proficienthealth.com
Open in
urlscan Pro
138.197.55.187
Public Scan
Submitted URL: http://proficienthealth.com/
Effective URL: https://proficienthealth.com/
Submission: On October 08 via api from US — Scanned from DE
Effective URL: https://proficienthealth.com/
Submission: On October 08 via api from US — Scanned from DE
Form analysis 4 forms found in the DOM
POST https://forms.hsforms.com/submissions/v3/public/submit/formsnext/multipart/20041163/ad190481-0aed-4f1e-8742-916eeb328b5a
<form novalidate="" accept-charset="UTF-8" action="https://forms.hsforms.com/submissions/v3/public/submit/formsnext/multipart/20041163/ad190481-0aed-4f1e-8742-916eeb328b5a" enctype="multipart/form-data"
id="hsForm_ad190481-0aed-4f1e-8742-916eeb328b5a" method="POST"
class="hs-form stacked hs-form-private hsForm_ad190481-0aed-4f1e-8742-916eeb328b5a hs-form-ad190481-0aed-4f1e-8742-916eeb328b5a hs-form-ad190481-0aed-4f1e-8742-916eeb328b5a_acadbcc0-75e8-4127-8efc-d903961a3c47"
data-form-id="ad190481-0aed-4f1e-8742-916eeb328b5a" data-portal-id="20041163" target="target_iframe_ad190481-0aed-4f1e-8742-916eeb328b5a" data-reactid=".hbspt-forms-1" data-hs-cf-bound="true">
<fieldset class="form-columns-2" data-reactid=".hbspt-forms-1.1:$0">
<div class="hs_firstname hs-firstname hs-fieldtype-text field hs-form-field" data-reactid=".hbspt-forms-1.1:$0.1:$firstname"><label id="label-firstname-ad190481-0aed-4f1e-8742-916eeb328b5a" class="" placeholder="Enter your First name"
for="firstname-ad190481-0aed-4f1e-8742-916eeb328b5a" data-reactid=".hbspt-forms-1.1:$0.1:$firstname.0"><span data-reactid=".hbspt-forms-1.1:$0.1:$firstname.0.0">First name</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-1.1:$0.1:$firstname.1"></legend>
<div class="input" data-reactid=".hbspt-forms-1.1:$0.1:$firstname.$firstname"><input id="firstname-ad190481-0aed-4f1e-8742-916eeb328b5a" class="hs-input" type="text" name="firstname" value="" placeholder="" autocomplete="given-name"
data-reactid=".hbspt-forms-1.1:$0.1:$firstname.$firstname.0" inputmode="text"></div>
</div>
<div class="hs_lastname hs-lastname hs-fieldtype-text field hs-form-field" data-reactid=".hbspt-forms-1.1:$0.1:$lastname"><label id="label-lastname-ad190481-0aed-4f1e-8742-916eeb328b5a" class="" placeholder="Enter your Last name"
for="lastname-ad190481-0aed-4f1e-8742-916eeb328b5a" data-reactid=".hbspt-forms-1.1:$0.1:$lastname.0"><span data-reactid=".hbspt-forms-1.1:$0.1:$lastname.0.0">Last name</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-1.1:$0.1:$lastname.1"></legend>
<div class="input" data-reactid=".hbspt-forms-1.1:$0.1:$lastname.$lastname"><input id="lastname-ad190481-0aed-4f1e-8742-916eeb328b5a" class="hs-input" type="text" name="lastname" value="" placeholder="" autocomplete="family-name"
data-reactid=".hbspt-forms-1.1:$0.1:$lastname.$lastname.0" inputmode="text"></div>
</div>
</fieldset>
<fieldset class="form-columns-1" data-reactid=".hbspt-forms-1.1:$1">
<div class="hs_company hs-company hs-fieldtype-text field hs-form-field" data-reactid=".hbspt-forms-1.1:$1.1:$company"><label id="label-company-ad190481-0aed-4f1e-8742-916eeb328b5a" class="" placeholder="Enter your Company name"
for="company-ad190481-0aed-4f1e-8742-916eeb328b5a" data-reactid=".hbspt-forms-1.1:$1.1:$company.0"><span data-reactid=".hbspt-forms-1.1:$1.1:$company.0.0">Company name</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-1.1:$1.1:$company.1"></legend>
<div class="input" data-reactid=".hbspt-forms-1.1:$1.1:$company.$company"><input id="company-ad190481-0aed-4f1e-8742-916eeb328b5a" class="hs-input" type="text" name="company" value="" placeholder="" autocomplete="organization"
data-reactid=".hbspt-forms-1.1:$1.1:$company.$company.0" inputmode="text"></div>
</div>
</fieldset>
<fieldset class="form-columns-1" data-reactid=".hbspt-forms-1.1:$2">
<div class="hs_email hs-email hs-fieldtype-text field hs-form-field" data-reactid=".hbspt-forms-1.1:$2.1:$email"><label id="label-email-ad190481-0aed-4f1e-8742-916eeb328b5a" class="" placeholder="Enter your Email"
for="email-ad190481-0aed-4f1e-8742-916eeb328b5a" data-reactid=".hbspt-forms-1.1:$2.1:$email.0"><span data-reactid=".hbspt-forms-1.1:$2.1:$email.0.0">Email</span><span class="hs-form-required"
data-reactid=".hbspt-forms-1.1:$2.1:$email.0.1">*</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-1.1:$2.1:$email.1"></legend>
<div class="input" data-reactid=".hbspt-forms-1.1:$2.1:$email.$email"><input id="email-ad190481-0aed-4f1e-8742-916eeb328b5a" class="hs-input" type="email" name="email" required="" placeholder="" value="" autocomplete="email"
data-reactid=".hbspt-forms-1.1:$2.1:$email.$email.0" inputmode="email"></div>
</div>
</fieldset>
<fieldset class="form-columns-1" data-reactid=".hbspt-forms-1.1:$3">
<div class="hs_phone hs-phone hs-fieldtype-text field hs-form-field" data-reactid=".hbspt-forms-1.1:$3.1:$phone"><label id="label-phone-ad190481-0aed-4f1e-8742-916eeb328b5a" class="" placeholder="Enter your Phone number"
for="phone-ad190481-0aed-4f1e-8742-916eeb328b5a" data-reactid=".hbspt-forms-1.1:$3.1:$phone.0"><span data-reactid=".hbspt-forms-1.1:$3.1:$phone.0.0">Phone number</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-1.1:$3.1:$phone.1"></legend>
<div class="input" data-reactid=".hbspt-forms-1.1:$3.1:$phone.$phone"><input id="phone-ad190481-0aed-4f1e-8742-916eeb328b5a" class="hs-input" type="tel" name="phone" value="" placeholder="" autocomplete="tel"
data-reactid=".hbspt-forms-1.1:$3.1:$phone.$phone.0" inputmode="tel"></div>
</div>
</fieldset>
<fieldset class="form-columns-1" data-reactid=".hbspt-forms-1.1:$4">
<div class="hs_product_type_v2 hs-product_type_v2 hs-fieldtype-select field hs-form-field" data-reactid=".hbspt-forms-1.1:$4.1:$product_type_v2"><label id="label-product_type_v2-ad190481-0aed-4f1e-8742-916eeb328b5a" class=""
placeholder="Enter your Product" for="product_type_v2-ad190481-0aed-4f1e-8742-916eeb328b5a" data-reactid=".hbspt-forms-1.1:$4.1:$product_type_v2.0"><span data-reactid=".hbspt-forms-1.1:$4.1:$product_type_v2.0.0">Product</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-1.1:$4.1:$product_type_v2.1"></legend>
<div class="input" data-reactid=".hbspt-forms-1.1:$4.1:$product_type_v2.$product_type_v2"><select id="product_type_v2-ad190481-0aed-4f1e-8742-916eeb328b5a" class="hs-input is-placeholder" name="product_type_v2"
data-reactid=".hbspt-forms-1.1:$4.1:$product_type_v2.$product_type_v2.0">
<option value="" disabled="" selected="" data-reactid=".hbspt-forms-1.1:$4.1:$product_type_v2.$product_type_v2.0.0">Please Select</option>
<option value="PH Exchange" data-reactid=".hbspt-forms-1.1:$4.1:$product_type_v2.$product_type_v2.0.1:$PH Exchange">PH Exchange: Referrals Management</option>
<option value="PH Connect" data-reactid=".hbspt-forms-1.1:$4.1:$product_type_v2.$product_type_v2.0.1:$PH Connect">PH Connect: Provider Communication</option>
<option value="PH Capture" data-reactid=".hbspt-forms-1.1:$4.1:$product_type_v2.$product_type_v2.0.1:$PH Capture">PH Capture: Fax/Document Management</option>
</select></div>
</div>
</fieldset><noscript data-reactid=".hbspt-forms-1.2"></noscript>
<div class="hs_submit hs-submit" data-reactid=".hbspt-forms-1.5">
<div class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-1.5.0"></div>
<div class="actions" data-reactid=".hbspt-forms-1.5.1"><input type="submit" value="Submit" class="hs-button primary large" data-reactid=".hbspt-forms-1.5.1.0"></div>
</div><noscript data-reactid=".hbspt-forms-1.6"></noscript><input name="hs_context" type="hidden"
value="{"rumScriptExecuteTime":1072,"rumServiceResponseTime":1408.7999999523163,"rumFormRenderTime":1.4000000953674316,"rumTotalRenderTime":1410.4000000953674,"rumTotalRequestTime":329.5,"lang":"en","embedType":"REGULAR","renderRawHtml":"true","embedAtTimestamp":"1665217529054","formDefinitionUpdatedAt":"1640207167573","pageUrl":"https://proficienthealth.com/","pageTitle":"Aligning Healthcare Referral Management | Proficient Health","source":"FormsNext-static-5.543","sourceName":"FormsNext","sourceVersion":"5.543","sourceVersionMajor":"5","sourceVersionMinor":"543","timestamp":1665217529054,"userAgent":"Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/106.0.5249.91 Safari/537.36","originalEmbedContext":{"region":"na1","portalId":"20041163","formId":"ad190481-0aed-4f1e-8742-916eeb328b5a","target":"#hbspt-form-1665217528815-1984471129"},"renderedFieldsIds":["firstname","lastname","company","email","phone","product_type_v2"],"formTarget":"#hbspt-form-1665217528815-1984471129","correlationId":"b86cac70-e74d-4ad4-b02d-082740321cb8","hutk":"9ec47c386eff8c373b77adc932077593","captchaStatus":"NOT_APPLICABLE"}"
data-reactid=".hbspt-forms-1.7"><iframe name="target_iframe_ad190481-0aed-4f1e-8742-916eeb328b5a" style="display:none;" data-reactid=".hbspt-forms-1.8"></iframe>
</form>POST https://forms.hsforms.com/submissions/v3/public/submit/formsnext/multipart/20041163/9a03fc05-1eff-4325-9573-2bb0e8f8666c
<form novalidate="" accept-charset="UTF-8" action="https://forms.hsforms.com/submissions/v3/public/submit/formsnext/multipart/20041163/9a03fc05-1eff-4325-9573-2bb0e8f8666c" enctype="multipart/form-data"
id="hsForm_9a03fc05-1eff-4325-9573-2bb0e8f8666c" method="POST"
class="hs-form stacked hs-form-private hsForm_9a03fc05-1eff-4325-9573-2bb0e8f8666c hs-form-9a03fc05-1eff-4325-9573-2bb0e8f8666c hs-form-9a03fc05-1eff-4325-9573-2bb0e8f8666c_6cd986c2-2962-438a-b14e-0f5b8eb0dd87"
data-form-id="9a03fc05-1eff-4325-9573-2bb0e8f8666c" data-portal-id="20041163" target="target_iframe_9a03fc05-1eff-4325-9573-2bb0e8f8666c" data-reactid=".hbspt-forms-2" data-hs-cf-bound="true">
<fieldset class="form-columns-3" data-reactid=".hbspt-forms-2.1:$0">
<div class="hs_firstname hs-firstname hs-fieldtype-text field hs-form-field" data-reactid=".hbspt-forms-2.1:$0.1:$firstname"><label id="label-firstname-9a03fc05-1eff-4325-9573-2bb0e8f8666c" class="" placeholder="Enter your First name"
for="firstname-9a03fc05-1eff-4325-9573-2bb0e8f8666c" data-reactid=".hbspt-forms-2.1:$0.1:$firstname.0"><span data-reactid=".hbspt-forms-2.1:$0.1:$firstname.0.0">First name</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-2.1:$0.1:$firstname.1"></legend>
<div class="input" data-reactid=".hbspt-forms-2.1:$0.1:$firstname.$firstname"><input id="firstname-9a03fc05-1eff-4325-9573-2bb0e8f8666c" class="hs-input" type="text" name="firstname" value="" placeholder="" autocomplete="given-name"
data-reactid=".hbspt-forms-2.1:$0.1:$firstname.$firstname.0" inputmode="text"></div>
</div>
<div class="hs_lastname hs-lastname hs-fieldtype-text field hs-form-field" data-reactid=".hbspt-forms-2.1:$0.1:$lastname"><label id="label-lastname-9a03fc05-1eff-4325-9573-2bb0e8f8666c" class="" placeholder="Enter your Last name"
for="lastname-9a03fc05-1eff-4325-9573-2bb0e8f8666c" data-reactid=".hbspt-forms-2.1:$0.1:$lastname.0"><span data-reactid=".hbspt-forms-2.1:$0.1:$lastname.0.0">Last name</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-2.1:$0.1:$lastname.1"></legend>
<div class="input" data-reactid=".hbspt-forms-2.1:$0.1:$lastname.$lastname"><input id="lastname-9a03fc05-1eff-4325-9573-2bb0e8f8666c" class="hs-input" type="text" name="lastname" value="" placeholder="" autocomplete="family-name"
data-reactid=".hbspt-forms-2.1:$0.1:$lastname.$lastname.0" inputmode="text"></div>
</div>
<div class="hs_email hs-email hs-fieldtype-text field hs-form-field" data-reactid=".hbspt-forms-2.1:$0.1:$email"><label id="label-email-9a03fc05-1eff-4325-9573-2bb0e8f8666c" class="" placeholder="Enter your Email"
for="email-9a03fc05-1eff-4325-9573-2bb0e8f8666c" data-reactid=".hbspt-forms-2.1:$0.1:$email.0"><span data-reactid=".hbspt-forms-2.1:$0.1:$email.0.0">Email</span><span class="hs-form-required"
data-reactid=".hbspt-forms-2.1:$0.1:$email.0.1">*</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-2.1:$0.1:$email.1"></legend>
<div class="input" data-reactid=".hbspt-forms-2.1:$0.1:$email.$email"><input id="email-9a03fc05-1eff-4325-9573-2bb0e8f8666c" class="hs-input" type="email" name="email" required="" placeholder="" value="" autocomplete="email"
data-reactid=".hbspt-forms-2.1:$0.1:$email.$email.0" inputmode="email"></div>
</div>
</fieldset><noscript data-reactid=".hbspt-forms-2.2"></noscript>
<div class="hs_recaptcha hs-recaptcha field hs-form-field" data-reactid=".hbspt-forms-2.3">
<div class="input" data-reactid=".hbspt-forms-2.3.0">
<div class="grecaptcha-badge" data-style="inline" style="width: 256px; height: 60px; box-shadow: gray 0px 0px 5px;">
<div class="grecaptcha-logo"><iframe title="reCAPTCHA"
src="https://www.google.com/recaptcha/enterprise/anchor?ar=1&k=6Ld_ad8ZAAAAAAqr0ePo1dUfAi0m4KPkCMQYwPPm&co=aHR0cHM6Ly9wcm9maWNpZW50aGVhbHRoLmNvbTo0NDM.&hl=de&v=vP4jQKq0YJFzU6e21-BGy3GP&size=invisible&badge=inline&cb=kvg2wnt1iw34"
width="256" height="60" role="presentation" name="a-64qsxwm6wf7m" frameborder="0" scrolling="no" sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe>
</div>
<div class="grecaptcha-error"></div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div>
</div><input type="hidden" name="g-recaptcha-response" id="hs-recaptcha-response" value="" data-reactid=".hbspt-forms-2.3.1">
</div>
<div class="hs_submit hs-submit" data-reactid=".hbspt-forms-2.5">
<div class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-2.5.0"></div>
<div class="actions" data-reactid=".hbspt-forms-2.5.1"><input type="submit" value="Submit" class="hs-button primary large" data-reactid=".hbspt-forms-2.5.1.0"></div>
</div><noscript data-reactid=".hbspt-forms-2.6"></noscript><input name="hs_context" type="hidden"
value="{"rumScriptExecuteTime":1044.9000000953674,"rumServiceResponseTime":1662.5999999046326,"rumFormRenderTime":1.5999999046325684,"rumTotalRenderTime":1664.7999999523163,"rumTotalRequestTime":607,"lang":"en","embedType":"REGULAR","renderRawHtml":"true","embedAtTimestamp":"1665217529315","formDefinitionUpdatedAt":"1630421359673","pageUrl":"https://proficienthealth.com/","pageTitle":"Aligning Healthcare Referral Management | Proficient Health","source":"FormsNext-static-5.543","sourceName":"FormsNext","sourceVersion":"5.543","sourceVersionMajor":"5","sourceVersionMinor":"543","timestamp":1665217529315,"userAgent":"Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/106.0.5249.91 Safari/537.36","originalEmbedContext":{"region":"na1","portalId":"20041163","formId":"9a03fc05-1eff-4325-9573-2bb0e8f8666c","target":"#hbspt-form-1665217528791-7316384318"},"renderedFieldsIds":["firstname","lastname","email"],"formTarget":"#hbspt-form-1665217528791-7316384318","correlationId":"03733c94-d714-48cb-969d-453d3bfc2692","hutk":"9ec47c386eff8c373b77adc932077593","captchaStatus":"LOADED"}"
data-reactid=".hbspt-forms-2.7"><iframe name="target_iframe_9a03fc05-1eff-4325-9573-2bb0e8f8666c" style="display:none;" data-reactid=".hbspt-forms-2.8"></iframe>
</form>POST https://forms.hsforms.com/submissions/v3/public/submit/formsnext/multipart/20041163/ed588c6f-7377-4bc0-a564-d1e2a0a5a37c
<form novalidate="" accept-charset="UTF-8" action="https://forms.hsforms.com/submissions/v3/public/submit/formsnext/multipart/20041163/ed588c6f-7377-4bc0-a564-d1e2a0a5a37c" enctype="multipart/form-data"
id="hsForm_ed588c6f-7377-4bc0-a564-d1e2a0a5a37c" method="POST"
class="hs-form stacked hs-form-private hsForm_ed588c6f-7377-4bc0-a564-d1e2a0a5a37c hs-form-ed588c6f-7377-4bc0-a564-d1e2a0a5a37c hs-form-ed588c6f-7377-4bc0-a564-d1e2a0a5a37c_5561ccc9-6049-4ab9-bbc6-6df24897971d"
data-form-id="ed588c6f-7377-4bc0-a564-d1e2a0a5a37c" data-portal-id="20041163" target="target_iframe_ed588c6f-7377-4bc0-a564-d1e2a0a5a37c" data-reactid=".hbspt-forms-3" data-hs-cf-bound="true">
<div class="hs_email hs-email hs-fieldtype-text field hs-form-field" data-reactid=".hbspt-forms-3.1:$0"><label id="label-email-ed588c6f-7377-4bc0-a564-d1e2a0a5a37c" class="" placeholder="Enter your Email"
for="email-ed588c6f-7377-4bc0-a564-d1e2a0a5a37c" data-reactid=".hbspt-forms-3.1:$0.0"><span data-reactid=".hbspt-forms-3.1:$0.0.0">Email</span><span class="hs-form-required" data-reactid=".hbspt-forms-3.1:$0.0.1">*</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-3.1:$0.1"></legend>
<div class="input" data-reactid=".hbspt-forms-3.1:$0.$email"><input id="email-ed588c6f-7377-4bc0-a564-d1e2a0a5a37c" class="hs-input" type="email" name="email" required="" placeholder="" value="" autocomplete="email"
data-reactid=".hbspt-forms-3.1:$0.$email.0" inputmode="email"></div>
</div><noscript data-reactid=".hbspt-forms-3.2"></noscript>
<div class="hs_recaptcha hs-recaptcha field hs-form-field" data-reactid=".hbspt-forms-3.3">
<div class="input" data-reactid=".hbspt-forms-3.3.0">
<div class="grecaptcha-badge" data-style="inline" style="width: 256px; height: 60px; box-shadow: gray 0px 0px 5px;">
<div class="grecaptcha-logo"><iframe title="reCAPTCHA"
src="https://www.google.com/recaptcha/enterprise/anchor?ar=1&k=6Ld_ad8ZAAAAAAqr0ePo1dUfAi0m4KPkCMQYwPPm&co=aHR0cHM6Ly9wcm9maWNpZW50aGVhbHRoLmNvbTo0NDM.&hl=de&v=vP4jQKq0YJFzU6e21-BGy3GP&size=invisible&badge=inline&cb=s495gv8ysuu5"
width="256" height="60" role="presentation" name="a-26zjafpj2bb1" frameborder="0" scrolling="no" sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe>
</div>
<div class="grecaptcha-error"></div><textarea id="g-recaptcha-response-1" name="g-recaptcha-response" class="g-recaptcha-response"
style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div><input type="hidden" name="g-recaptcha-response" id="hs-recaptcha-response" value="" data-reactid=".hbspt-forms-3.3.1">
</div>
<div class="hs_submit hs-submit" data-reactid=".hbspt-forms-3.5">
<div class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-3.5.0"></div>
<div class="actions" data-reactid=".hbspt-forms-3.5.1"><input type="submit" value="Submit" class="hs-button primary large" data-reactid=".hbspt-forms-3.5.1.0"></div>
</div><noscript data-reactid=".hbspt-forms-3.6"></noscript><input name="hs_context" type="hidden"
value="{"rumScriptExecuteTime":1044.9000000953674,"rumServiceResponseTime":1663.0999999046326,"rumFormRenderTime":1.4000000953674316,"rumTotalRenderTime":1678,"rumTotalRequestTime":604.2999999523163,"lang":"en","embedType":"REGULAR","renderRawHtml":"true","embedAtTimestamp":"1665217529317","formDefinitionUpdatedAt":"1630421161164","pageUrl":"https://proficienthealth.com/","pageTitle":"Aligning Healthcare Referral Management | Proficient Health","source":"FormsNext-static-5.543","sourceName":"FormsNext","sourceVersion":"5.543","sourceVersionMajor":"5","sourceVersionMinor":"543","timestamp":1665217529317,"userAgent":"Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/106.0.5249.91 Safari/537.36","originalEmbedContext":{"region":"na1","portalId":"20041163","formId":"ed588c6f-7377-4bc0-a564-d1e2a0a5a37c","target":"#hbspt-form-1665217528795-6785550330"},"renderedFieldsIds":["email"],"formTarget":"#hbspt-form-1665217528795-6785550330","correlationId":"29db4072-4952-4be5-b56e-66d7e098afa2","hutk":"9ec47c386eff8c373b77adc932077593","captchaStatus":"LOADED"}"
data-reactid=".hbspt-forms-3.7"><iframe name="target_iframe_ed588c6f-7377-4bc0-a564-d1e2a0a5a37c" style="display:none;" data-reactid=".hbspt-forms-3.8"></iframe>
</form>POST https://forms.hsforms.com/submissions/v3/public/submit/formsnext/multipart/20041163/407a0fab-d10a-4060-81f2-fe1a74a16fb4
<form novalidate="" accept-charset="UTF-8" action="https://forms.hsforms.com/submissions/v3/public/submit/formsnext/multipart/20041163/407a0fab-d10a-4060-81f2-fe1a74a16fb4" enctype="multipart/form-data"
id="hsForm_407a0fab-d10a-4060-81f2-fe1a74a16fb4" method="POST"
class="hs-form stacked hs-form-private hsForm_407a0fab-d10a-4060-81f2-fe1a74a16fb4 hs-form-407a0fab-d10a-4060-81f2-fe1a74a16fb4 hs-form-407a0fab-d10a-4060-81f2-fe1a74a16fb4_0a61a9f4-3bf3-4ff8-8287-9d808c255fb8"
data-form-id="407a0fab-d10a-4060-81f2-fe1a74a16fb4" data-portal-id="20041163" target="target_iframe_407a0fab-d10a-4060-81f2-fe1a74a16fb4" data-reactid=".hbspt-forms-0" data-hs-cf-bound="true">
<fieldset class="form-columns-2" data-reactid=".hbspt-forms-0.1:$0">
<div class="hs_firstname hs-firstname hs-fieldtype-text field hs-form-field" data-reactid=".hbspt-forms-0.1:$0.1:$firstname"><label id="label-firstname-407a0fab-d10a-4060-81f2-fe1a74a16fb4" class="" placeholder="Enter your First name"
for="firstname-407a0fab-d10a-4060-81f2-fe1a74a16fb4" data-reactid=".hbspt-forms-0.1:$0.1:$firstname.0"><span data-reactid=".hbspt-forms-0.1:$0.1:$firstname.0.0">First name</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-0.1:$0.1:$firstname.1"></legend>
<div class="input" data-reactid=".hbspt-forms-0.1:$0.1:$firstname.$firstname"><input id="firstname-407a0fab-d10a-4060-81f2-fe1a74a16fb4" class="hs-input" type="text" name="firstname" value="" placeholder="" autocomplete="given-name"
data-reactid=".hbspt-forms-0.1:$0.1:$firstname.$firstname.0" inputmode="text"></div>
</div>
<div class="hs_lastname hs-lastname hs-fieldtype-text field hs-form-field" data-reactid=".hbspt-forms-0.1:$0.1:$lastname"><label id="label-lastname-407a0fab-d10a-4060-81f2-fe1a74a16fb4" class="" placeholder="Enter your Last name"
for="lastname-407a0fab-d10a-4060-81f2-fe1a74a16fb4" data-reactid=".hbspt-forms-0.1:$0.1:$lastname.0"><span data-reactid=".hbspt-forms-0.1:$0.1:$lastname.0.0">Last name</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-0.1:$0.1:$lastname.1"></legend>
<div class="input" data-reactid=".hbspt-forms-0.1:$0.1:$lastname.$lastname"><input id="lastname-407a0fab-d10a-4060-81f2-fe1a74a16fb4" class="hs-input" type="text" name="lastname" value="" placeholder="" autocomplete="family-name"
data-reactid=".hbspt-forms-0.1:$0.1:$lastname.$lastname.0" inputmode="text"></div>
</div>
</fieldset>
<fieldset class="form-columns-1" data-reactid=".hbspt-forms-0.1:$1">
<div class="hs_company hs-company hs-fieldtype-text field hs-form-field" data-reactid=".hbspt-forms-0.1:$1.1:$company"><label id="label-company-407a0fab-d10a-4060-81f2-fe1a74a16fb4" class="" placeholder="Enter your Company name"
for="company-407a0fab-d10a-4060-81f2-fe1a74a16fb4" data-reactid=".hbspt-forms-0.1:$1.1:$company.0"><span data-reactid=".hbspt-forms-0.1:$1.1:$company.0.0">Company name</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-0.1:$1.1:$company.1"></legend>
<div class="input" data-reactid=".hbspt-forms-0.1:$1.1:$company.$company"><input id="company-407a0fab-d10a-4060-81f2-fe1a74a16fb4" class="hs-input" type="text" name="company" value="" placeholder="" autocomplete="organization"
data-reactid=".hbspt-forms-0.1:$1.1:$company.$company.0" inputmode="text"></div>
</div>
</fieldset>
<fieldset class="form-columns-1" data-reactid=".hbspt-forms-0.1:$2">
<div class="hs_email hs-email hs-fieldtype-text field hs-form-field" data-reactid=".hbspt-forms-0.1:$2.1:$email"><label id="label-email-407a0fab-d10a-4060-81f2-fe1a74a16fb4" class="" placeholder="Enter your Email"
for="email-407a0fab-d10a-4060-81f2-fe1a74a16fb4" data-reactid=".hbspt-forms-0.1:$2.1:$email.0"><span data-reactid=".hbspt-forms-0.1:$2.1:$email.0.0">Email</span><span class="hs-form-required"
data-reactid=".hbspt-forms-0.1:$2.1:$email.0.1">*</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-0.1:$2.1:$email.1"></legend>
<div class="input" data-reactid=".hbspt-forms-0.1:$2.1:$email.$email"><input id="email-407a0fab-d10a-4060-81f2-fe1a74a16fb4" class="hs-input" type="email" name="email" required="" placeholder="" value="" autocomplete="email"
data-reactid=".hbspt-forms-0.1:$2.1:$email.$email.0" inputmode="email"></div>
</div>
</fieldset>
<fieldset class="form-columns-1" data-reactid=".hbspt-forms-0.1:$3">
<div class="hs_phone hs-phone hs-fieldtype-text field hs-form-field" data-reactid=".hbspt-forms-0.1:$3.1:$phone"><label id="label-phone-407a0fab-d10a-4060-81f2-fe1a74a16fb4" class="" placeholder="Enter your Phone number"
for="phone-407a0fab-d10a-4060-81f2-fe1a74a16fb4" data-reactid=".hbspt-forms-0.1:$3.1:$phone.0"><span data-reactid=".hbspt-forms-0.1:$3.1:$phone.0.0">Phone number</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-0.1:$3.1:$phone.1"></legend>
<div class="input" data-reactid=".hbspt-forms-0.1:$3.1:$phone.$phone"><input id="phone-407a0fab-d10a-4060-81f2-fe1a74a16fb4" class="hs-input" type="tel" name="phone" value="" placeholder="" autocomplete="tel"
data-reactid=".hbspt-forms-0.1:$3.1:$phone.$phone.0" inputmode="tel"></div>
</div>
</fieldset>
<fieldset class="form-columns-1" data-reactid=".hbspt-forms-0.1:$4">
<div class="hs_product_type_v2 hs-product_type_v2 hs-fieldtype-select field hs-form-field" data-reactid=".hbspt-forms-0.1:$4.1:$product_type_v2"><label id="label-product_type_v2-407a0fab-d10a-4060-81f2-fe1a74a16fb4" class=""
placeholder="Enter your Product" for="product_type_v2-407a0fab-d10a-4060-81f2-fe1a74a16fb4" data-reactid=".hbspt-forms-0.1:$4.1:$product_type_v2.0"><span data-reactid=".hbspt-forms-0.1:$4.1:$product_type_v2.0.0">Product</span></label>
<legend class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-0.1:$4.1:$product_type_v2.1"></legend>
<div class="input" data-reactid=".hbspt-forms-0.1:$4.1:$product_type_v2.$product_type_v2"><select id="product_type_v2-407a0fab-d10a-4060-81f2-fe1a74a16fb4" class="hs-input is-placeholder" name="product_type_v2"
data-reactid=".hbspt-forms-0.1:$4.1:$product_type_v2.$product_type_v2.0">
<option value="" disabled="" selected="" data-reactid=".hbspt-forms-0.1:$4.1:$product_type_v2.$product_type_v2.0.0">Please Select</option>
<option value="PH Exchange" data-reactid=".hbspt-forms-0.1:$4.1:$product_type_v2.$product_type_v2.0.1:$PH Exchange">PH Exchange: Referrals Management</option>
<option value="PH Connect" data-reactid=".hbspt-forms-0.1:$4.1:$product_type_v2.$product_type_v2.0.1:$PH Connect">PH Connect: Provider Communication</option>
<option value="PH Capture" data-reactid=".hbspt-forms-0.1:$4.1:$product_type_v2.$product_type_v2.0.1:$PH Capture">PH Capture: Fax/Document Management</option>
</select></div>
</div>
</fieldset><noscript data-reactid=".hbspt-forms-0.2"></noscript>
<div class="hs_submit hs-submit" data-reactid=".hbspt-forms-0.5">
<div class="hs-field-desc" style="display:none;" data-reactid=".hbspt-forms-0.5.0"></div>
<div class="actions" data-reactid=".hbspt-forms-0.5.1"><input type="submit" value="Submit" class="hs-button primary large" data-reactid=".hbspt-forms-0.5.1.0"></div>
</div><noscript data-reactid=".hbspt-forms-0.6"></noscript><input name="hs_context" type="hidden"
value="{"rumScriptExecuteTime":1044.9000000953674,"rumServiceResponseTime":1373,"rumFormRenderTime":2,"rumTotalRenderTime":1375.9000000953674,"rumTotalRequestTime":313.59999990463257,"notifyHubSpotOwner":"true","renderRawHtml":"true","lang":"en","embedType":"REGULAR","embedAtTimestamp":"1665217529042","formDefinitionUpdatedAt":"1640207251200","pageUrl":"https://proficienthealth.com/","pageTitle":"Aligning Healthcare Referral Management | Proficient Health","source":"FormsNext-static-5.543","sourceName":"FormsNext","sourceVersion":"5.543","sourceVersionMajor":"5","sourceVersionMinor":"543","timestamp":1665217529042,"userAgent":"Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/106.0.5249.91 Safari/537.36","originalEmbedContext":{"region":"na1","portalId":"20041163","formId":"407a0fab-d10a-4060-81f2-fe1a74a16fb4","target":"#hbspt-form-1665217528795-2371992469"},"renderedFieldsIds":["firstname","lastname","company","email","phone","product_type_v2"],"formTarget":"#hbspt-form-1665217528795-2371992469","correlationId":"c7c16e35-bbdf-46c8-b9dd-1014ed50c19d","hutk":"9ec47c386eff8c373b77adc932077593","captchaStatus":"NOT_APPLICABLE"}"
data-reactid=".hbspt-forms-0.7"><iframe name="target_iframe_407a0fab-d10a-4060-81f2-fe1a74a16fb4" style="display:none;" data-reactid=".hbspt-forms-0.8"></iframe>
</form>Text Content
* PH ExchangeReferrals Management * PH ConnectProvider Access * PH CaptureFax/Document Management * About * Resources * Case Studies * Events * News * Webinars * Whitepapers * Contact * PH ExchangeReferral Management * PH ConnectProvider Access * PH CaptureFax/Document Management * About * Insights * Case Studies * News And Events * Contact Free Demo CONNECTING COMPLEX PROVIDER NETWORKS Proficient Health streamlines access, communications, and workflows across provider communities delivering data and insights that improve patient outcomes and optimize financial performance. Request a Demo IN PROUD PARTNERSHIP WITH Enable Communication & Collaboration CONNECT YOUR CARE COMMUNITY & OPTIMIZE YOUR NETWORK * SIMPLIFIED WORKFLOWS Built for complex networks * ACTIONABLE DATA SETS Improve patient care coordination * SPECIALIST ACCESS Fast answers for urgent needs * REAL-TIME INSIGHTS Data for network optimization * EHR/EMR COMPANION Compliment your technology stack Bridging interoperability THREE SOLUTIONS. ONE PLATFORM. SEAMLESS INTEGRATIONS. * PH EXCHANGE Centralized Referrals Management Read More * PH CONNECT Provider Access Read More * PH CAPTURE Fax & Document Management Read More Real results PROFICIENT HEALTH BY THE NUMBERS * Up To 0% Improvement In Care Retention * 0% Reduction in time-to-appointment * 0 Seconds Average Provider Response Time * Up To 0% User Adoption “We now have a seamless, ‘closed loop’ workflow to support prompter and better-coordinated care delivery. Everyone benefits, including both our member practices and our patients.” Elissa Langley VP Chief Operating Officer, Triad HealthCare Network “Within our client base, referrals managed by PH Exchange out-performed claims data care retention metrics by up to 40%.” David Heenan Cone Health Ventures, Principal When patients know I already know them and why I am going to see them, it makes them feel more confident in my care. Dr. Jay Ganji Cardiologist View Their Story “PH Connect has truly revolutionized the way we take care of patients.” Mark Wood MD, Orthopedic Surgeon, Medical Director of NCFC, Wake Ortho We now have a seamless, ‘closed loop’ workflow to support prompter and better-coordinated care delivery. Everyone benefits, including both our member practices and our patients. Within our client base, referrals managed by PH Exchange out-performed claims data care retention metrics by up to 40%. PH Connect has truly revolutionized the way we take care of patients. This technology has enabled us to build on established provider relationships both within our system and the community as well as access to new opportunities with regional sports teams, trainers and therapists. Patient care questions, x-ray consultations, and follow-up arrangement is significantly more efficient and has allowed our practice to increase access for referring providers. LET'S TALK Take control of your referrals First name Last name Company name Email* Phone number Product Please SelectPH Exchange: Referrals ManagementPH Connect: Provider CommunicationPH Capture: Fax/Document Management KEEP UP WITH PROFICIENT HEALTH VIEW ALL POSTS * Blogs GROWTH, ACCESS, AND CAPACITY IMPACTING CHILDREN’S HOSPITALS IN 2022 * PH Exchange 2022 TECHNOLOGY REVOLUTION: USING INNOVATION TO DRIVE QUALITY IN VALUE-BASED CARE ORGANIZATIONS * Blogs PROFICIENT HEALTH SPONSORS AND RIDES IN LOWVELO BIKE RACE * Blogs PROFICIENT HEALTH ATTENDS THE FLORIDA ASSOCIATION OF ACOS CONFERENCE STAY CONNECTED WITH YOUR COMMUNITY PROVIDERS. Our whitepaper can show you how! download now DOWNLOAD A "How to Guide" for Solving 5 Patient Access Pain Points Please fill out the fields below to download. First name Last name Email* * Contact * Solutions * Careers * NEWS AND EVENTS 336-389-6600 SUBSCRIBE TO KEEP UP! Email* © 2022 Proficienthealth.com. All Rights Reserved. * Privacy Policy * Terms of Service SUBSCRIBE TO KEEP UP! Your Health System Efficiency First name Last name Company name Email* Phone number Product Please SelectPH Exchange: Referrals ManagementPH Connect: Provider CommunicationPH Capture: Fax/Document Management Cancel