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Submitted URL: http://e-casebook.com/
Effective URL: https://www.e-casebook.com/
Submission: On May 19 via manual from JP — Scanned from JP

Form analysis 1 forms found in the DOM

<form class="gathering-form">
  <dl class="gathering-list">
    <dt class="gathering-list__team">
      <label class="gathering__label" for="jds-id"> 日本循環器学会 専門医番号（※半角数字） </label>
    </dt>
    <dd class="gathering-list__description">
      <input type="text" data-bind="textInput: $data.otherSystemObjectId" id="jds-id" class="form-control member-id">
      <p style="font-size: 1.4rem; margin-top: 2px;">専門医番号をお持ちで無い場合は「000」とご入力ください。</p>
    </dd>
  </dl>
  <!-- ko if: registeredExperienceCount === 0 --> <!-- ko if: isNeedConfirmUserName() -->
  <dl class="gathering-list">
    <dt class="gathering-list__team">
      <label class="gathering__label" for="user_name">Name（例: 山田 太郎）:</label>
    </dt>
    <dd class="gathering-list__description">
      <input type="text" name="user_name" id="user_name" class="form-control gathering__input" data-bind="value: user.name, css: { 'gathering__input--error': noticeWarningFor('name') }">
      <p class="gathering__message--error" data-bind="visible: noticeWarningFor('name')">Please enter Kanji, Hiragana and Katakana</p>
    </dd>
  </dl>
  <!-- /ko -->
  <!-- ko if: isNeedConfirmUserBirthday() -->
  <dl class="gathering-list">
    <dt class="gathering-list__team"><label class="gathering__label" for="birthday-year">BOD :</label></dt>
    <dd class="gathering-list__description">
      <select data-bind="options: getSelectableYears(),
                         value: selectedBirthday.year,
                         optionsCaption: getSelectableYearsCaption()" class="form-control gathering__select" id="birthday-year"></select>
      <!-- 生年月日の月 -->
      <select data-bind="options: getSelectableMonths(),
                         value: selectedBirthday.month,
                         optionsCaption: getSelectableMonthsCaption()" class="form-control gathering__select" id="birthday-month"></select>
      <!-- 生年月日の日 -->
      <select data-bind="options: getSelectableDays(selectedBirthday.year, selectedBirthday.month),
                       value: selectedBirthday.date,
                       optionsCaption: getSelectableDaysCaption()" class="form-control gathering__select" id="birthday-date"></select>
    </dd>
  </dl>
  <!-- /ko -->
  <dl class="gathering-list">
    <dt class="gathering-list__team"><label class="gathering__label" for="country">Country :</label></dt>
    <dd class="gathering-list__description">
      <select data-bind="options: countries,
                         optionsText: 'name',
                         value: selectedCountry,
                         optionsCaption: getSelectableCountryCaption()" class="form-control gathering__select" id="country"></select>
    </dd>
    <!-- ko if: isEnablePrefectures() -->
    <dt class="gathering-list__team"><label class="gathering__label" for="prefecture"> Prefecture<!-- ko if: lang !== 'ja' --> (Japanese only)<!-- /ko --> :</label></dt>
    <dd class="gathering-list__description">
      <select data-bind="options: prefectures,
                         optionsText: 'name',
                         value: selectedPrefecture,
                         optionsCaption: getSelectablePrefectureCaption()" class="form-control gathering__select" id="prefecture"></select>
    </dd>
    <!-- /ko -->
    <dt class="gathering-list__team">
      <label class="gathering__label" for="organizationName">Organization&lt;span class="label__sub-text"&gt;(hospital, university, company, etc.)&lt;/span&gt;:</label>
      <span class="organization__number"> <!-- ko if: !isVisibleOrganizationChoices() || !organizationName || loadingOrganizationInfo -->- <!-- /ko -->
        <!-- ko if: isVisibleOrganizationChoices() && organizationName && !loadingOrganizationInfo -->
        <!-- ko text: searchResultNum --><!-- /ko -->
        <!-- /ko --> Organizations</span>
    </dt>
    <dd class="gathering-list__description">
      <input data-bind="textInput: enterOrganizationName, hasfocus: inFocusOrganizationName" type="text" name="organizationName" id="organizationName" class="form-control gathering__input">
      <div class="organization-choices-wrapper" data-bind="css: { 'organization-choices-wrapper--visible': isVisibleOrganizationChoices() }">
        <!-- ko if: loadingOrganizationInfo -->
        <div class="organization-loading-wrapper" data-bind="visible: loadingOrganizationInfo">
          <img class="organization__loading" src="/img/loading.gif?20220202" alt="loading organization information">
        </div>
        <!-- /ko -->
        <ul class="organization-choices" data-bind="visible: organizations.length &amp;&amp; !loadingOrganizationInfo, HOScrollIntoView: {
                isScrollable: isVisibleOrganizationChoices() &amp;&amp; !loadingOrganizationInfo &amp;&amp; organizations.length > 1,
                duration: 500
              }">
          <!-- ko foreach: organizations -->
          <li data-bind="click: $parent.selectOrganization.bind($parent,$data)" class="organization__choice">
            <dl class="organization-details">
              <dt data-bind="text: name" class="organization-details__name"></dt>
              <dd data-bind="text: location" class="organization-details__location"></dd>
            </dl>
          </li>
          <!-- /ko -->
        </ul>
      </div>
    </dd>
    <!-- ko if: selectedOrganization -->
    <dt class="gathering-list__team" data-bind="visible: isJapaneseOrganization() || (selectedOrganization.id)">
      <label class="gathering__label" for="zip-code">Zip Code:</label>
    </dt>
    <dd class="gathering-list__description" data-bind="visible: isJapaneseOrganization() || (selectedOrganization.id)">
      <input data-bind="textInput: selectedOrganization.zip_code, enable: !(selectedOrganization.id), hasfocus: isSelectedZipCodeInput" type="text" name="zip_code" class="form-control gathering__input gathering__input--short" id="zip-code">
    </dd>
    <dt class="gathering-list__team" data-bind="visible: isJapaneseOrganization() || (selectedOrganization.id)">
      <label class="gathering__label" for="location">Location:</label>
    </dt>
    <dd class="gathering-list__description" data-bind="visible: isJapaneseOrganization() || (selectedOrganization.id)">
      <input data-bind="textInput: selectedOrganization.location, enable: !(selectedOrganization.id)" type="text" name="location" class="form-control gathering__input" id="location">
    </dd>
    <dt class="gathering-list__team">
      <label class="gathering__label" for="from-join-year">Enrollment period&lt;span class="label__sub-text"&gt;(roughly)&lt;/span&gt;</label>
    </dt>
    <dd class="gathering-list__description enrollment-period">
      <div class="enrollment-period-from">
        <select data-bind="options: getSelectableYears(),
                             value: selectedFromJoinYear,
                             optionsCaption: getSelectableYearsCaption(),
                             hasfocus: isSelectedFromJoinYear,
                             event:{ change: changeFromJoinYear },
                             css: { 'gathering__select--error': noticeWarningFor('from_join_year') }" class="form-control gathering__select" id="from-join-year"></select>
        <select data-bind="options: getSelectableMonths(),
                             value: selectedFromJoinMonth,
                             optionsCaption: getSelectableMonthsCaption(),
                             hasfocus: isSelectedFromJoinMonth,
                             css: { 'gathering__select--error': noticeWarningFor('from_join_month') }" class="form-control gathering__select" id="from-join-month"></select>
      </div><!--
          -->〜<!--
          -->
      <div class="enrollment-period-to">
        <label class="gathering__label">
          <input type="radio" name="period_to" class="enrollment-period-to__choice" data-bind="checked: current, checkedValue: true">During enrollment </label>
        <div>
          <input type="radio" name="period_to" class="enrollment-period-to__choice" data-bind="checked: current, checkedValue: false">
          <select data-bind="options: getSelectableYears(),
                             value: selectedToJoinYear,
                             optionsCaption: getSelectableYearsCaption(), attr: { disabled: current },
                             css: { 'gathering__select--error': noticeWarningFor('to_join_year') }" class="form-control gathering__select"></select>
          <select data-bind="options: getSelectableMonths(),
                             value: selectedToJoinMonth,
                             optionsCaption: getSelectableMonthsCaption(), attr: { disabled: current },
                             css: { 'gathering__select--error': noticeWarningFor('to_join_month') }" class="form-control gathering__select"></select>
        </div>
      </div>
      <p class="gathering__message--error" data-bind="visible: noticeWarningFor('from_join_year')">Please enter a valid period</p>
    </dd>
    <!-- /ko -->
  </dl>
  <!-- /ko -->
</form>

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REQUEST FROM E-CASEBOOK

日本循環器学会 専門医番号（※半角数字）

専門医番号をお持ちで無い場合は「000」とご入力ください。

Name（例: 山田 太郎）:

Please enter Kanji, Hiragana and Katakana

BOD : Country : Prefecture (Japanese only) : Organization<span
class="label__sub-text">(hospital, university, company, etc.)</span>: -
Organizations
   
 * 
   

Zip Code: Location: Enrollment period<span
class="label__sub-text">(roughly)</span>

〜
During enrollment


Please enter a valid period

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that it is not intended to provide information for the general public.

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