<?php include 'header.php'; ?>
<?php
include '../koneksi.php';

?>


<div id="wrapper">
    <!-- Sidebar -->
    <!-- Tambahkan Sidebar sesuai template SB Admin -->
    <!-- Content Wrapper -->
    <div id="content-wrapper" class="d-flex flex-column">
        <!-- Main Content -->
        <div id="content">
            <!-- Topbar -->
            <!-- Tambahkan Topbar sesuai template SB Admin -->

            <!-- Begin Page Content -->
            <div class="container-fluid">
                <!-- Page Heading -->
                <h1 class="h3 mb-4 text-gray-800">Data Pasien</h1>
                 
                <!-- Form Tambah Album -->
                <div class="card shadow mb-4">
                    <div class="card-header py-3">
                        <h6 class="m-0 font-weight-bold text-primary">Tambah Pasien</h6>
                    </div>
                    <div class="card-body">
            
                        <form action="pasien_act.php" method="post" enctype="multipart/form-data">
                            
                           
                            <div class="form-group mb-3">
                                <label for="artist_id">NIK Pasien</label>
                                <input type="text" class="form-control" id="artist_id" name="nik" placeholder="Masukkan Nik Pasien" required>
                            </div>
                            <div class="form-group mb-3">
                                <label for="artist_id">Nama Pasien</label>
                                <input type="text" class="form-control" id="artist_id" name="nama_pasien" placeholder="Masukkan Nama Pasien" required>
                            </div>
                            
                            <div class="form-group mb-3">
                                <label for="release_date">Username</label>
                                <input type="text" class="form-control" id="release_date" name="username" required>
                            </div>
                            <div class="form-group mb-3">
                                <label for="release_date">Password</label>
                                <input type="text" class="form-control" id="release_date" name="password" required>
                            </div>

              <div class="form-group">
                  <div class="row">
                     <div class="col-lg-2">
                <input type="submit" class="btn btn-sm btn-primary" value="Simpan">
              </div>

            </form>
                </div>
            </div>
            <!-- /.container-fluid -->
        </div>
        <!-- End of Main Content --><?php include 'footer.php'; ?>