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Submitted URL: http://www6.webcrf.net/dalgene
Effective URL: http://www6.webcrf.net/dalgene/pfts.dll?PVN=73838&LogoutLangID=0
Submission: On October 05 via manual from US — Scanned from DE
Effective URL: http://www6.webcrf.net/dalgene/pfts.dll?PVN=73838&LogoutLangID=0
Submission: On October 05 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
Name: frmLogin — POST ./pfts.dll
<form name="frmLogin" action="./pfts.dll" method="post" target="_top" autocomplete="off"> <!--17-->
<noscript>
<center><b> InForm</b> requires a browser that supports JavaScript. Your browser either does not support JavaScript or support it is disabled.</center>
</noscript>
<table cellpadding="0" cellspacing="0" align="center">
<tbody>
<tr>
<td>
<input type="hidden" name="C" value="AppMgr_LogIn">
<input type="hidden" name="ColorBits" value="0">
<input type="hidden" name="BrowserType" value="safari">
<input type="hidden" name="BrowserMajVer" value="NaN">
<input type="hidden" name="BrowserMinVer" value="0">
<input type="hidden" name="Platform" value="pc">
<input type="hidden" name="pwdpfLogType" value=""><!--18-->
<input type="hidden" id="pwdpfCacheOn" name="pwdpfCacheOn" value="0">
<input type="hidden" id="pwdpfHTTP11" name="pwdpfHTTP11" value="1">
</td>
</tr>
<!--19-->
<script language="JavaScript">
var st = bPWDExpired ? (bEnableFgtPwdFn ? 2 : 1) : 0,
aBT, pr, bDisp = (top == window || !(bExpired || bLogout)) && login > 0;
var inpCtrlData = new Array(); /*20*/
var loginBtnTop, loginBtnLeft;
switch (st) {
case 0:
pr = 'Enter your name and password for study dalgene';
break; /*21 trial name*/
case 1:
pr = 'Change password, if desired';
break;
case 2:
pr = 'Change password options'
}
if (bNoMsg) d.write('<input type=hidden name=pwdpfNoMsg value=1>')
if (bDisp) {
d.write('<tr><td style="position:relative;width:200px;height:340px" class=', st == 2 ? 'login2' : 'login', '></td>', '<td>', '<table align=center>', '<tr>', '<td colspan="2" class="label" style="position:relative;height:24px">', pr,
'</td>', '</tr>', '<tr>', '<td class="label inpCapWidth" style="position:relative;height:24px">User Name:</td>',
'<td class="editTxt"><input class="edt LgnPwdWidth" style="position:relative" title="Enter your user name here" type=text maxLength=32 name=pwdpfUser id=pwdpfUser value=""></td>' /*22*/ , '</tr>', '<tr>',
'<td class="label inpCapWidth" style="position:relative;height:24px">', bPWDExpired ? 'Current Password:' : 'Password:', '</td>', '<td class="editTxt">',
'<input class="edt LgnPwdWidth" style="position:relative" type=password name=pwdpfPassword id=pwdpfPassword title="Enter your password here" autocomplete="off">', '</td>', '</tr>');
if (bPWDExpired) {
if (bPWDExpired) {
d.write('<input type=hidden name=pwdpfUpdatePWD>');
} else {
d.write('<input type=hidden name=pwdpfUpdateIUsrPWD>');
}
d.write('<tr>', '<td class="label inpCapWidth" style="position:relative;height:24px">New Password:</td>',
'<td class="editTxt"><input class="edt LgnPwdWidth" style="position:relative" type=password maxLength=32 name=pwdpfNewPassword id=pwdpfNewPassword title="Enter your new password here"></td>', '</tr><tr>',
'<td class="label inpCapWidth" style="position:relative;height:24px">Confirm Password:</td>',
'<td class="editTxt"><input class="edt LgnPwdWidth" style="position:relative" type=password maxLength=32 name=pwdpfNewPasswordConf id=pwdpfNewPasswordConf title="Retype your new password here"></td>', '</tr>');
if (bEnableFgtPwdFn) {
d.write('<tr>',
'<td colspan="2" class=info style="width:450px;position:relative;">Please enter the additional information below. This information allows you to regain access to the system, in the event of a lost or forgotten password. You can also update this information in your user profile screen by clicking on your user name or picture. </td>',
'</tr>', '<tr>', '<td class="label inpCapWidth" style="position:relative;height:24px">E-mail Address:</td>',
'<td class="editTxt"><input class="edt inpCtrlWidth" style="position:relative" type=text maxLength=255 name=pwdpfEMail id=pwdpfEMail title="Enter your e-mail address here"></td>', '</tr>');
//Initialize controls
document.getElementById('pwdpfEMail').value = inpCtrlData[0];
}
aBT = ['Submit', 'Click to submit new password'];
} else { //bPWDExpired == false
aBT = ['Log In', 'Click to log-in to InForm'];
}
var forgetPwdLink = '';
if (bDisp && bForgotPwd) {
forgetPwdLink = '<input type=hidden name=pwdpfForgotPWD value=0>' + '<a id="login_fgtpwd_id" tabindex=-1 href=javascript:fgtpwd()>Forgot Your Password?</a>';
}
d.write('<tr><td>' + forgetPwdLink + '</td><td class="submitBtn"><input type=submit class=btn style="width:100px;position:relative;height:24px" id=btnLogin title="', aBT[1], '" value="', aBT[0], '" name=btnLogin>',
'</td></tr></table></td></tr>' + '<tr><td class="label"> </td></tr>'); /*23*/
} else if (login <= 0) {
ErrMsg(login);
}
if (login > 0) {
if (!cacheOn || !bHTTP11) d.write('<tr><td colspan="2"><table class="warning" cellpadding=8 cellspacing=0>', '<tr><td rowspan="3"><img src="./pfts.dll?C=ResMgr_1&pfLang=en-US&pfR=F9" border=0></td>',
'<td class="warning">Your browser or infrastructure does not support the following optimal settings for InForm:</td></tr>', '<tr><td class="warning"><ul>', bHTTP11 ? '' :
'<li>Configure your browser to support the HTTP 1.1 protocol.</li>', cacheOn ? '' : '<li>Configure your browser to save encrypted files locally.</li>', '</ul></td></tr></table></td></tr>');
if (sW != '') d.write('<tr><td colspan="2" id=msg1 class=err>', sW, '</td></tr>');
if (sM != '') d.write('<tr><td colspan="2" id=msg2 class=err>', sM, '</td></tr>');
d.write('<tr id=msg3 style=display:none><td colspan="2" class=err>', lmsg, '</td></tr>');
if (top == window || !(bExpired || bLogout)) d.write('<tr><td colspan="2"><div class="disclaimer en-US">',
'<div class="paragraph">By entering my user name and password above, I am using my electronic signature to log in to the InForm™ system and establish a continuous session, which will end when I am logged out. During this continuous session, by entering my password on an e-signature affidavit when prompted, I am affixing my electronic signature to the electronic record indicated.</div>',
'<div class="paragraph">The InForm system is a data collection and trial management tool and is not to be used in the diagnosis or treatment of subjects.</div>',
'<div class="paragraph">HEALTHCARE PROFESSIONALS HAVE THE SOLE RESPONSIBILITY TO BE FULLY AWARE OF CURRENT PRACTICES AND STANDARDS, TO AVOID USE OF OUTDATED REGIMENS, AND TO EMPLOY GOOD CLINICAL JUDGMENT IN SELECTING PATIENT TREATMENTS. Computer software in general and the InForm system in particular should NEVER substitute for up-to-date personal knowledge and good clinical judgment.</div>',
'<div class="paragraph">USERS OF THIS SYSTEM HAVE THE RESPONSIBILITY TO ENSURE COMPLIANCE WITH ALL LAWS, RULES, AND REGULATIONS GOVERNING THE COLLECTION AND HANDLING OF PERSONAL DATA.</div>',
'<div>Use of the InForm system signifies acceptance of the foregoing terms.</div></div></td></tr>');
d.write('<tr><td colspan="2"><div class="copyright">',
'<div>Copyright © 1998, 2013 Oracle. All rights reserved. Oracle is a registered trademark of Oracle Corporation and/or its affiliates. Other names may be trademarks of their respective owners.</div></div></td></tr>');
SetFmFields();
}
</script>
<tr>
<td style="position:relative;width:200px;height:340px" class="login"></td>
<td>
<table align="center">
<tbody>
<tr>
<td colspan="2" class="label" style="position:relative;height:24px">Enter your name and password for study dalgene</td>
</tr>
<tr>
<td class="label inpCapWidth" style="position:relative;height:24px">User Name:</td>
<td class="editTxt"><input class="edt LgnPwdWidth" style="position:relative" title="Enter your user name here" type="text" maxlength="32" name="pwdpfUser" id="pwdpfUser" value=""></td>
</tr>
<tr>
<td class="label inpCapWidth" style="position:relative;height:24px">Password:</td>
<td class="editTxt"><input class="edt LgnPwdWidth" style="position:relative" type="password" name="pwdpfPassword" id="pwdpfPassword" title="Enter your password here" autocomplete="off"></td>
</tr>
<tr>
<td><input type="hidden" name="pwdpfForgotPWD" value="0"><a id="login_fgtpwd_id" tabindex="-1" href="javascript:fgtpwd()">Forgot Your Password?</a></td>
<td class="submitBtn"><input type="submit" class="btn" style="width:100px;position:relative;height:24px" id="btnLogin" title="Click to log-in to InForm" value="Log In" name="btnLogin"></td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr>
<td class="label"> </td>
</tr>
<tr>
<td colspan="2">
<table class="warning" cellpadding="8" cellspacing="0">
<tbody>
<tr>
<td rowspan="3"><img src="./pfts.dll?C=ResMgr_1&pfLang=en-US&pfR=F9" border="0"></td>
<td class="warning">Your browser or infrastructure does not support the following optimal settings for InForm:</td>
</tr>
<tr>
<td class="warning">
<ul>
<li>Configure your browser to save encrypted files locally.</li>
</ul>
</td>
</tr>
</tbody>
</table>
</td>
</tr>
<tr id="msg3" style="display:none">
<td colspan="2" class="err">Logging in...</td>
</tr>
<tr>
<td colspan="2">
<div class="disclaimer en-US">
<div class="paragraph">By entering my user name and password above, I am using my electronic signature to log in to the InForm™ system and establish a continuous session, which will end when I am logged out. During this continuous
session, by entering my password on an e-signature affidavit when prompted, I am affixing my electronic signature to the electronic record indicated.</div>
<div class="paragraph">The InForm system is a data collection and trial management tool and is not to be used in the diagnosis or treatment of subjects.</div>
<div class="paragraph">HEALTHCARE PROFESSIONALS HAVE THE SOLE RESPONSIBILITY TO BE FULLY AWARE OF CURRENT PRACTICES AND STANDARDS, TO AVOID USE OF OUTDATED REGIMENS, AND TO EMPLOY GOOD CLINICAL JUDGMENT IN SELECTING PATIENT TREATMENTS.
Computer software in general and the InForm system in particular should NEVER substitute for up-to-date personal knowledge and good clinical judgment.</div>
<div class="paragraph">USERS OF THIS SYSTEM HAVE THE RESPONSIBILITY TO ENSURE COMPLIANCE WITH ALL LAWS, RULES, AND REGULATIONS GOVERNING THE COLLECTION AND HANDLING OF PERSONAL DATA.</div>
<div>Use of the InForm system signifies acceptance of the foregoing terms.</div>
</div>
</td>
</tr>
<tr>
<td colspan="2">
<div class="copyright">
<div>Copyright © 1998, 2013 Oracle. All rights reserved. Oracle is a registered trademark of Oracle Corporation and/or its affiliates. Other names may be trademarks of their respective owners.</div>
</div>
</td>
</tr>
</tbody>
</table>
</form>Text Content
InForm requires a browser that supports JavaScript. Your browser either does not support JavaScript or support it is disabled. Enter your name and password for study dalgeneUser Name:Password:Forgot Your Password? Your browser or infrastructure does not support the following optimal settings for InForm: * Configure your browser to save encrypted files locally. Logging in... By entering my user name and password above, I am using my electronic signature to log in to the InForm™ system and establish a continuous session, which will end when I am logged out. During this continuous session, by entering my password on an e-signature affidavit when prompted, I am affixing my electronic signature to the electronic record indicated. The InForm system is a data collection and trial management tool and is not to be used in the diagnosis or treatment of subjects. HEALTHCARE PROFESSIONALS HAVE THE SOLE RESPONSIBILITY TO BE FULLY AWARE OF CURRENT PRACTICES AND STANDARDS, TO AVOID USE OF OUTDATED REGIMENS, AND TO EMPLOY GOOD CLINICAL JUDGMENT IN SELECTING PATIENT TREATMENTS. Computer software in general and the InForm system in particular should NEVER substitute for up-to-date personal knowledge and good clinical judgment. USERS OF THIS SYSTEM HAVE THE RESPONSIBILITY TO ENSURE COMPLIANCE WITH ALL LAWS, RULES, AND REGULATIONS GOVERNING THE COLLECTION AND HANDLING OF PERSONAL DATA. Use of the InForm system signifies acceptance of the foregoing terms. Copyright © 1998, 2013 Oracle. All rights reserved. Oracle is a registered trademark of Oracle Corporation and/or its affiliates. Other names may be trademarks of their respective owners.