<label>Nomor SEP</label>
                      <input type="text" name="no_sep" id="no_sep" class="form-control" value="{$no_sep}"/>
                      <input type="text" style="display: none;" name="no_surkon" id="no_surkon" class="form-control" />
                  </div>
              </div>
              <div class="col-md-6 dokter">
                  <div class="form-group">
                      <label>Dokter</label>
                      <select class="form-control" name="dokter" id="dokter" data-