>
<td width="50">
</td>
<td bgcolor="white">
<h3>DATA TEMPAT TINGGAL PASIEN</h3>
<p>
Propinsi :
<br>
<?php
//Dapatkan semua
$query = mysqli_query($koneksi, "SELECT * FROM provinsi ".
"ORDER BY nama ASC");
$row = mysqli_fetch_assoc($query);
?>
<select name="provinsi" id="provinsi" class="btn btn-info">
<option value="<?php echo $pok_propinsi;?>">- <?php echo $pok_propinsi;?> -</option>
<?php
do
{
$r_idprov = nosql($row['id_prov']);
$r_nama = balikin($row['nama']);
echo '<option value="'.$r_idprov.'">'.$r_nama.'</option>';
}
while ($row = mysqli_fetch_assoc($query));
?>
</select>
</p>
<p>
Kabupaten / Kota :
<br>
<select name="kabupaten" id="kabupaten" class="btn btn-info">
<option value="<?php echo $pok_kabupaten;?>">- <?php echo $pok_kabupaten;?> -</option>
</select>
</p>
<p>
Kecamatan :
<br>
<select name="kecamatan" id="kecamatan" class="btn btn-info">
<option value="<?php echo $pok_kecamatan;?>">- <?php echo $pok_kecamatan;?> -</option>
</select>
</p>
<p>
Kelurahan :
<br>
<input name="e_kelurahan" id="e_kelurahan" type="text" size="10" value="<?php echo $pok_kelurahan;?>" class="btn btn-info">
</p>
<p>
Jalan :
<br>
<input name="e_alamat_jalan" id="e_alamat_jalan" type="text" size="50" value="<?php echo $pok_alamat_jalan;?>" class="btn btn-info">
</p>
<p>
RT/RW :
<br>
<input name="e_alamat_rt" id="e_alamat_rt" type="text" size="5" value="<?php echo $pok_alamat_rt;?>" class="btn btn-info">
/
<input name="e_alamat_rw" id="e_alamat_rw" type="text" size="5" value="<?php echo $pok_alamat_rw;?>" class="btn btn-info">
</p>
<p>
Kode Pos :
<br>
<input name="e_kodepos" id="e_kodepos" type="text" size="5" value="<?php echo $pok_alamat_kodepos;?>" class="btn btn-info">
</p>
</td>
</tr>
</table>
<hr>
<table border="0" cellpadding="3" cellspacing="3" width="100%">
<tr valign="top">
<td align="right">
<input name="btnSMP" id="btnSMP" type="submit" value="SELANJUTNYA >>" class="btn btn-danger">
</td>
</tr>
</table>
<hr>
</td>
<td width="10">
</td>
</tr>
</table>
</form>
<?php
}
//jika simpan entri
if ($aksi == "simpan")
{
//ambil nilai
$e_nama = trim(cegah($_GET["e_nama"]));
$e_provinsi = trim(cegah($_GET["provinsi"]));
$e_kabupaten = trim(cegah($_GET["kabupaten"]));
$e_kecamatan = trim(cegah($_GET["kecamatan"]));
$e_kelurahan = trim(cegah($_GET["e_kelurahan"]));
$e_alamat = trim(cegah($_GET["e_alamat_jalan"]));
$e_alamat_rt = trim(cegah($_GET["e_alamat_rt"]));
$e_alamat_rw = trim(cegah($_GET["e_alamat_rw"]));
$e_kodepos = trim(cegah($_GET["e_kodepos"]));
$e_tmp_lahir = trim(cegah($_GET["e_tmp_lahir"]));
$e_title = trim(cegah($_GET["e_title"]));
$e_kelamin = trim(cegah($_GET["e_kelamin"]));
$e_tgl_lahir = trim(cegah($_GET["e_tgl_lahir"]));
$e_norm = trim(cegah($_GET["e_norm"]));
$e_poli = trim(cegah($_GET["e_poli"]));
$e_tglku = trim(balikin($_GET["e_tglku"]));
//pecah tanggal
$pecahku = explode("/", $e_tglku);
$tg_tgl = trim($pecahku[0]);
$tg_bln = trim($pecahku[1]);
$tg_thn = trim($pecahku[2]);
$tgl_booking = "$tg_thn:$tg_bln:$tg_tgl";
//kode booking
$booking_kode = $passbaru;
//pecah tanggal
$e_tgl2 = balikin($e_tgl_lahir);
$pecahku = explode("/", $e_tgl2);
$e_tgl2_bln = $pecahku[0];
$e_tgl2_tgl = $pecahku[1];
$e_tgl2_thn = $pecahku[2];
$e_tgl_lahir = "$e_tgl2_thn:$e_tgl2_bln:$e_tgl2_tgl";
//ambil sesi
$kdku = nosql($_SESSION['kdku']);
//cek
if ((empty($e_alamat)) OR (empty($e_nama)) OR (empty($e_tgl_lahir)))
{
echo "<h3>ENTRI TIDAK LENGKAP</h3>";
exit();
}
else
{
//cek
$qcc = mysqli_query($koneksi, "SELECT * FROM m_pasien ".
"WHERE kd = '$kdku'");
$tcc = mysqli_num_rows($qcc);
//jika null
if (empty($tcc))
{
//insert
mysqli_query($koneksi, "INSERT INTO pasien(kd, nama, alamat_jalan, alamat_rt, alamat_rw, alamat_kodepos, propinsi, kabupaten, kecamatan, ".
"kelurahan, tmp_lahir, tgl_lahir, title, kelamin, postdate) VALUES ".
"('$kdku', '$e_nama', '$e_alamat', '$e_alamat_rt', '$e_alamat_rw', '$e_kodepos', '$e_provinsi', '$e_kabupaten', '$e_kecamatan', ".
"'$e_kelurahan', '$e_tmp_lahir', '$e_tgl_lahir', '$e_title', '$e_kelamin', '$today');");
}
else
{
//update
mysqli_query($koneksi, "UPDATE pasien SET nama = '$e_nama', ".
"alamat_jalan = '$e_alamat', ".
"alamat_rt = '$e_alamat_rt', ".
"alamat_rw = '$e_alamat_rw', ".
"alamat_kodepos = '$e_kodepos', ".
"propinsi = '$e_provinsi', ".
"kabupaten = '$e_kabupaten', ".
"kecamatan = '$e_kecamatan', ".
"kelurahan = '$e_kelurahan', ".
"tmp_lahir = '$e_tmp_lahir', ".
"tgl_lahir = '$e_tgl_lahir', ".
"title = '$e_title', ".
"kelamin = '$e_kelamin', ".
"postdate = '$today' ".
"WHERE kd = '$kdku'");
}
//insert
mysqli_query($koneksi, "INSERT INTO pasien_periksa(kd, kd_pasien, tgl_periksa, poli_nama, kode_booking, postdate) VALUES ".
"('$x', '$kdku', '$tgl_booking', '$e_poli', '$booking_kode', '$today');");
//update
mysqli_query($koneksi, "UPDATE pasien SET kode_booking = '$booking_kode' ".
"WHERE kd = '$kdku'");
echo "<font color=red>
<b>ENTRI BERHASIL</b>
</font>";
exit();
}
exit();
}
//jika daftar2
if ($aksi == "daftar2")
{
//ambil sesi
$kdku = nosql($_SESSION['kdku']);
?>
<script language='javascript'>
//membuat document jquery
$(document).ready(function(){
<?php
//jika selesai
if (!empty($_SESSION['selesai']))
{
?>
$("#iform").load("<?php echo $filenyax;?>?aksi=daftar4");
<?php
}
else
{
?>
$("#btnSMP2").on('click', function(){
$("#formx22").submit(function(){
$.ajax({
url: "<?php echo $filenyax;?>?aksi=simpan2",
type:$(this).attr("method"),
data:$(this).serialize(),
success:function(data){
$("#iproses").show();
$("#ihasil2").html(data);
setTimeout('$("#iproses").hide()',1000);
$("#iform").load("<?php echo $filenyax;?>?aksi=daftar3");
$('.myimage3').attr('src', 'img/proses31.png');
$('.myimage2').attr('src', 'img/proses2.png');
$('.myimage1').attr('src', 'img/proses1.png');
$('.myimage4').attr('src', 'img/proses4.png');
}
});
return false;
});
});
$("#btnBACK").on('click', function(){
$("#iform").load("<?php echo $filenyax;?>?aksi=daftar");
$('.myimage1').attr('src', 'img/proses11.png');
$('.myimage2').attr('src', 'img/proses2.png');
$('.myimage3').attr('src', 'img/proses3.png');
$('.myimage4').attr('src', 'img/proses4.png');
});
$('#provinsi2').change(function() {
var provinsi = $(this).val();
$.ajax({
type: 'POST',
url: 'i_alamat.php',
data: 'id_provinsi=' + provinsi,
success: function(response) {
$('#kabupaten2').html(response);
}
});
});
$('#kabupaten2').change(function() {
var kabupaten = $(this).val();
$.ajax({
type: 'POST',
url: 'i_alamat.php',
data: 'id_kabupaten=' + kabupaten,
success: function(response) {
$('#kecamatan2').html(response);
}
});
});
<?php
}
?>
});
</script>
<form name="formx22" id="formx22">
<?php
//detail..
$qyuk = mysqli_query($koneksi, "SELECT * FROM pasien ".
"WHERE kd = '$kdku'");
$ryuk = mysqli_fetch_assoc($qyuk);
$yuk_jenis_identitas = balikin($ryuk['jenis_identitas']);
$yuk_no_identitas = balikin($ryuk['no_identitas']);
$yuk_agama = balikin($ryuk['agama']);
$yuk_telepon = balikin($ryuk['telepon']);
$yuk_email = balikin($ryuk['email']);
$yuk_pendidikan = balikin($ryuk['pendidikan']);
$yuk_pekerjaan = balikin($ryuk['pekerjaan']);
$yuk_suku = balikin($ryuk['suku']);
$yuk_rhesus = balikin($ryuk['rhesus']);
$yuk_warga_negara = balikin($ryuk['warga_negara']);
$yuk_gol_darah = balikin($ryuk['gol_darah']);
$yuk_status_nikah = balikin($ryuk['status_nikah']);
//keluarga
$qjuk = mysqli_query($koneksi, "SELECT * FROM pasien_keluarga ".
"WHERE kd_pasien = '$kdku'");
$rjuk = mysqli_fetch_assoc($qjuk);
$juk_nama_ayah = balikin($rjuk['nama_ayah']);
$juk_nama_ibu = balikin($rjuk['nama_ibu']);
$juk_nama_keluarga = balikin($rjuk['nama_keluarga']);
$juk_nama_pasangan = balikin($rjuk['nama_pasangan']);
$juk_propinsi = balikin($rjuk['propinsi']);
$juk_kabupaten = balikin($rjuk['kabupaten']);
$juk_kecamatan = balikin($rjuk['kecamatan']);
$juk_kelurahan = balikin($rjuk['kelurahan']);
$juk_alamat_jalan = balikin($rjuk['alamat_jalan']);
$juk_alamat_rt = balikin($rjuk['alamat_rt']);
$juk_alamat_rw = balikin($rjuk['alamat_rw']);
$juk_alamat_kodepos = balikin($rjuk['alamat_kodepos']);
//propinsi
$query = mysqli_query($koneksi, "SELECT * FROM provinsi ".
"WHERE id_prov = '$juk_propinsi'");
$row = mysqli_fetch_assoc($query);
$juk_propinsi = balikin($row['nama']);
//kabupaten
$query = mysqli_query($koneksi, "SELECT * FROM kabupaten ".
"WHERE id_kab = '$juk_kabupaten'");
$row = mysqli_fetch_assoc($query);
$juk_kabupaten = balikin($row['nama']);
//kecamatan
$query = mysqli_query($koneksi, "SELECT * FROM kecamatan ".
"WHERE id_kec = '$juk_kecamatan'");
$row = mysqli_fetch_assoc($query);
$juk_kecamatan = balikin($row['nama']);
?>
<table border="0" cellpadding="3" cellspacing="3" width="100%">
<tr valign="top" bgcolor="white">
<td width="10">
</td>
<td>
<hr>
<table border="0" cellpadding="3" cellspacing="3" width="100%">
<tr valign="top" bgcolor="white">
<td width="500">
<h3>DATA LENGKAP PASIEN</h3>
<p>
Nomor Identitas :
<br>
<select name="e_jenis" id="e_jenis" class="btn btn-info">
<option value="<?php echo $yuk_jenis_identitas;?>" selected>- <?php echo $yuk_jenis_identitas;?> -</option>
<option value="KTP">KTP</option>
<option value="SIM">SIM</option>
</select>,
<input name="e_jenis_no" id="e_jenis_no" type="text" size="20" value="<?php echo $yuk_no_identitas;?>" class="btn btn-info">
</p>
<p>
Agama :
<br>
<select name="e_agama" id="e_agama" class="btn btn-info">
<option value="<?php echo $yuk_agama;?>" selected>- <?php echo $yuk_agama;?> -</option>
<?php
//daftar agama
$qyuk = mysqli_query($koneksi, "SELECT * FROM m_agama ".
"ORDER BY nama ASC");
$ryuk = mysqli_fetch_assoc($qyuk);
do
{
$yuk_kd = nosql($ryuk['kd']);
$yuk_nama = balikin($ryuk['nama']);
echo '<option value="'.$yuk_nama.'">'.$yuk_nama.'</option>';
}
while ($ryuk = mysqli_fetch_assoc($qyuk));
?>
</select>
</p>
<p>
Nomor Telepon :
<br>
<input name="e_telp" id="e_telp" type="text" size="20" value="<?php echo $yuk_telepon;?>" class="btn btn-info">
</p>
<p>
E-Mail :
<br>
<input name="e_email" id="e_email" type="text" size="20" value="<?php echo $yuk_email;?>" class="btn btn-info">
</p>
<p>
Pendidikan :
<br>
<select name="e_pddkn" id="e_pddkn" class="btn btn-info">
<option value="<?php echo $yuk_pendidikan;?>" selected>- <?php echo $yuk_pendidikan;?> -</option>
<?php
//daftar
$qyuk = mysqli_query($koneksi, "SELECT * FROM m_pendidikan ".
"ORDER BY nama ASC");
$ryuk = mysqli_fetch_assoc($qyuk);
do
{
$yuk_kd = nosql($ryuk['kd']);
$yuk_nama = balikin($ryuk['nama']);
echo '<option value="'.$yuk_nama.'">'.$yuk_nama.'</option>';
}
while ($ryuk = mysqli_fetch_assoc($qyuk));
?>
</select>
</p>
<p>
Pekerjaan :
<br>
<select name="e_pekerjaan" id="e_pekerjaan" class="btn btn-info">
<option value="<?php echo $yuk_pekerjaan;?>" selected>- <?php echo $yuk_pekerjaan;?> -</option>
<?php
//daftar
$qyuk = mysqli_query($koneksi, "SELECT * FROM m_pekerjaan ".
"ORDER BY nama ASC");
$ryuk = mysqli_fetch_assoc($qyuk);
do
{
$yuk_kd = nosql($ryuk['kd']);
$yuk_nama = balikin($ryuk['nama']);
echo '<option value="'.$yuk_nama.'">'.$yuk_nama.'</option>';
}
while ($ryuk = mysqli_fetch_assoc($qyuk));
?>
</select>
</p>
<p>
Suku :
<br>
<select name="e_suku" id="e_suku" class="btn btn-info">
<option value="<?php echo $yuk_suku;?>" selected>- <?php echo $yuk_suku;?> -</option>