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2606:4700::6812:6b1  Public Scan

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Submitted URL: https://trk.cp20.com/click/g5yv-2fwmmn-g3iiph-bkinj574/pmreg33oorqwg5bonv2wszc7nbqxg2bchirgimjrg44wgztgha2gkztggm4gcy...
Effective URL: https://primeinc.org/online/resolving-complex-cases-hiv/solving-complex-cases-in-art-initiation/quiz?utm_campaign=54B...
Submission: On September 07 via api from US

Form analysis 4 forms found in the DOM

POST 

<form class="form-horizontal row" method="POST" id="prime-login-modal-login-form" autocomplete="off">
  <div class="col-xs-12">
    <div class="alert alert-info"> In a continued effort to keep your information secure, we have upgraded our password security policy. If you do not remember your current password, simply click "Forgot Password" and you will be sent an email
      allowing you to change it. </div>
    <div class="alert alert-danger fade" style="margin:0;padding:0;"></div>
  </div>
  <div class="col-sm-6 col-sm-offset-3">
    <div class="form-group prime-field-label-wrap">
      <label for="prime-login-modal-field-email" class="col-xs-12 prime-field-label sr-only"> Email address </label>
      <div class="col-xs-12">
        <input type="text" id="prime-login-modal-field-email" name="email" placeholder="Email address…" class="form-control" autocomplete="username">
      </div>
    </div>
    <div class="form-group prime-field-label-wrap">
      <label for="prime-login-modal-field-password" class="col-xs-12 prime-field-label sr-only"> Password </label>
      <div class="col-xs-12">
        <input type="password" id="prime-login-modal-field-password" name="password" placeholder="Password…" class="form-control" autocomplete="current-password">
      </div>
    </div>
    <div class="clearfix mt-2 text-center">
      <button type="submit" class="btn btn-md btn-aqua">Log In <i class="arrow-icon arrow-icon-right"></i></button>
    </div>
  </div>
  <div class="clearfix"></div>
</form>

POST 

<form class="form-horizontal has-opt-in-field" method="POST" id="prime-reg-modal-reg-form" autocomplete="off">
  <div class="alert alert-info fade" style="margin:0;padding:0;"></div>
  <div class="alert alert-danger fade" style="margin:0;padding:0;"></div>
  <input type="hidden" name="country" value="AT">
  <input type="hidden" name="_program_code" value="" data-live-event-program-code="">
  <input type="hidden" name="require_phone" value="" data-live-event-require-phone="">
  <div class="form-group prime-field-label-wrap mb-1">
    <label for="prime-reg-field-firstname" class="col-xs-12 prime-field-label sr-only"> First name </label>
    <div class="col-xs-12">
      <input type="text" id="prime-reg-field-firstname" name="firstname" value="" placeholder="First name…" class="form-control">
    </div>
  </div>
  <div class="form-group prime-field-label-wrap mb-1">
    <label for="prime-reg-field-lastname" class="col-xs-12 prime-field-label sr-only"> Last name </label>
    <div class="col-xs-12">
      <input type="text" id="prime-reg-field-lastname" name="lastname" value="" placeholder="Last name…" class="form-control">
    </div>
  </div>
  <div class="form-group prime-field-label-wrap mb-1">
    <label for="prime-reg-field-email" class="col-xs-12 prime-field-label sr-only"> Email address </label>
    <div class="col-xs-12">
      <input type="text" id="prime-reg-field-email" name="email" value="" placeholder="Email address…" class="form-control" autocomplete="off">
    </div>
  </div>
  <div class="form-group reg-modal-default reg-modal-live-event-any prime-field-label-wrap mb-1">
    <label for="prime-reg-field-password" class="col-xs-12 prime-field-label sr-only"> Create a password </label>
    <div class="col-xs-12">
      <input type="password" id="prime-reg-field-password" name="password" placeholder="Password…" class="form-control" autocomplete="new-password">
      <small class="center-block text-left text-primary mt-1"> Create a new password with at least 6 characters and 1 letter and 1 digit or symbol. </small>
    </div>
  </div>
  <div class="form-group reg-modal-default reg-modal-live-event-any prime-field-label-wrap mb-1">
    <label for="prime-reg-field-password2" class="col-xs-12 prime-field-label sr-only"> Confirm your password </label>
    <div class="col-xs-12">
      <input type="password" id="prime-reg-field-password2" name="confirmpassword" placeholder="Confirm password…" class="form-control" autocomplete="new-password">
      <small class="center-block text-left text-primary mt-1"> Enter your new password again. </small>
    </div>
  </div>
  <div class="form-group fade prime-field-label-wrap mb-1 in">
    <label for="prime-reg-field-profession" class="col-xs-12 prime-field-label sr-only"> Profession </label>
    <div class="col-xs-12">
      <select name="profession" class="form-control" id="prime-reg-field-profession" data-load-select-options="professions" data-selected="">
        <option value="" class="placeholder">Profession…</option>
        <option></option>
        <option value="1">Physician</option>
        <option value="2">Nurse</option>
        <option value="3">Pharmacist</option>
        <option value="4">Nurse Practitioner</option>
        <option value="5">Case Manager</option>
        <option value="6">Physician Assistant</option>
        <option value="7">Resident</option>
        <option value="9">Medical Assistant</option>
        <option value="10">Dentist</option>
        <option value="11">Pharm Tech</option>
        <option value="12">Health Education Specialist</option>
        <option value="13">Respiratory Therapist</option>
        <option value="15">Physical Therapist</option>
        <option value="16">Psychologist</option>
        <option value="17">Dietician</option>
        <option value="96">Dietetic Technician</option>
        <option value="18">HR Specialist</option>
        <option value="21">Medical Director</option>
        <option value="22">Fellow</option>
        <option value="93">Social Worker</option>
        <option value="24">Genetic Counselor</option>
        <option value="14">Other HCP</option>
        <option value="26">Patient/Caregiver</option>
      </select>
    </div>
  </div>
  <div class="form-group fade prime-field-label-wrap mb-1 in">
    <label for="prime-reg-field-setting" class="col-xs-12 prime-field-label sr-only"> Practice setting </label>
    <div class="col-xs-12">
      <select name="practice" class="form-control" id="prime-reg-field-setting" data-load-select-options="practices" data-selected="">
        <option value="" class="placeholder">Practice setting…</option>
        <option></option>
        <option value="7">Community / Retail</option>
        <option value="13">Consultant</option>
        <option value="17">Consumer</option>
        <option value="10">Employer</option>
        <option value="3">Health Plan</option>
        <option value="18">Home Health Care</option>
        <option value="1">Hospital</option>
        <option value="16">Integrated (ACO, PCMH, etc.)</option>
        <option value="12">Long Term Care</option>
        <option value="5">Medical Practice</option>
        <option value="21">None / Other</option>
        <option value="19">Research / Academia</option>
        <option value="14">Specialty Pharmacy / PBM</option>
        <option value="2">State / Federal Government</option>
      </select>
    </div>
  </div>
  <div class="form-group fade prime-field-label-wrap mb-1 in">
    <label for="prime-reg-field-specialty" class="col-xs-12 prime-field-label sr-only"> Specialty </label>
    <div class="col-xs-12">
      <select name="specialty" class="form-control" id="prime-reg-field-specialty" data-load-select-options="specialties" data-selected="">
        <option value="" class="placeholder">Specialty…</option>
        <option></option>
        <option value="3">Family Medicine</option>
        <option value="4">Neurology</option>
        <option value="5">Internal Medicine</option>
        <option value="6">Hematology / Oncology</option>
        <option value="7">Psychiatry</option>
        <option value="8">Pediatrics</option>
        <option value="10">Surgery</option>
        <option value="11">Geriatric Medicine</option>
        <option value="12">Infectious Disease</option>
        <option value="13">Cardiology</option>
        <option value="14">Gastroenterology</option>
        <option value="15">Emergency Medicine</option>
        <option value="16">Critical Care</option>
        <option value="17">Dermatology</option>
        <option value="18">Anesthesiology</option>
        <option value="20">Pain Management</option>
        <option value="19">Med / Surg</option>
        <option value="21">Allergy / Immunology</option>
        <option value="22">Pulmonology</option>
        <option value="23">Rheumatology</option>
        <option value="24">Orthopedics</option>
        <option value="25">OBGYN</option>
        <option value="26">Radiology</option>
        <option value="27">Women's Health</option>
        <option value="29">Endocrinology</option>
        <option value="30">Nephrology</option>
        <option value="31">Ophthalmology</option>
        <option value="34">Pathology</option>
        <option value="36">Hepatology</option>
        <option value="38">Urology</option>
        <option value="40">Genetic Disorders</option>
        <option value="39">Neonatal / Perinatal</option>
        <option value="46">Otolaryngology</option>
        <option value="56">Oncology</option>
        <option value="1">Other</option>
        <option value="2">None</option>
      </select>
    </div>
  </div>
  <div class="form-group prime-field-label-wrap mb-1">
    <label for="prime-reg-field-zip" class="col-xs-12 prime-field-label sr-only"> Zip code </label>
    <div class="col-xs-12">
      <input type="tel" id="prime-reg-field-zip" name="zip" value="" maxlength="12" placeholder="Zip code…" class="form-control" style="max-width: 170px">
    </div>
  </div>
  <div class="form-group prime-field-label-wrap mb-1 reg-modal-live-event-live-meeting">
    <label for="prime-reg-field-company" class="col-xs-12 prime-field-label sr-only"> Company/Organization </label>
    <div class="col-xs-12">
      <input type="text" id="prime-reg-field-company" name="company" value="" placeholder="Company/Organization…" class="form-control">
    </div>
  </div>
  <div class="form-group prime-field-label-wrap mb-1">
    <label for="prime-reg-field-phone" class="col-xs-12 prime-field-label sr-only"> Mobile number </label>
    <div class="col-xs-12">
      <input type="tel" id="prime-reg-field-phone" name="phone" value="" placeholder="Mobile number…" class="form-control">
      <small class="center-block text-left text-primary mt-1">For text message reminders prior to the event.</small>
    </div>
  </div>
  <hr class="mt-3 mb-3">
  <div class="row">
    <div class="col-md-6 text-sm">
      <label for="prime-reg-field-agree" class="col-xs-12 ml-0 mr-0 pl-0 pr-0">
        <input type="checkbox" id="prime-reg-field-agree" name="terms" value="1"> I have read and agree to the PRIME <a href="https://primeinc.org/privacy" target="_blank">Privacy Policy</a> and
        <a href="https://primeinc.org/terms" target="_blank">Terms of Use</a>. </label>
      <div class="clearfix"></div>
    </div>
    <div class="col-md-6 hidden-xs text-right">
      <button type="submit" id="prime-reg-field-submit" class="btn btn-md btn-aqua btn-block mr-1">Register <i class="arrow-icon arrow-icon-right"></i></button>
    </div>
    <div class="col-xs-12 visible-xs text-center">
      <button type="submit" id="prime-reg-field-submit-xs" class="btn btn-md btn-aqua mt-1">Register <i class="arrow-icon arrow-icon-right"></i></button>
    </div>
  </div>
  <div class="clearfix"></div>
  <div style="display: block; margin: 15px auto 0; text-align: center;"><input type="hidden" name="mpt-geo" class="mpt-geo" value="AT"><label style="padding: 5px 15px; margin: 0 -15px; background-color: #FFF4DF; border-radius: 3px;"
      for="mpt-opt-in-prime-reg-modal-reg-form"><input type="checkbox" name="mpt-opt-in" id="mpt-opt-in-prime-reg-modal-reg-form" value="1"> Opt-in to receive all PRIME emails.</label></div>
</form>

POST 

<form class="form-horizontal row has-opt-in-field" method="POST" id="prime-more-info-modal-more-info-form" autocomplete="off">
  <div class="col-xs-12">
    <div class="alert alert-danger fade" style="margin:0;padding:0;"></div>
    <div class="form-group prime-field-label-wrap mb-1">
      <label for="prime-more-info-field-firstname" class="col-xs-12 prime-field-label sr-only"> First name </label>
      <div class="col-xs-12">
        <input type="text" id="prime-more-info-field-firstname" name="firstname" value="" placeholder="First name…" class="form-control">
      </div>
    </div>
    <div class="form-group prime-field-label-wrap mb-1">
      <label for="prime-more-info-field-lastname" class="col-xs-12 prime-field-label sr-only"> Last name </label>
      <div class="col-xs-12">
        <input type="text" id="prime-more-info-field-lastname" name="lastname" value="" placeholder="Last name…" class="form-control">
      </div>
    </div>
    <div class="form-group prime-field-label-wrap mb-1">
      <label for="prime-more-info-field-email" class="col-xs-12 prime-field-label sr-only"> Email address </label>
      <div class="col-xs-12">
        <input type="text" id="prime-more-info-field-email" name="email" value="" placeholder="Email address…" class="form-control" autocomplete="off">
      </div>
    </div>
    <div class="form-group fade prime-field-label-wrap mb-1 in">
      <label for="prime-more-info-field-profession" class="col-xs-12 prime-field-label sr-only"> Profession </label>
      <div class="col-xs-12">
        <select name="profession" class="form-control" id="prime-more-info-field-profession" data-load-select-options="professions" data-selected="">
          <option value="" class="placeholder">Profession…</option>
          <option></option>
          <option value="1">Physician</option>
          <option value="2">Nurse</option>
          <option value="3">Pharmacist</option>
          <option value="4">Nurse Practitioner</option>
          <option value="5">Case Manager</option>
          <option value="6">Physician Assistant</option>
          <option value="7">Resident</option>
          <option value="9">Medical Assistant</option>
          <option value="10">Dentist</option>
          <option value="11">Pharm Tech</option>
          <option value="12">Health Education Specialist</option>
          <option value="13">Respiratory Therapist</option>
          <option value="15">Physical Therapist</option>
          <option value="16">Psychologist</option>
          <option value="17">Dietician</option>
          <option value="96">Dietetic Technician</option>
          <option value="18">HR Specialist</option>
          <option value="21">Medical Director</option>
          <option value="22">Fellow</option>
          <option value="93">Social Worker</option>
          <option value="24">Genetic Counselor</option>
          <option value="14">Other HCP</option>
          <option value="26">Patient/Caregiver</option>
        </select>
      </div>
    </div>
    <div class="form-group fade prime-field-label-wrap mb-1 in">
      <label for="prime-more-info-field-setting" class="col-xs-12 prime-field-label sr-only"> Practice setting </label>
      <div class="col-xs-12">
        <select name="practice" class="form-control" id="prime-more-info-field-setting" data-load-select-options="practices" data-selected="">
          <option value="" class="placeholder">Practice setting…</option>
          <option></option>
          <option value="7">Community / Retail</option>
          <option value="13">Consultant</option>
          <option value="17">Consumer</option>
          <option value="10">Employer</option>
          <option value="3">Health Plan</option>
          <option value="18">Home Health Care</option>
          <option value="1">Hospital</option>
          <option value="16">Integrated (ACO, PCMH, etc.)</option>
          <option value="12">Long Term Care</option>
          <option value="5">Medical Practice</option>
          <option value="21">None / Other</option>
          <option value="19">Research / Academia</option>
          <option value="14">Specialty Pharmacy / PBM</option>
          <option value="2">State / Federal Government</option>
        </select>
      </div>
    </div>
    <div class="form-group fade prime-field-label-wrap mb-1 in">
      <label for="prime-more-info-field-specialty" class="col-xs-12 prime-field-label sr-only"> Specialty </label>
      <div class="col-xs-12">
        <select name="specialty" class="form-control" id="prime-more-info-field-specialty" data-load-select-options="specialties" data-selected="">
          <option value="" class="placeholder">Specialty…</option>
          <option></option>
          <option value="3">Family Medicine</option>
          <option value="4">Neurology</option>
          <option value="5">Internal Medicine</option>
          <option value="6">Hematology / Oncology</option>
          <option value="7">Psychiatry</option>
          <option value="8">Pediatrics</option>
          <option value="10">Surgery</option>
          <option value="11">Geriatric Medicine</option>
          <option value="12">Infectious Disease</option>
          <option value="13">Cardiology</option>
          <option value="14">Gastroenterology</option>
          <option value="15">Emergency Medicine</option>
          <option value="16">Critical Care</option>
          <option value="17">Dermatology</option>
          <option value="18">Anesthesiology</option>
          <option value="20">Pain Management</option>
          <option value="19">Med / Surg</option>
          <option value="21">Allergy / Immunology</option>
          <option value="22">Pulmonology</option>
          <option value="23">Rheumatology</option>
          <option value="24">Orthopedics</option>
          <option value="25">OBGYN</option>
          <option value="26">Radiology</option>
          <option value="27">Women's Health</option>
          <option value="29">Endocrinology</option>
          <option value="30">Nephrology</option>
          <option value="31">Ophthalmology</option>
          <option value="34">Pathology</option>
          <option value="36">Hepatology</option>
          <option value="38">Urology</option>
          <option value="40">Genetic Disorders</option>
          <option value="39">Neonatal / Perinatal</option>
          <option value="46">Otolaryngology</option>
          <option value="56">Oncology</option>
          <option value="1">Other</option>
          <option value="2">None</option>
        </select>
      </div>
    </div>
    <div class="form-group prime-field-label-wrap mb-1">
      <label for="prime-more-info-field-zip" class="col-xs-12 prime-field-label sr-only"> Zip code </label>
      <div class="col-xs-12">
        <input type="tel" id="prime-more-info-field-zip" name="zip" value="" maxlength="12" placeholder="Zip code…" class="form-control" style="max-width: 170px">
      </div>
    </div>
    <div class="form-group prime-field-label-wrap mb-1 reg-modal-live-event-live-meeting">
      <label for="prime-more-info-field-company" class="col-xs-12 prime-field-label sr-only"> Company/Organization </label>
      <div class="col-xs-12">
        <input type="text" id="prime-more-info-field-company" name="company" value="" placeholder="Company/Organization…" class="form-control">
      </div>
    </div>
    <div class="form-group prime-field-label-wrap mb-1">
      <label for="prime-more-info-field-phone" class="col-xs-12 prime-field-label sr-only"> Mobile number </label>
      <div class="col-xs-12">
        <input type="tel" id="prime-more-info-field-phone" name="phone" value="" placeholder="Mobile number…" class="form-control">
        <small class="center-block text-left text-primary mt-1">For text message reminders prior to the event.</small>
      </div>
    </div>
    <hr class="mt-2 mb-1">
    <div class="clearfix mt-2 text-center">
      <button type="submit" class="btn btn-md btn-aqua">Continue</button>
    </div>
  </div>
  <div class="clearfix"></div>
  <div style="display: block; margin: 15px auto 0; text-align: center;"><input type="hidden" name="mpt-geo" class="mpt-geo" value="AT"><label style="padding: 5px 15px; margin: 0 -15px; background-color: #FFF4DF; border-radius: 3px;"
      for="mpt-opt-in-prime-more-info-modal-more-info-form"><input type="checkbox" name="mpt-opt-in" id="mpt-opt-in-prime-more-info-modal-more-info-form" value="1"> Opt-in to receive all PRIME emails.</label></div>
</form>

POST 

<form class="form-horizontal row" method="POST" id="prime-forgot-password-modal-form" autocomplete="off">
  <div class="col-sm-6 col-sm-offset-3">
    <div class="alert alert-danger fade" style="margin:0;padding:0;"></div>
    <div class="form-group prime-field-label-wrap">
      <label for="prime-forgot-password-modal-field-email" class="col-xs-12 prime-field-label sr-only"> Email address </label>
      <div class="col-xs-12">
        <input type="text" id="prime-forgot-password-modal-field-email" name="email" placeholder="Email address…" class="form-control">
      </div>
    </div>
    <div class="clearfix mt-2 text-center">
      <button type="submit" class="btn btn-md btn-aqua">Submit <i class="arrow-icon arrow-icon-right"></i></button>
    </div>
  </div>
  <div class="clearfix"></div>
</form>

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Profession
Profession…Physician Nurse Pharmacist Nurse Practitioner Case Manager Physician
Assistant Resident Medical Assistant Dentist Pharm Tech Health Education
Specialist Respiratory Therapist Physical Therapist Psychologist Dietician
Dietetic Technician HR Specialist Medical Director Fellow Social Worker Genetic
Counselor Other HCP Patient/Caregiver
Practice setting
Practice setting…Community / Retail Consultant Consumer Employer Health Plan
Home Health Care Hospital Integrated (ACO, PCMH, etc.) Long Term Care Medical
Practice None / Other Research / Academia Specialty Pharmacy / PBM State /
Federal Government
Specialty
Specialty…Family Medicine Neurology Internal Medicine Hematology / Oncology
Psychiatry Pediatrics Surgery Geriatric Medicine Infectious Disease Cardiology
Gastroenterology Emergency Medicine Critical Care Dermatology Anesthesiology
Pain Management Med / Surg Allergy / Immunology Pulmonology Rheumatology
Orthopedics OBGYN Radiology Women's Health Endocrinology Nephrology
Ophthalmology Pathology Hepatology Urology Genetic Disorders Neonatal /
Perinatal Otolaryngology Oncology Other None
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Company/Organization

Mobile number
For text message reminders prior to the event.

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