platform.emmiqa.com Open in urlscan Pro
104.129.79.216  Public Scan

Form analysis
1 forms found in the DOM

Name: LoginForm —

<form id="LoginForm" name="LoginForm" class="Login-form undefined" novalidate="">
  <fieldset class="u-clearfix">
    <div class="Login-formInputs">
      <div class="Login-formGroup" data-test="LoginForm-AccessCodeField"><label for="AccessCodeField">Access Code:</label><input type="number" class="Login-formControl" id="AccessCodeField" name="accessCode" tabindex="1" pattern="\d*" maxlength="11"
          title="Access code, 11-digit number expected" aria-label="Access code, 11-digit number expected" value=""></div>
      <div class="Login-formGroup" data-test="LoginForm-DOBField"><label for="DOBField">Patient's Date of Birth:</label><input type="text" pattern="[0-9]*" class="Login-formControl" id="DOBField" name="dob" placeholder="mm/dd/yyyy" tabindex="2"
          maxlength="10" inputmode="numeric" title="Date of birth, 2-digit month, 2-digit day, 4-digit year" aria-label="Date of birth, 2-digit month, 2-digit day, 4-digit year" value=""></div>
      <div class="Login-formGroup EmailFieldWrapper" data-test="LoginForm-EmailField"><label for="EmailField" aria-hidden="true">Email</label><input type="text" id="EmailField" class="Login-emailControl" tabindex="-1" value=""></div>
    </div>
    <div class="Login-formAction" data-test="LoginForm-LoginButton"><button class="Button Button--blue" type="submit" title="Log In" aria-label="Log In"><span class="Button-text">Log In</span></button></div><input type="hidden" name="sso"
      value=""><input type="hidden" name="skey" value=""><input type="hidden" name="selectedLocale" value="">
  </fieldset>
</form>

Text Content

Access Code:
Patient's Date of Birth:
Email
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