staging.ldl-container.leapfroggroup.org Open in urlscan Pro
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Form analysis
1 forms found in the DOM

GET https://staging.ldl-container.leapfroggroup.org/generate

<form method="GET" action="https://staging.ldl-container.leapfroggroup.org/generate" class="mt-4" id="TestForm">
  <div class="row">
    <div class="col-lg-6">
      <div class="mb-3">
        <label for="total_inpatient" class="form-label">Total inpatient admissions</label>
        <input required="" type="number" class="form-control" id="total_inpatient" name="total_inpatient" value="1000">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-6">
      <div class="mb-3">
        <label for="a_hospitals" class="form-label">A hospital admission percentage</label>
        <input required="" type="number" class="form-control" id="a_hospitals" name="a_hospitals" value="0.3">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-6">
      <div class="mb-3">
        <label for="b_hospitals" class="form-label">B hospital admission percentage</label>
        <input required="" type="number" class="form-control" id="b_hospitals" name="b_hospitals" value="0.28">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-6">
      <div class="mb-3">
        <label for="c_hospitals" class="form-label">C hospital admission percentage</label>
        <input required="" type="number" class="form-control" id="c_hospitals" name="c_hospitals" value="0.35">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-6">
      <div class="mb-3">
        <label for="df_hospitals" class="form-label">D and F hospital admission percentage</label>
        <input required="" type="number" class="form-control" id="df_hospitals" name="df_hospitals" value="0.07">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-6">
      <div class="mb-3">
        <label for="surgery" class="form-label">Percent of admissions that require surgery</label>
        <input required="" type="number" class="form-control" id="surgery" name="surgery" value="0.29">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-6">
      <div class="mb-3">
        <label for="intensive_care_unit_icu" class="form-label">Percent of admissions that require an ICU stay</label>
        <input required="" type="number" class="form-control" id="intensive_care_unit_icu" name="intensive_care_unit_icu" value="0.20">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-6">
      <div class="mb-3">
        <label for="productivity_lost_cost" class="form-label">Estimated employee productivity lost</label>
        <input required="" type="number" class="form-control" id="productivity_lost_cost" name="productivity_lost_cost" value="1.00">
      </div>
    </div>
  </div>
  <div class="row">
    <div class="col-lg-6">
      <div class="mb-3">
        <label for="annual_total_expense" class="form-label">Estimated annual health care expense</label>
        <input required="" type="number" class="form-control" id="annual_total_expense" name="annual_total_expense" value="100000000">
      </div>
    </div>
  </div>
  <div class="mt-4">
    <button id="SubmitButton" type="submit" class="btn btn-primary">
      <span class="active"><i class="fas fa-file-pdf me-1"></i> Generate PDF</span>
      <span class="waiting" style="display:none;"><i class="fas fa-circle-notch fa-spin me-1"></i> Working</span>
    </button>
  </div>
</form>

Text Content

LDL CALCULATOR TEST PAGE

Total inpatient admissions
A hospital admission percentage
B hospital admission percentage
C hospital admission percentage
D and F hospital admission percentage
Percent of admissions that require surgery
Percent of admissions that require an ICU stay
Estimated employee productivity lost
Estimated annual health care expense
Generate PDF Working
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