el>
              <input type="text" name="ket_nyeri" class="form-control" value="{$penilaian_igd.ket_nyeri}" maxlength="40">
            </div>
          </div>
          <div class="col-md-3">
            <div class="form-group">
              <label>Pada Dokter</label>
              <select name="pada_dokter" class="form-control" required>
                <option value="Tidak" {if: $penilaian_igd.pada_dokter == 'Tidak'}selected{/if}>Tidak</option>
                <option value="Ya" {if: $penilaian_igd.pa