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  • Nama: Putri Sirajuddin NIM: 17.042.AF Kelas: Reguler A

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    Dinda
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    PUTRI

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    3 views3 pages

    Nama: Putri Sirajuddin NIM: 17.042.AF Kelas: Reguler A

    Uploaded by

    Dinda

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    NAMA: PUTRI SIRAJUDDIN

    NIM : 17.042.AF

    KELAS: REGULER A

    <!DOCTYPE html>

    <html>

    <head>

    <title>Apotek Diploma D3 Farmasi Yamasi Makassar</title>

    </head>

    <body>

    <link rel="stylesheet" href="style.css">

    <h2><marquee>Form pengimputan Data</marquee></h2>

    <p><a href="index.php">Home</a></p>

    <form action="tambah-proses.php" method="post">

    <table cellpadding="5" cellspacing="0">

    <tr>

    <td>No. Registrasi Obat</td>

    <td>:</td>

    <td><input type="text" name="no_reg"required></td>

    </tr>

    <tr>

    <td>Nama Generik</td>

    <td>:</td>

    <td><input type="text" name="nm_gen" size="20" required></td>

    </tr>

    <tr>
    <td>Nama Paten</td>

    <td>:</td>

    <td><input type="text" name="nm_ptn" size="50" required></td>

    </tr>

    <tr>

    <td>Kemasan/Sediaan</td>

    <td>:</td>

    <td>

    <input type="radio" name="kms" value="Tablet" required>Tablet

    <input type="radio" name="kms" value="Injeksi" required>Injeksi

    <input type="radio" name="kms" value="Injeksi" required>Kapsul

    </td>

    </tr>

    <tr>

    <td>Kadar/Komposisi Obat</td>

    <td>:</td>

    <td>

    <select name="type_Obat"required="0">

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

    <option value="Keras">Rakotik</option>

    <option value="Resep Dokter">Resep</option>

    </select>

    </td>

    <tr>

    <td>Alamat PBF</td>
    <td>:</td>

    <td>

    <textarea name="alamat" cols="30" rows="4" required></textarea>

    </td>

    </tr>

    <tr>

    <td>NO HP PBF</td>

    <td>:</td>

    <td>

    <input type="text" name="no_hp_pbf"required>

    </td>

    </tr>

    <tr>

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

    <td>

    <input type="submit" value="TAMBAH" name="tambah">

    </td>

    </tr>

    </table>

    </form>

    </body>

    </html>

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