gi 71</option>
                <option value="gg_81">Gigi 81</option>
                <option value="gg_82">Gigi 82</option>
                <option value="gg_83">Gigi 83</option>
                <option value="gg_84">Gigi 84</option>
                <option value="gg_85">Gigi 85</option>
              </select>
            </div>
          </div>
          <div class="col-md-6">
            <div class="form-group">
              <label for="hasil">Kondisi Pemeriksaan</label>
              <select name="kon