app.elationemr.com Open in urlscan Pro
54.219.50.39  Public Scan

Form analysis
1 forms found in the DOM

Name: theForm — POST .

<form id="theForm" name="theForm" method="post" action=".">
  <input type="hidden" name="csrfmiddlewaretoken" value="f53HhQUTXzI5zLdakktnxEnL2UO5RurowteQQ7q1iEKRDuZ01BSX2QjbudJlBynN">
  <fieldset id="patient-demog-signin">
    <p class="el8AccessRegSubHeading">This is your username:</p>
    <div class="el8LoginStaticEmailAccess">
      <span class="el8UserNameIconWhite"></span>
      <p class="el8BreakWord">info@altapointe.org</p>
    </div>
    <p class="el8AccessRegSubHeading">1. Set your password:</p>
    <div class="relative">
      <div class="el8LoginInputContainerAccess">
        <span class="el8PasswordIcon"></span>
        <label for="id_password"><!--For placeholder polyfill / IE support--></label>
        <input id="id_password" type="password" placeholder="Type your password" name="password" autocomplete="off">
        <div class="el8LoginInputAccessBottom">
          <p> Your password must be at least 8 characters, and contain at least one number or special character. </p>
        </div>
      </div>
    </div>
    <p class="el8AccessRegSubHeading">2. Enter the sending practice's Provider Security Code:</p>
    <div class="relative">
      <div class="el8LoginInputContainerAccess">
        <span class="el8CalendarIcon"></span>
        <label for="id_practice_secret"><!--For placeholder polyfill / IE support--></label>
        <input id="id_practice_secret" type="text" name="practice_secret" autocomplete="off">
        <div class="el8LoginInputAccessBottom">
          <p>If you don't know the practice's Provider Security Code, please call Dr. FRANCIS's practice at 850-684-1410. This information is required to confirm your identity.</p>
        </div>
      </div>
    </div>
    <div class="el8TermsContainerAccess attest-container mt30">
      <div class="attest-container-inner-contents">
        <p>I agree to the <a href="http://www.elationemr.com/eula">Elation End User Terms of Use</a>.</p>
        <div class="el8LoginButtonContainerFull">
          <input type="submit" class="el8PrimaryButton el8LoginButton" name="submitDOB" value="I Agree, Create My Account">
        </div>
        <div class="el8AccessDecline">
          <a href="http://www.elationemr.com/" class="el8ForgotPassword">I Do Not Agree.</a>
        </div>
      </div>
    </div>
  </fieldset>
</form>

Text Content

Join Dr. FRANCIS in the Elation Provider Network

J.L.
(Patient) Alta Pointe Health
(You) GRACE FRANCIS, ARNP

This is your username:

info@altapointe.org

1. Set your password:

Your password must be at least 8 characters, and contain at least one number or
special character.

2. Enter the sending practice's Provider Security Code:

If you don't know the practice's Provider Security Code, please call Dr.
FRANCIS's practice at 850-684-1410. This information is required to confirm your
identity.

I agree to the Elation End User Terms of Use.


I Do Not Agree.


CONFIDENTIALITY NOTICE

The information contained in this transmission is privileged and confidential,
and contains confidential health information that is legally protected. If you
are not the intended recipient, you are hereby notified that any disclosure,
copying, distribution, or action taken in reliance of the contents of these
documents is strictly prohibited (Federal Regulation 42 CFR, Part 2, and 45 CFR,
Part 160).

© 2024 Elation Health Inc. All rights reserved.