<style media="screen">
  table td,
  table th {
    padding: 5px;
  }
</style>
<div class="modal-header">
    <button type="button" class="close" data-dismiss="modal" aria-label="Close"><span aria-hidden="true">&times;</span> Tutup</button>
    <h4 class="modal-title">e-Resep</h4>
</div>
<div class="modal-body">
  <div class="row" id="form_rincian_eresep">
    <div class="col-md-12">
      <div class="panel panel-default">
        <div class="panel-body">
          <div class="form-horizontal">
            