alue="{$penilaian_igd.jumlah_perdarahan}" maxlength="5">
            </div>
          </div>
        </div>

        <div class="row">
          <div class="col-md-6">
            <div class="form-group">
              <label>Warna Perdarahan</label>
              <input type="text" name="warna_perdarahan" class="form-control" value="{$penilaian_igd.warna_perdarahan}" maxlength="40">
            </div>
          </div>
          <div class="col-md-6">
            <div class="form-group">
              <labe