class="form-control" required>
                <option value="Tidak Ada" {if: $penilaian_igd.perdarahan == 'Tidak Ada'}selected{/if}>Tidak Ada</option>
                <option value="Ada" {if: $penilaian_igd.perdarahan == 'Ada'}selected{/if}>Ada</option>
              </select>
            </div>
          </div>
          <div class="col-md-4">
            <div class="form-group">
              <label>Jumlah Perdarahan</label>
              <input type="text" name="jumlah_perdarahan" class="form-control" v