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POST mmail-setprofile.php

<form action="mmail-setprofile.php" method="post">
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  <input type="hidden" name="c" value="1784673">
  <!-- If we have any overriding custom styles,
			     remember them in case the update button is pressed. -->
  <fieldset class="yourSubscriptions">
    <legend>Please select one of these options to update your subscriptions:</legend>
    <div class="choice">
      <input type="radio" name="subscribeChoice" id="contRadioButton" value="continue" checked="">
      <label for="contRadioButton">Keep me subscribed to the following selected lists:</label>
      <fieldset class="listsTable">
        <table>
          <tbody>
            <tr>
              <td>
                <input type="checkbox" id="list_157049" name="groupid[]" value="157049" checked="checked">
                <label for="list_157049">JH Part A News</label>
              </td>
              <td class="listStatus">Subscribed</td>
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      </fieldset>
    </div>
    <div class="choice">
      <input type="radio" name="subscribeChoice" id="unsubRadioButton" value="unsub">
      <label for="unsubRadioButton">Unsubscribe me from all of my current email lists.</label>
      <div class="unsubscribeMsg"> This sender can still add you to future email lists. </div>
    </div>
    <div class="choice">
      <input type="radio" name="subscribeChoice" id="dncRadioButton" value="dnc">
      <label for="dncRadioButton">Never email me again.</label>
      <div id="dncConfirmMsgBox" style="display: none;">
        <p> Check the box to never receive email from this sender. <br>
        </p>
        <div id="dncConfirmMsgBoxDetail"> For a less permanent solution, use the controls above to unsubscribe from one or more lists. </div>
        <p></p>
        <input type="checkbox" name="dncConfirmCheckbox" id="dncConfirmCheckbox">
        <label for="dncConfirmCheckbox" class="confirmCheckbox">I never want to receive email from this sender.</label>
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  </fieldset>
  <fieldset id="yourProfile" class="">
    <legend id="editLegend" style="display: block;"><a id="editProfileLink" href="#blank">Edit Profile</a><span> (including email address)</span></legend>
    <div id="profileContainer" style="display: none;">
      <h1 class="profileSectionTitle">My Profile</h1>
      <div class="email">
        <label for="email">*Email Address</label>
        <input type="text" id="email" name="fields[email]" value="sandra.hensgens@ochsner.org">
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      <div class="prefix">
        <label for="prefix">Prefix</label>
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      <div class="fname">
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      <div class="lname">
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        <input type="text" id="lname" name="fields[lname]" value="">
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      <div class="suffix">
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      <div class="address1">
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      <div class="address2">
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        <input type="text" id="address2" name="fields[address2]" value="">
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      <div class="city">
        <label for="city">City</label>
        <input type="text" id="city" name="fields[city]" value="">
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      <div class="state">
        <label for="state">State or Province</label>
        <input type="text" id="state" name="fields[state]" value="">
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      <div class="zip">
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        <input type="text" id="zip" name="fields[zip]" value="">
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      <div class="business">
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      <div class="phone">
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      <div class="custom text">
        <label for="intro"> Jurisdiction L: For Providers in Pennsylvania, New Jersey, Maryland, Delaware and Washington D.C.</label>
        <input type="text" id="intro" name="fields[intro]" value="">
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      <div class="custom checkbox">
        <input type="checkbox" id="jh-indianhealthservicenews" name="fields[jh-indianhealthservicenews]" value="1">
        <label for="jh-indianhealthservicenews">Indian Health Service News</label>
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      <div class="custom checkbox">
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        <label for="jh-partanews">Part A News</label>
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      <div class="custom checkbox">
        <input type="checkbox" id="jh-partbnews" name="fields[jh-partbnews]" value="1">
        <label for="jh-partbnews">Part B News</label>
      </div>
      <div class="custom checkbox">
        <input type="checkbox" id="jh-veteransaffairs" name="fields[jh-veteransaffairs]" value="1">
        <label for="jh-veteransaffairs">Veteran's Affairs</label>
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      <div class="custom checkbox">
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        <label for="jhelectronicbillingedi-parta">Electronic Billing (EDI) - Part A</label>
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        <label for="jhelectronicbillingedi-partb">Electronic Billing (EDI) - Part B</label>
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      <div class="custom checkbox">
        <input type="checkbox" id="jl-ediparta" name="fields[jl-ediparta]" value="1">
        <label for="jl-ediparta">Electronic Billing (EDI) - Part A</label>
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      <div class="custom checkbox">
        <input type="checkbox" id="jl-edipartb" name="fields[jl-edipartb]" value="1">
        <label for="jl-edipartb">Electronic Billing (EDI) - Part B</label>
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      <div class="custom checkbox">
        <input type="checkbox" id="jl-partanews" name="fields[jl-partanews]" value="1">
        <label for="jl-partanews">Part A News</label>
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      <div class="custom checkbox">
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        <label for="jl-partbnews">Part B News</label>
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      <div class="custom text">
        <label for="jlintro">Jurisdiction L: For Providers in Pennsylvania, New Jersey, Maryland, Delaware and Washington D.C.</label>
        <input type="text" id="jlintro" name="fields[jlintro]" value="">
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      <div class="custom checkbox">
        <input type="checkbox" id="mrep-newsandupdates" name="fields[mrep-newsandupdates]" value="1">
        <label for="mrep-newsandupdates">News &amp; Software Updates</label>
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        <label for="novitasphere-parta">Part A Providers</label>
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      <div class="custom checkbox">
        <input type="checkbox" id="novitasphere-partb" name="fields[novitasphere-partb]" value="1">
        <label for="novitasphere-partb">Part B Providers</label>
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      <div class="custom checkbox">
        <input type="checkbox" id="pc-ace-softwareupdates" name="fields[pc-ace-softwareupdates]" value="1">
        <label for="pc-ace-softwareupdates">Software Updates</label>
      </div>
    </div>
    <!--/profileContainer-->
  </fieldset>
  <input type="submit" name="submit" id="submit" value="Update" class="activatedBtn">
</form>

Text Content

Manage Your Email Subscriptions and Profile


EMAIL SUBSCRIPTIONS FOR SANDRA.HENSGENS@OCHSNER.ORG

If your email address is not sandra.hensgens@ochsner.org, then this email was
most likely forwarded to you.
If this is the case, please ignore this page.

Please select one of these options to update your subscriptions:
Keep me subscribed to the following selected lists:

JH Part A News Subscribed

Unsubscribe me from all of my current email lists.
This sender can still add you to future email lists.
Never email me again.

Check the box to never receive email from this sender.


For a less permanent solution, use the controls above to unsubscribe from one or
more lists.



I never want to receive email from this sender.
Edit Profile (including email address)


MY PROFILE

*Email Address
Prefix
First Name
Last Name
Suffix
Address 1
Address 2
City
State or Province
Zip
Business Name
Phone
Jurisdiction L: For Providers in Pennsylvania, New Jersey, Maryland, Delaware
and Washington D.C.
Indian Health Service News
Part A News
Part B News
Veteran's Affairs
Electronic Billing (EDI) - Part A
Electronic Billing (EDI) - Part B
Electronic Billing (EDI) - Part A
Electronic Billing (EDI) - Part B
Part A News
Part B News
Jurisdiction L: For Providers in Pennsylvania, New Jersey, Maryland, Delaware
and Washington D.C.
News & Software Updates
Part A Providers
Part B Providers
Software Updates


You can manage your email subscriptions and choose to unsubscribe or update your
profile settings from this page. If you feel that the email was sent to you by
mistake, please forward the original message to abuse@icontact.com or report
spam here.