 class="col-md-3">
            <div class="form-group">
              <label>BAK (x/hari)</label>
              <input type="text" name="bak" class="form-control" value="{$penilaian_igd.bak}" maxlength="2">
            </div>
          </div>
          <div class="col-md-3">
            <div class="form-group">
              <label>Frekuensi BAK</label>
              <input type="text" name="xbak" class="form-control" value="{$penilaian_igd.xbak}" maxlength="10">
            </div>
          </div>
        