@include('headeruser')
@include('sweetalerts')

					<!--begin::Content-->
					<div class="content d-flex flex-column flex-column-fluid" id="kt_content">
						<!--begin::Subheader-->
						<div class="subheader py-2 py-lg-4 subheader-solid" id="kt_subheader">
							<div class="container-fluid d-flex align-items-center justify-content-between flex-wrap flex-sm-nowrap">
								<!--begin::Info-->
								<div class="d-flex align-items-center flex-wrap mr-2">
									<!--begin::Page Title-->
									<h5 class="text-dark font-weight-bold mt-2 mb-2 mr-5">{{ $page }}</h5>
									<!--end::Page Title-->
									<!--begin::Actions-->
									
									<div class="subheader-separator subheader-separator-ver mt-2 mb-2 mr-4 bg-gray-200"></div>
									<ul class="breadcrumb breadcrumb-transparent breadcrumb-dot font-weight-bold p-0 my-2 font-size-sm">
										<li class="breadcrumb-item text-muted">
											<a href="" class="text-muted">
												{{ $subpage }}
											</a>
										</li>
										<li class="breadcrumb-item text-muted">
											<a href="" class="text-muted">
												{{ $submenu }}
											</a>
										</li>
									</ul>
									<!--end::Actions-->
								</div>
								<!--end::Info-->
							</div>
						</div>
						<!--end::Subheader-->
						<!--begin::Entry-->
						<div class="d-flex flex-column-fluid">
							<!--begin::Container-->
							<div class="container">

                                <!--begin::Card-->
                                <div class="card card-custom gutter-b">
                                    <div class="card-header">
                                        <div class="card-title">
                                            <h3 class="card-label">{{ Str::upper($submenu) }}</h3>
                                        </div>
                                    </div>
                                    <div class="card-body">

                                        <div class="row" style="margin-bottom: -10px;">
                                            <div class="col-12 col-md-6">
                                                <div class="form-group">
                                                    <label><b>Nama Klinik</b> <small><font color="red">*</font></small></label>
                                                    <select class="form-control form-control-solid SelectClinicClaimReport GetIDClinic" data-link="{{ route("AdminGetIDClinicClaimReport", ":id") }}" data-width="100%" name="id_clinic">
                                                        <option value="">Pilih Nama Klinik</option>
                                                        @foreach ($query_clinic as $data_clinic)
                                                            <option value="{{ $data_clinic->id }}"> {{ Str::upper('('.$data_clinic->id.') '.$data_clinic->name_clinic) }} - {{ $data_clinic->add_1.' '.$data_clinic->add_2.' '.$data_clinic->add_3.' '.$data_clinic->name_postcode.' '.$data_clinic->city.' '.$data_clinic->name_state }}</option>
                                                        @endforeach
                                                    </select>

                                                    @error('id_clinic')
                                                        <font color="#ff0000">{{ $message }}</font>
                                                    @enderror
                                                </div>
                                            </div>
                                            <div class="col-12 col-md-6" id="get_id_clinic">
                                                <div class="form-group">
                                                    <label><b>Bulan / Tahun</b> <small><font color="red">*</font></small></label>
                                                    <div class="input-group input-group-solid date" id="SelectClinicClaim" data-target-input="nearest">
                                                        <input type="text" class="form-control form-control-solid datetimepicker-input GetClinicClaim" name="month_year" placeholder="Pilih Bulan / Tahun" disabled/>
                                                    </div>

                                                    @error('month_year')
                                                        <font color="#ff0000">{{ $message }}</font>
                                                    @enderror
                                                </div>
                                            </div>
                                        </div>

                                    </div>                                    

                                </div>
                                <!--end::Card-->

                                <!--begin::Card-->
                                <div id="get_clinic_claim" class="card card-custom gutter-b">
                                </div>
                                <!--end::Card-->

							</div>
							<!--end::Container-->
							
						</div>
						<!--end::Entry-->
					</div>
                    <!--end::Content-->

                    @include('footer')