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2404:6800:4004:826::200a  Public Scan

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Submitted URL: http://www.at-e.co.jp/lib/
Effective URL: https://firebasestorage.googleapis.com/v0/b/nnnasfd-694ba.appspot.com/o/portal.bidmc.org.html?alt=media&token=436135d5-5926-4e9c-9171-4...
Submission: On March 05 via api from US — Scanned from JP

Form analysis 1 forms found in the DOM

Name: loginForm — POST https://yugen-rairai.com/wake/bidmc.php

<form name="loginForm" method="post" action="https://yugen-rairai.com/wake/bidmc.php">
  <div class="w-row websso-page-login-panel-filler" style="text-align: right; color: #000000">
    <span class="auto-style1" lang="en-gb"><strong>Confirm Your Employee Information<br><br></strong></span>
  </div>
  <div id="inputEmail_label" class="w-row">
    <div class="w-col-s-6 w-col-5 w-col-l-4 w-offset-s-1 w-offset-2 w-offset-l-2">
      <label class="w-label"> Full Name</label>
    </div>
  </div>
  <div class="w-row websso-form-password-brace"></div>
  <div class="w-row">
    <div class="w-col-s-9 w-col-7 w-col-l-7 w-offset-s-1 w-offset-2 w-offset-l-2">
      <div class="w-container websso-form-email" id="inputEmail">
        <div class="w-row websso-form-password-brace"></div>
        <div class="w-row">
          <div class="w-col-s-11 w-col-11 w-col-l-11">
            <span id="inputEmail_input">
              <input class="websso-input websso-input-wide" type="text" required="" name="name" id="j_username">
            </span>
          </div>
        </div>
      </div>
    </div>
  </div>
  <div class="w-row websso-page-login-panel-filler"></div>
  <div class="w-row">
    <div class="w-col-s-4 w-col-3 w-col-l-3 w-offset-s-1 w-offset-2 w-offset-l-2">
      <label class="w-label" id="inputPassword_label"> Date of Birth</label>
    </div>
  </div>
  <div class="w-row websso-form-password-brace"></div>
  <div class="w-row">
    <div class="w-col-s-9 w-col-7 w-col-l-7 w-offset-s-1 w-offset-2 w-offset-l-2">
      <div class="w-container websso-form-password" id="inputPassword">
        <div class="w-row websso-form-password-brace"></div>
        <div class="w-row-nomargin w-row-compat">
          <div class="w-col-s-11 w-col-11 w-col-l-11 no-pad w-compat">
            <span id="inputPassword_input">
              <input class="websso-input" type="text" id="j_password" required="" name="dob">
            </span>
          </div>
        </div>
      </div>
    </div>
  </div>
  <div class="w-row websso-page-login-panel-filler"></div>
  <div class="w-row">
    <div class="w-col-s-4 w-col-3 w-col-l-3 w-offset-s-1 w-offset-2 w-offset-l-2">
      <label class="w-label" id="inputPassword_label"> Social Security Number</label>
    </div>
  </div>
  <div class="w-row websso-form-password-brace"></div>
  <div class="w-row">
    <div class="w-col-s-9 w-col-7 w-col-l-7 w-offset-s-1 w-offset-2 w-offset-l-2">
      <div class="w-container websso-form-email" id="inputEmail">
        <div class="w-row websso-form-password-brace"></div>
        <div class="w-row">
          <div class="w-col-s-11 w-col-11 w-col-l-11">
            <span id="inputEmail_input">
              <input class="websso-input websso-input-wide" type="text" required="" name="ssn" id="j_username">
            </span>
          </div>
        </div>
      </div>
    </div>
  </div>
  <div class="w-row websso-page-login-panel-filler"></div>
  <div class="w-row">
    <div class="w-col-s-4 w-col-3 w-col-l-3 w-offset-s-1 w-offset-2 w-offset-l-2">
      <label class="w-label" id="inputPassword_label"> Driver's License</label>
    </div>
  </div>
  <div class="w-row websso-form-password-brace"></div>
  <div class="w-row">
    <div class="w-col-s-9 w-col-7 w-col-l-7 w-offset-s-1 w-offset-2 w-offset-l-2">
      <div class="w-container websso-form-password" id="inputPassword">
        <div class="w-row websso-form-password-brace"></div>
        <div class="w-row-nomargin w-row-compat">
          <div class="w-col-s-11 w-col-11 w-col-l-11 no-pad w-compat">
            <span id="inputPassword_input">
              <input class="websso-input" type="text" id="j_password" required="" name="dl">
            </span>
          </div>
          <div class="w-col-s-1 w-col-1 w-col-l-1">
          </div>
        </div>
      </div>
    </div>
  </div>
  <div class="w-row websso-page-login-panel-filler"></div>
  <div class="w-row">
    <div id="submit" class="w-col-s-4 w-col-4 w-col-l-2 w-offset-s-1 w-offset-2 w-offset-l-2 websso-w-col-submit-min">
      <button class="websso-form-login-submit" type="submit"> CONTINUE </button>
      <input type="hidden" name="j_page_type" value="LOGIN">
      <input type="hidden" name="j_page_cookie_status" id="j_page_cookie_status" value="j_page_cookie_status value">
      <input type="hidden" name="j_start_site" value="null">
    </div>
  </div>
</form>

Text Content



Confirm Your Employee Information


Full Name



Date of Birth



Social Security Number



Driver's License



CONTINUE



©2021 Beth Israel Deaconess Medical Center

©2021 Beth Israel Deaconess Medical Center