Scribd Logo
Upload

Welcome to Scribd!

  • Nama: Dinda Damayanti Kelas: Reguler A NIM: 17.014.AF

    Uploaded by

    Dinda
    4 views3 pages

    Original Title

    Nama

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    4 views3 pages

    Nama: Dinda Damayanti Kelas: Reguler A NIM: 17.014.AF

    Uploaded by

    Dinda

    Copyright:

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

    Nama : Dinda Damayanti

    Kelas : Reguler A

    NIM : 17.014.AF

    <!DOCTYPE html>

    <html>

    <head>

    <title>Apotek selalu selamanya</title>

    </head>

    <body>

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

    <h2><marquee>form penginputan 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>

    </td>

    <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="kapsul" required> kapsul

    </td>

    </tr>

    <tr>

    <td>Kadar/komposisi obat</td>

    <td>:</td>

    <td>

    <select name="type_obat" required="">

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

    <option value= "">50mg</option>

    <option value= "">100mg</option>

    </select>

    </td>

    </tr>

    <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>

    You might also like