eauths.onecallcm.com
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Submitted URL: https://eauths.onecallcm.com/Auths/621629_938734_270261_ZmlFHNq52huixlhgViMdeix6WJnYJYxbJ4jJawgT0GY.aspx
Effective URL: https://eauths.onecallcm.com/profiles/621629_938734_270261_ZmlFHNq52huixlhgViMdeix6WJnYJYxbJ4jJawgT0GY.aspx
Submission: On November 08 via manual from US — Scanned from DE
Effective URL: https://eauths.onecallcm.com/profiles/621629_938734_270261_ZmlFHNq52huixlhgViMdeix6WJnYJYxbJ4jJawgT0GY.aspx
Submission: On November 08 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
Name: aspnetForm — POST https://eauths.onecallcm.com/Profile.aspx?repid=621629&aid=938734&authid=270261&token=ZmlFHNq52huixlhgViMdeix6WJnYJYxbJ4jJawgT0GY
<form name="aspnetForm" method="post" action="https://eauths.onecallcm.com/Profile.aspx?repid=621629&aid=938734&authid=270261&token=ZmlFHNq52huixlhgViMdeix6WJnYJYxbJ4jJawgT0GY" id="aspnetForm">
<div>
<input type="hidden" name="sigNbr" id="sigNbr" value="0">
<input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE" value="/wEPDwULLTE5OTMzNzY1OTFkZDG0aJ49jSJ5A0SW98xrCs/hJM2NPbkqKEKMdacUgHcC">
</div>
<div>
<input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="BA87ED80">
</div>
<div>
<div>
<script>
function ChangeFont() {
var t = Math.round(document.getElementById("sigNbr").value);
t++;
if (t > 6) t = 0;
document.getElementById("sigNbr").value = t;
document.getElementById("sig1").src = String.format("/imagegenerator.aspx?t={0}&name={1} {2}", t, document.getElementById("fname").value, document.getElementById("lname").value);
//Ext.get("sig1").src = "imagegenerator.aspx?t=2&name=Bob Dombroski";
}
function RefreshImage() {
var t = Math.round(document.getElementById("sigNbr").value);
document.getElementById("sig1").src = String.format("/imagegenerator.aspx?t={0}&name={1} {2}", t, document.getElementById("fname").value, document.getElementById("lname").value);
}
function SetQuestion(question) {
document.getElementById("question").value = question;
}
//document.forms[0].action = "/" + document.forms[0].action;
var str = document.forms[0].action;
if (str.substring(4, 0) == "http") str = str.replace("/profiles/", "/");
else str = "/" + document.forms[0].action;
document.forms[0].action = str;
</script>
<br><br>
<table width="70%">
<tbody>
<tr>
<td width="10%"></td>
<td valign="top">
<font color="red"></font><br>
<font color="red">Since this is the first time you are using the One Call Care Dental + Doctor Electronic Authorization Service, we need to set up your Electronic Authorization Profile</font><br>
</td>
</tr>
</tbody>
</table>
<table width="80%">
<tbody>
<tr>
<td width="10%"></td>
<td valign="top">
<div class="x-box" id="ext-gen7">
<div class="x-box-tl">
<div class="x-box-tr">
<div class="x-box-tc"></div>
</div>
</div>
<div class="x-box-ml">
<div class="x-box-mr">
<div class="x-box-mc" id="ext-gen8">
<table width="100%" id="p1">
<tbody>
<tr>
<td colspan="2" align="center">
<b>Your Personalized Electronic Authorization Profile</b>
</td>
</tr>
<tr>
<td colspan="2">
<br>
<hr><b>Security Question/Anwser</b>
<br>Anytime you authorize a service using the One Call Care Dental + Doctor Electronic Authorization service, the question you enter below will will be asked and the response must match what you enter as the anwser here.
You can enter any question you would like or use one of these common ones below simply by clicking on one.<br><br>
<a href="javascript:SetQuestion('What is your mother\'s maiden name?')">What is your mother's maiden name?</a><br>
<a href="javascript:SetQuestion('What was your 1st grade teacher\'s name?')">What was your 1st grade teacher's name?</a><br>
<a href="javascript:SetQuestion('What was the name of your first pet?')">What was the name of your first pet?</a><br>
<a href="javascript:SetQuestion('What is the name of your favorite fruit?')">What is the name of your favorite fruit?</a><br>
<a href="javascript:SetQuestion('What is the name of your favorite fish?')">What is the name of your favorite fish?</a><br><br>
</td>
</tr>
<tr>
<td> Question: </td>
<td><input type="text" name="question" size="64" id="question" value=""> </td>
</tr>
<tr>
<td> Answer: </td>
<td><input type="text" name="anwser" id="anwser" value=""> </td>
</tr>
<tr>
<td colspan="2">
<hr>
</td>
</tr>
<tr>
<td colspan="2">
<br><b>Signature Information</b>
<br>When you authorize a service using the One Call Care Dental + Doctor Electronic Authorization service, the One Call Care Dental + Doctor system will generate authorization documents using the information in your
profile. You can control what name and the style of the signature that will be put on the documents. <br><br>
</td>
</tr>
<tr>
</tr>
<tr>
<td width="180"> First Name: </td>
<td><input type="text" name="fname" id="fname" value="Julie " onchange="RefreshImage()"></td>
</tr>
<tr>
<td> Last Name: </td>
<td><input type="text" name="lname" id="lname" value="Schaumberg" onchange="RefreshImage()"> </td>
</tr>
<tr>
<td> Signature: </td>
<td><img id="sig1" name="sig1" src="/imagegenerator.aspx?t=0&name=Julie++Schaumberg"><br> [<a href="javascript:ChangeFont("2")">Try a Different Signature Look</a>] </td>
</tr>
<tr>
<td colspan="2" align="center"><br>
<input type="submit" name="save" value="Save">
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<div class="x-box-bl">
<div class="x-box-br">
<div class="x-box-bc"></div>
</div>
</div>
</div>
</td>
<td width="100"></td>
<td valign="top">
<div class="x-box x-box-blue" id="ext-gen11">
<div class="x-box-tl">
<div class="x-box-tr">
<div class="x-box-tc"></div>
</div>
</div>
<div class="x-box-ml">
<div class="x-box-mr">
<div class="x-box-mc" id="ext-gen12">
<table width="100%" id="profileHelp">
<tbody>
<tr>
<td colspan="2" align="center">
<b>Electronic Authorization Profile</b>
</td>
</tr>
<tr>
<td colspan="2"> You are in control or your own custom electronic authorization. By setting up your profile you can define how the One Call Care Dental + Doctor Electronic Authorization applies
authorizations to your request's <br><br>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<div class="x-box-bl">
<div class="x-box-br">
<div class="x-box-bc"></div>
</div>
</div>
</div>
<div class="x-box x-box-blue" id="ext-gen9">
<div class="x-box-tl">
<div class="x-box-tr">
<div class="x-box-tc"></div>
</div>
</div>
<div class="x-box-ml">
<div class="x-box-mr">
<div class="x-box-mc" id="ext-gen10">
<table width="100%" id="c2">
<tbody>
<tr>
<td colspan="2" align="center">
<b>About One Call Care Dental + Doctor Electronic Authorizations</b>
</td>
</tr>
<tr>
<td colspan="2"> One Call Care Dental + Doctor Electronic Authorization helps save both time and money by eliminating the faxing of authorization documents. <br><br> When an
authorization is needed, the One Call Care Dental + Doctor team will generate an email with a link in it. The receiver of the email can simply either click on or copy the link into any web browser and view the
authorization electronically. If the receiver wants to grant authorization for the service they can apply their custom authorization defined within their authorization profile. </td>
</tr>
</tbody>
</table>
</div>
</div>
</div>
<div class="x-box-bl">
<div class="x-box-br">
<div class="x-box-bc"></div>
</div>
</div>
</div>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</form>Text Content
Since this is the first time you are using the One Call Care Dental + Doctor Electronic Authorization Service, we need to set up your Electronic Authorization Profile Your Personalized Electronic Authorization Profile -------------------------------------------------------------------------------- Security Question/Anwser Anytime you authorize a service using the One Call Care Dental + Doctor Electronic Authorization service, the question you enter below will will be asked and the response must match what you enter as the anwser here. You can enter any question you would like or use one of these common ones below simply by clicking on one. What is your mother's maiden name? What was your 1st grade teacher's name? What was the name of your first pet? What is the name of your favorite fruit? What is the name of your favorite fish? Question: Answer: -------------------------------------------------------------------------------- Signature Information When you authorize a service using the One Call Care Dental + Doctor Electronic Authorization service, the One Call Care Dental + Doctor system will generate authorization documents using the information in your profile. You can control what name and the style of the signature that will be put on the documents. First Name: Last Name: Signature: [Try a Different Signature Look] Electronic Authorization Profile You are in control or your own custom electronic authorization. By setting up your profile you can define how the One Call Care Dental + Doctor Electronic Authorization applies authorizations to your request's About One Call Care Dental + Doctor Electronic Authorizations One Call Care Dental + Doctor Electronic Authorization helps save both time and money by eliminating the faxing of authorization documents. When an authorization is needed, the One Call Care Dental + Doctor team will generate an email with a link in it. The receiver of the email can simply either click on or copy the link into any web browser and view the authorization electronically. If the receiver wants to grant authorization for the service they can apply their custom authorization defined within their authorization profile.