{"id":382,"date":"2025-09-22T16:50:32","date_gmt":"2025-09-22T09:50:32","guid":{"rendered":"https:\/\/rsinucakramedikamayong.com\/?page_id=382"},"modified":"2025-09-22T18:42:00","modified_gmt":"2025-09-22T11:42:00","slug":"pendaftaran-pasien","status":"publish","type":"page","link":"https:\/\/rsinucakramedikamayong.com\/?page_id=382","title":{"rendered":"Pendaftaran Pasien"},"content":{"rendered":"\n<div class=\"wp-block-contact-form-7-contact-form-selector\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f355-o1\" lang=\"id-ID\" dir=\"ltr\" data-wpcf7-id=\"355\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F382#wpcf7-f355-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulir Kontak\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"355\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"id_ID\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f355-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p><label> Nama<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"nama\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nama\" \/><\/span> <\/label>\n<\/p>\n<p><label> NIK<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-962\"><input size=\"40\" maxlength=\"200\" minlength=\"10\" class=\"wpcf7-form-control wpcf7-text NIK\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-962\" \/><\/span> <\/label>\n<\/p>\n<p><label> Tanggal Lahir<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-684\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date Tanggal Lahir\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-684\" \/><\/span> <\/label>\n<\/p>\n<p><label> Jenis Kelamin<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select-399\"><select class=\"wpcf7-form-control wpcf7-select Jenis Kelamin\" aria-invalid=\"false\" name=\"select-399\"><option value=\"Pilih\">Pilih<\/option><option value=\"Laki-Laki\">Laki-Laki<\/option><option value=\"Perempuan\">Perempuan<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> Whatsapp<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Whatsapp\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Whatsapp\" \/><\/span> <\/label>\n<\/p>\n<p><label> Telepon<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-19\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel No Telpon\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel-19\" \/><\/span> <\/label>\n<\/p>\n<p><label> E-mail anda<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email\" \/><\/span> <\/label>\n<\/p>\n<p><label> Alamat Anda<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-441\"><textarea cols=\"40\" rows=\"10\" maxlength=\"400\" minlength=\"10\" class=\"wpcf7-form-control wpcf7-textarea Alamat\" aria-invalid=\"false\" name=\"textarea-441\">Jl\/gg :\nno :\nKomplek\/Kampung\/Dukuh\/Dusun :\nRT\/RW :\nDesa :\nKecamatan :\nKabupaten :\nProvinsi :<\/textarea><\/span> <\/label>\n<\/p>\n<p><label> Tipe Pasien<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select-158\"><select class=\"wpcf7-form-control wpcf7-select Tipe Pasien\" aria-invalid=\"false\" name=\"select-158\"><option value=\"Pilih\">Pilih<\/option><option value=\"Mandiri\/Umum\">Mandiri\/Umum<\/option><option value=\"BPJS\">BPJS<\/option><option value=\"Asuransi Lain\">Asuransi Lain<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> Berobat Ke Dokter<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select-397\"><select class=\"wpcf7-form-control wpcf7-select Berobat Ke Dokter\" aria-invalid=\"false\" name=\"select-397\"><option value=\"Pilih\">Pilih<\/option><option value=\"Dokter Umum\">Dokter Umum<\/option><option value=\"Dokter Gigi Umum\">Dokter Gigi Umum<\/option><option value=\"Dokter Spesialis Kandungan\">Dokter Spesialis Kandungan<\/option><option value=\"Dokter Spesialis Anak\">Dokter Spesialis Anak<\/option><option value=\"Dokter Spesialis Penyakit Dalam\">Dokter Spesialis Penyakit Dalam<\/option><option value=\"Dokter Bedah\">Dokter Bedah<\/option><option value=\"Vaksinasi Perjalanan Internasional\">Vaksinasi Perjalanan Internasional<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> Rencana Berobat<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-911\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date Rencana Berobat\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-911\" \/><\/span> <\/label>\n<\/p>\n<p><label> Pesan (opsional)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"pesan\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"pesan\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Kirim\" \/>\n<\/p><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"56\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_uag_custom_page_level_css":"","_themeisle_gutenberg_block_has_review":false,"footnotes":""},"class_list":["post-382","page","type-page","status-publish","hentry"],"uagb_featured_image_src":{"full":false,"thumbnail":false,"medium":false,"medium_large":false,"large":false,"1536x1536":false,"2048x2048":false},"uagb_author_info":{"display_name":"AdminRS","author_link":"https:\/\/rsinucakramedikamayong.com\/?author=1"},"uagb_comment_info":0,"uagb_excerpt":null,"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/rsinucakramedikamayong.com\/index.php?rest_route=\/wp\/v2\/pages\/382","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/rsinucakramedikamayong.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/rsinucakramedikamayong.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/rsinucakramedikamayong.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/rsinucakramedikamayong.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=382"}],"version-history":[{"count":6,"href":"https:\/\/rsinucakramedikamayong.com\/index.php?rest_route=\/wp\/v2\/pages\/382\/revisions"}],"predecessor-version":[{"id":396,"href":"https:\/\/rsinucakramedikamayong.com\/index.php?rest_route=\/wp\/v2\/pages\/382\/revisions\/396"}],"wp:attachment":[{"href":"https:\/\/rsinucakramedikamayong.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=382"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}