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my.wellspan.org Open in urlscan Pro
205.172.187.226  Public Scan

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Submitted URL: https://my.wellspan.org/mywellspan/s/SAD2I4MQVRJ3ENH2QONWVCK36U/NoAcctLogin
Effective URL: https://my.wellspan.org/MyWellSpan/Authentication/SecondaryValidation
Submission: On December 04 via manual from IN — Scanned from DE

Form analysis 1 forms found in the DOM

<form id="two-factor-wrapper-form" autocomplete="off">
  <div class="grid padded">
    <div class="row">
      <div class="col-12">
        <h1 id="twoFactorHeader" class="alignCenter">Verify Your Identity</h1>
      </div>
    </div>
    <div class="grid compact" id="demographicsGrid">
      <div class="row" id="demographics-desc-wrapper">
        <div class="col-12 alignCenter"><span id="demographics-desc" class="alignCenter">Confirm information for Trisha or</span><a class="logoutLink" href="/MyWellSpan/Home/Logout?skipabandoncurrent=1">Login with MyWellSpan</a></div>
      </div>
      <div id="demographics">
        <div class="row">
          <div class="col-12">
            <div class="required alignCenter">Indicates a required field.</div>
          </div>
        </div>
        <div id="dobEntry" class="col-12 alignCenter">
          <div class="ghostInput"><label class="required ellipsisOverflow" for="DateOfBirth">Date of Birth</label><input id="DateOfBirth" name="DateOfBirth" class="required demographics-entry" inputmode="numeric" autocomplete="bday" value=""
              data-validation-settings="{&quot;required&quot;:true,&quot;isDate&quot;:true,&quot;isDOB&quot;:true,&quot;maxDate&quot;:&quot;2023-12-04&quot;,&quot;format&quot;:true}" placeholder="MM/DD/YYYY"
              aria-describedby="DateOfBirth_message DateOfBirth_autoformatted" aria-required="true" data-invalid="true" data-fieldhistory="[&quot;&quot;]" data-fieldhistoryptr="1"><span class="clearlabel" id="DateOfBirth_autoformatted"
              aria-live="polite"></span></div>
          <div id="DateOfBirth_message" data-message-display-for="DateOfBirth" aria-live="polite" aria-atomic="true"></div>
        </div>
        <div class="row">
          <div class="col-12">
            <div id="demographics-mismatch-error" aria-live="assertive" class="hidden alert alignCenter"><img src="/MyWellSpan/en-US/images/error_circle.png" class="yield" alt=""><span id="demographics-mismatch-error-text">The information you entered
                does not match our records.</span></div>
          </div>
        </div>
      </div>
    </div>
    <div class="grid compact">
      <div class="row">
        <div id="submitButtonContainer" class="col-12 alignCenter"><span><button type="submit" class="button primary positive disabled" id="submitSecondaryValidation" data-disable-if-invalid="true" disabled=""
              title="Verify button. At least one required item is missing a valid response. Please check the form." aria-label="Verify button. At least one required item is missing a valid response. Please check the form.">Verify</button></span>
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

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VERIFY YOUR IDENTITY

Confirm information for Trisha orLogin with MyWellSpan
Indicates a required field.
Date of Birth

The information you entered does not match our records.
Verify
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