{{-- Tab Umum --}}
<div class="row g-3">
    <div class="col-md-3">
        <label class="form-label">Kode Faskes <span class="text-danger">*</span></label>
        <input type="text" id="{{ $prefix }}_kode" class="form-control form-control-sm text-uppercase" maxlength="20" placeholder="Contoh: SLOAM" style="text-transform:uppercase">
        <div class="invalid-feedback" id="err_{{ $prefix }}_kode"></div>
        <div class="form-text">Digunakan pada nomor PPB</div>
    </div>
    <div class="col-md-6">
        <label class="form-label">Nama <span class="text-danger">*</span></label>
        <input type="text" id="{{ $prefix }}_nama" class="form-control form-control-sm text-uppercase" maxlength="255" style="text-transform:uppercase">
        <div class="invalid-feedback" id="err_{{ $prefix }}_nama"></div>
    </div>
    <div class="col-md-3">
        <label class="form-label">Tipe <span class="text-danger">*</span></label>
        <select id="{{ $prefix }}_tipe" class="form-select form-select-sm">
            <option value="RS">Rumah Sakit</option>
            <option value="Klinik">Klinik</option>
            <option value="Puskesmas">Puskesmas</option>
            <option value="Apotek">Apotek</option>
            <option value="Lainnya">Lainnya</option>
        </select>
    </div>
    <div class="col-md-12">
        <label class="form-label">Alamat</label>
        <textarea id="{{ $prefix }}_alamat" class="form-control form-control-sm" rows="2"></textarea>
    </div>
    <div class="col-md-5">
        <label class="form-label">Kota</label>
        <input type="text" id="{{ $prefix }}_kota" class="form-control form-control-sm" maxlength="100">
    </div>
    <div class="col-md-5">
        <label class="form-label">Provinsi</label>
        <input type="text" id="{{ $prefix }}_provinsi" class="form-control form-control-sm" maxlength="100">
    </div>
    <div class="col-md-4">
        <label class="form-label">Telepon</label>
        <input type="text" id="{{ $prefix }}_telepon" class="form-control form-control-sm" maxlength="20">
    </div>
    <div class="col-md-5">
        <label class="form-label">Email</label>
        <input type="email" id="{{ $prefix }}_email" class="form-control form-control-sm" maxlength="100">
        <div class="invalid-feedback" id="err_{{ $prefix }}_email"></div>
    </div>
    <div class="col-md-3 d-flex align-items-end">
        <div class="form-check">
            <input class="form-check-input" type="checkbox" id="{{ $prefix }}_has_gudang_kso">
            <label class="form-check-label" for="{{ $prefix }}_has_gudang_kso">
                Memiliki Gudang KSO
            </label>
        </div>
    </div>
    <div class="col-md-4">
        <label class="form-label">Mode Pengiriman</label>
        <select id="{{ $prefix }}_mode_pengiriman" class="form-select form-select-sm">
            <option value="normal">Normal</option>
            <option value="per_lot">Serial Number</option>
        </select>
        <div class="form-text">Untuk PPB &amp; pemakaian barang</div>
    </div>
    <div class="col-md-4">
        <label class="form-label">Mode Penjualan</label>
        <select id="{{ $prefix }}_mode_penjualan" class="form-select form-select-sm">
            <option value="normal">Normal</option>
            <option value="normal_pasien">Normal + Identitas Pasien</option>
            <option value="per_lot">Per Serial Number / LOT</option>
            <option value="per_merek">Per Merek</option>
        </select>
        <div class="form-text">Untuk faktur &amp; cetak faktur KSO</div>
    </div>
    <div class="col-md-4">
        <label class="form-label">Mode Pemakaian</label>
        <select id="{{ $prefix }}_mode_pemakaian" class="form-select form-select-sm">
            <option value="normal">Normal</option>
            <option value="serial_number">Serial Number</option>
        </select>
        <div class="form-text">Untuk form pemakaian barang KSO</div>
    </div>
</div>