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Source: https://dadbaritoutara.com

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  6.    <title>Login Puskesmas</title>
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  24.                <form method="POST" action="https://puskeslinggarjati.com/" accept-charset="UTF-8" class="sign-box" autocomplete="off"><input name="_method" type="hidden" value="PUT"><input name="_token" type="hidden" value="fIxNOhV3Oa5utheMOmYV0IfJXB0d0zOzSMaGEMNx">
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  26.                    <header class="sign-title">
  27.                        Silahkan Masuk
  28.                        <h3><b>Puskes Linggar Jati</b></h3>
  29.                    </header>
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  31.                        <input class="form-control" placeholder="Nama Pengguna" name="username" type="text">
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  35.                        <input class="form-control" placeholder="Kata Sandi" name="password" type="password" value="">
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  38.                    <div class="form-group mt40">
  39.                        <div class="checkbox float-left">
  40.                            <input type="checkbox" id="signed-in"/>
  41.                            <label for="signed-in">Ingatkan Saya</label>
  42.                        </div>
  43.                        <button type="submit" class="btn btn-inline btn-secondary-outline btn-login">
  44.                            Masuk                        </button>
  45.                    </div>
  46.                </form>
  47.            </div>
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