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pmr.domaonline.com Open in urlscan Pro
18.254.126.108  Public Scan

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Submitted URL: https://pmr.domaonline.com/
Effective URL: https://pmr.domaonline.com/Login/Login?ReturnUrl=%2F
Submission: On December 07 via manual from US — Scanned from DE

Form analysis 1 forms found in the DOM

POST /Login/Login?returnUrl=%2F

<form action="/Login/Login?returnUrl=%2F" class="p-4" id="form" method="post" role="form"><input name="__RequestVerificationToken" type="hidden"
    value="C-FKsYlQS98F94_VTjI4BZ0lKbJ5hfY2v27UV3FtMUAJeMCCniU9T0bBsqUZ7bHdFFYG6KM-D-P_jF2GyLo5jEu3Zbh_US_bQKcqWuzHOTfIasjk0ML93gd3h7wb5D5zFnlJ4_G5AUdvrVHIOTT0hA2">
  <div id="helper-links" class="pb-2">
    <a href="javascript: showPopup('https://pmr.domaonline.com:443/Content/LinkContent/faq.html', 'Frequently Asked Questions')" title="Frequently Asked Questions">FAQ</a>
    <span class="px-2">|</span>
    <a href="https://pmr.domaonline.com:443/Content/LinkContent/2013_PMR Physician Fact Sheet_final_110613.pdf" target="_blank" title="Private Healthcare Provider (PHP) Fact Sheet">Provider Fact Sheet</a>
  </div>
  <p class="py-4">
    <b>Welcome to the Medical Records Requests Portal. Enter your passcode below to begin viewing or uploading files.</b>
  </p>
  <div class="mb-3 row justify-content-center">
    <div class="col-8">
      <div class="input-group">
        <span class="input-group-prepend"><i title="DX8 Passcode" name="DX8 Upload Passcode" class="fas fa-key input-group-text"></i></span>
        <input class="form-control" data-val="true" data-val-required="The Passcode field is required." id="passcode-input" name="Passcode" placeholder="Passcode" title="Passcode" type="password">
      </div>
      <span class="field-validation-valid error-text" data-valmsg-for="Passcode" data-valmsg-replace="true"></span>
    </div>
  </div>
  <div class="mb-3 row justify-content-center">
    <div class="col-8">
      <input id="login-button" type="submit" value="Submit" class="btn main-button">
    </div>
  </div>
  <div id="forgot-password-link">
    <a href="mailto:pmrsupport@domaonline.com">Problems with the passcode?</a>
  </div>
  <span class="error-text"></span>
</form>

Text Content

FAQ | Provider Fact Sheet

Welcome to the Medical Records Requests Portal. Enter your passcode below to
begin viewing or uploading files.



Problems with the passcode?
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