ucsantacruz.enterprise.health Open in urlscan Pro
64.186.38.159  Public Scan

Form analysis
2 forms found in the DOM

Name: login_form — POST webchart.cgi

<form name="login_form" id="login_form" action="webchart.cgi" method="post">
  <input type="hidden" name="login_post_redirect_get">
  <div class="login_input_container">
    <div id="login_user_field" class="input-container has-error-msg">
      <div class="invalid-tooltip">username is invalid</div>
      <input type="text" name="login_user" id="login_user" class="float-label" size="15" maxlength="255" autocomplete="off" autocapitalize="off" onchange="if (window.setCheckonUnloadFlag) setCheckonUnloadFlag(true);">
      <label for="login_user">Username</label>
      <span>Forgot your <a href="webchart.cgi?f=login&amp;s=ulookup">username</a>?</span>
    </div>
    <div id="login_pass_field" class="input-container has-error-msg">
      <div class="invalid-tooltip">password is invalid</div>
      <input tabindex="-1" type="password" name="login_passwd" id="login_passwd" class="float-label" autocomplete="off" autocapitalize="off" onchange="if (window.setCheckonUnloadFlag) setCheckonUnloadFlag(true);" size="15" maxlength="50">
      <label for="login_passwd">Password</label>
      <span>Forgot your <a tabindex="-1" href="webchart.cgi?f=login&amp;s=preset">password</a>?</span>
    </div>
  </div>
  <div class="form-footer">
    <input type="submit" value="Next" name="login_submit" id="login_submit" class="primary-bg">
    <button class="prev-stage"><span class="fa fa-arrow-left" title="Return to login" aria-hidden="true"></span> <span class="sr-only">Return to login</span> Back</button>
  </div>
</form>

Name: referral_form — POST

<form name="referral_form" id="referral_form" method="post">
  <input type="hidden" name="f" value="ajaxregister">
  <input type="hidden" name="unpw" value="1">
  <input type="hidden" name="termschecked" value="1">
  <input type="hidden" name="promobdate">
  <input type="hidden" name="promophone">
  <div class="referral_input_container">
    <div>
      <div id="login_promo_field" class="input-container has-error-msg">
        <div class="invalid-tooltip">activation code could not be validated</div>
        <input type="text" name="mrnumber" id="referral_code" value="" class="float-label" size="15" maxlength="50" onkeyup="if (this.value.length >=12) checkReferral();" onchange="if (this.value.length >=12) checkReferral();">
        <label for="referral_code">Activation code</label>
      </div>
      <div id="dob-container" class="input-container has-error-msg" style="visibility:hidden">
        <div class="invalid-tooltip">date of birth is invalid</div>
        <label id="dob-label" for="DPD_birth_dateMONTH">Date of birth</label>
        <input type="hidden" name="DPFN_birth_date" value="birth_date"><input type="hidden" name="DPI_birth_date" value="~DATE"><span class="dateinput"><span class="date">
            <div class="dob-input-container"><input type="text" class="month float-label" autocomplete="off" name="DPD_birth_dateMONTH" id="DPD_birth_dateMONTH" maxlength="2" title="Month"
                onblur="if(window.jsFormatInputs) formatDateM(this, 'month', 0, 1, event)" onkeydown="if(window.jsFormatInputs) incrementDateM(this, event, 'month', 0, 1)" onfocus="this.select();"
                onkeypress="if(window.jsFormatInputs) return handleKeyPressNS(this, event, 1,'month','',1)" onkeyup="if (window.setCheckonUnloadFlag) setCheckonUnloadFlag(true);if(window.jsFormatInputs) handleKeyUpNS(this,1,event)"
                onclick="if(window.jsFormatInputs) {}"><label id="month-label" for="DPD_birth_dateMONTH">MM</label></div>-<div class="dob-input-container"><input type="text" class="day float-label" autocomplete="off" name="DPD_birth_dateDAY"
                id="DPD_birth_dateDAY" maxlength="2" title="Day" onblur="if(window.jsFormatInputs) formatDateM(this, 'day', 0, 1, event)" onkeydown="if(window.jsFormatInputs) incrementDateM(this, event, 'day', 0, 1)"
                onkeypress="if(window.jsFormatInputs) return handleKeyPressNS(this, event, 1,'day','',1)" onfocus="this.select();"
                onkeyup="if (window.setCheckonUnloadFlag) setCheckonUnloadFlag(true);if(window.jsFormatInputs) handleKeyUpNS(this,1,event)" onclick="if(window.jsFormatInputs) {}"><label id="day-label" for="DPD_birth_dateDAY">DD</label></div>-<div
              class="dob-input-container"><input type="text" class="year float-label" autocomplete="off" name="DPD_birth_dateYEAR" id="DPD_birth_dateYEAR" maxlength="4" title="Year"
                onkeydown="if(window.jsFormatInputs) incrementDateM(this, event, 'year', 0, 1)" onblur="if(window.jsFormatInputs) formatDateM(this, 'year', 0, 1, event)" onfocus="this.select();"
                onkeypress="if(window.jsFormatInputs) return handleKeyPressNS(this, event, 1,'year','',1)" onkeyup="if (window.setCheckonUnloadFlag) setCheckonUnloadFlag(true);if(window.jsFormatInputs) handleKeyUpNS(this,1,event)"
                onclick="if(window.jsFormatInputs) {}"><label id="year-label" for="DPD_birth_dateYEAR">YYYY</label></div><button type="button" class="fa" id="DPD_birth_dateTODAY" title="Today"
              onclick="if (window.setCheckonUnloadFlag) setCheckonUnloadFlag(true); if(window.jsFormatInputs) getTodayM('DPD_birth_date', 0, 1, this.form, event);"></button>
          </span><button type="button" id="DPD_birth_date_link" class="fa" title="Calendar" onclick="if(window.jsFormatInputs) { ClickPickDate(this,'DPD_birth_dateMONTH','DPD_birth_date_cal','DPD_birth_date_link',false,1,true); }"
            aria-label="Calendar"></button></span>
      </div>
    </div>
    <div id="referral-accepted-stage">
      <div class="form-alert primary-bg" id="link-alert">
        <span class="fa fa-user-circle" title="The referral code you entered is linked to this individual." aria-hidden="true"></span> <span class="sr-only">The referral code you entered is linked to this individual.</span> <span
          id="referral-link-name"></span>
      </div>
      <div class="input-container">
        <fieldset>
          <div id="referral_self_check">
            <span id="reg-type-label">
              <legend>Who is this activation code for?</legend>
            </span>
            <div>
              <input class="toggle-reg-type" type="radio" id="reg-self" name="is_self" value="1" checked="">
              <label for="reg-self">myself</label>
            </div>
            <div>
              <input class="toggle-reg-type" type="radio" id="reg-other" name="is_self" value="0">
              <label for="reg-other">someone else</label>
            </div>
          </div>
        </fieldset>
        <div class="reg-other-input has-error-msg">
          <div class="invalid-tooltip">first name is invalid</div>
          <input type="text" name="first_name" id="first_name" class="float-label" size="15" maxlength="255" disabled="">
          <label for="first_name">Your first name</label>
        </div>
        <div class="reg-other-input has-error-msg">
          <div class="invalid-tooltip">last name is invalid</div>
          <input type="text" name="last_name" id="last_name" class="float-label" size="15" maxlength="255" disabled="">
          <label for="last_name">Your last name</label>
        </div>
        <div class="has-error-msg">
          <div class="invalid-tooltip">email is invalid</div>
          <input type="text" name="email" id="referral_email" class="float-label" size="15" maxlength="255">
          <label for="referral_email">Email</label>
        </div>
        <div class="has-help has-error-msg">
          <div id="user-help">
            <span class="fa fa-question-circle" title="Username Help" aria-hidden="true"></span> <span class="sr-only">Username Help</span>
          </div>
          <div class="invalid-tooltip">username is invalid</div>
          <input type="text" name="reg_user" id="referral_user" class="float-label" size="15" maxlength="15">
          <label for="referral_user">Username</label>
        </div>
        <div class="has-help has-error-msg">
          <div id="pass-help">
            <span class="fa fa-question-circle" title="Password Help" aria-hidden="true"></span> <span class="sr-only">Password Help</span>
          </div>
          <div class="invalid-tooltip">password is invalid</div>
          <input type="password" name="reg_passwd" id="referral_passwd" class="float-label" size="15" maxlength="50" autocomplete="off">
          <label for="referral_passwd">Password</label>
        </div>
        <div class="has-error-msg">
          <div class="invalid-tooltip">passwords do not match</div>
          <input type="password" name="password" id="referral_confirm_passwd" class="float-label" size="15" maxlength="50" autocomplete="off">
          <label for="referral_confirm_passwd">Confirm password</label>
        </div>
      </div>
    </div>
  </div>
  <div class="form-footer" id="form-server">
    <div id="server-msg-container"><span class="fa fa-exclamation-triangle" title="Error" aria-hidden="true"></span> <span class="sr-only">Error</span><span id="server-msg"></span></div>
    <input type="submit" value="Next" name="referral_submit" id="referral_submit" class="primary-bg">
    <button class="prev-stage"><span class="fa fa-arrow-left" title="Return to login" aria-hidden="true"></span> <span class="sr-only">Return to login</span> Back</button>
  </div>
</form>

Text Content

WELCOME

UC Santa Cruz Login Options Login Options
UC: Santa Cruz Shibboleth Sign On Standard Login


username is invalid
Username Forgot your username?
password is invalid
Password Forgot your password?
Return to login Back
activation code could not be validated
Activation code
date of birth is invalid
Date of birth
MM
-
DD
-
YYYY

The referral code you entered is linked to this individual.
Who is this activation code for?
myself
someone else
first name is invalid
Your first name
last name is invalid
Your last name
email is invalid
Email
Username Help
username is invalid
Username
Password Help
password is invalid
Password
passwords do not match
Confirm password
Error
Return to login Back


Need help? Contact for support.

Enterprise Health Confidentiality and Non-Disclosure Agreement

You are about to access patients' protected health information (PHI). The system
should only be accessed by authorized users. By logging in and accessing PHI,
you acknowledge that you are doing so in accordance with HIPAA and your
organization's policies and procedures. Access is monitored and you will be held
accountable for any activity on your login.

Organizational information may include, but is not limited to, financial,
patient identifiable, employee identifiable, intellectual property, financially
non-public, contractual, of a competitive advantage nature, and from any source
or in any form (i.e. paper, magnetic or optical media, conversations, film,
etc.), may be considered confidential. Information's confidentiality and
integrity are to be preserved and its availability maintained. The value and
sensitivity of information is protected by law and by the strict policies of
your organization. The intent of these laws and policies are to assure the
confidential information will remain confidential through its use, only as a
necessity to accomplish your organization's mission.

© 2024 Enterprise Health, All rights reserved Privacy Policy Terms and
Conditions
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