vrec.changehealthcare.com
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45.60.195.19
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Submitted URL: https://bnq6pkyy.r.us-west-2.awstrack.me/L0/https://www.albertsons.com/MyVaccineRecord/1/010101816df4d319-753dbbe8-67db-4d9a-9ae5-3e36d9b...
Effective URL: https://vrec.changehealthcare.com/
Submission: On June 20 via api from US — Scanned from US
Effective URL: https://vrec.changehealthcare.com/
Submission: On June 20 via api from US — Scanned from US
Form analysis 1 forms found in the DOM
<form role="info" style="padding-top: 20px;">
<div class="col-md-6 col-lg-6 col-xl-6 col-xs-12 col-sm-12 m-auto">
<div class="row">
<div class="form-group col-6 "><label for="firstName">FIRST NAME</label><input type="text" class="form-control" id="firstName" placeholder="" value=""></div>
<div class="form-group col-6"><label for="lastName">LAST NAME</label><input type="text" class="form-control" id="lastName" placeholder="" value=""></div>
</div>
<div class="form-group col-12 p-0"><label for="dob">DATE OF BIRTH</label><input class="form-control" type="text" id="datePickerId" placeholder="MM/DD/YYYY" value=""></div>
<div class="form-group col-12 p-0"><label for="dob">PHONE NUMBER</label><input class="form-control" type="text" id="phoneNumberId" placeholder="(000) 000-0000" value=""></div>
<div class="form-group col-12 p-0"><input name="isGoing" type="checkbox"> I agree to the <a target="_blank" class="footer-text" href="https://www.changehealthcare.com/terms-of-use/vaccination-record">Terms and Conditions</a> and, with the
understanding of the risks, choose to access my digital vaccination record and download or export it onto my device or third-party applications. I understand that once transferred, the third-party applications are then responsible for the
security of that information.</div>
<div>
<div z-index="-1">
<div>
<div class="grecaptcha-badge" data-style="bottomright"
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<div class="grecaptcha-logo"><iframe title="reCAPTCHA"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LeGPW0aAAAAAC2ZhAuUVlJaMoNK5UaJz23Qf_-X&co=aHR0cHM6Ly92cmVjLmNoYW5nZWhlYWx0aGNhcmUuY29tOjQ0Mw..&hl=en&type=image&v=4rwLQsl5N_ccppoTAwwwMrEN&theme=light&size=invisible&badge=bottomright&cb=xp2o5a8xz55u"
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<div class="grecaptcha-error"></div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
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</div><iframe style="display: none;"></iframe>
</div>
</div>
<div class="container">
<div class="row">
<div class="col text-center"><button type="submit" class="btn btn-primary text-center full-width" disabled="" style="margin-top: 25px;">SUBMIT</button></div>
</div>
</div>
</div>
</div>
</form>Text Content
ENTER INFORMATION To gain access to your Vaccination Record, enter the following information. Allow 24-48 hours for your record to update following your vaccination. Contact your pharmacy with questions or issues. FIRST NAME LAST NAME DATE OF BIRTH PHONE NUMBER I agree to the Terms and Conditions and, with the understanding of the risks, choose to access my digital vaccination record and download or export it onto my device or third-party applications. I understand that once transferred, the third-party applications are then responsible for the security of that information. SUBMIT Powered by Change Healthcare Privacy Policy|Terms of Service Powered by Change Healthcare Privacy Policy | Terms of Service You need to enable JavaScript to run this app.