erm-staging.simrs.rsusembiring.com Open in urlscan Pro
103.133.56.107  Public Scan

Form analysis
1 forms found in the DOM

POST

<form class="form-horizontal" method="POST" id="login-form">
  <input type="hidden" name="ci_csrf_token" value="">
  <div class="form-group">
    <label for="email" class="col-md-4 control-label">Username</label>
    <div class="col-md-8">
      <input id="username" type="text" class="form-control" name="username" required="" autofocus="">
    </div>
  </div>
  <div class="form-group">
    <label for="password" class="col-md-4 control-label">Password</label>
    <div class="col-md-8">
      <input id="password" type="password" class="form-control" name="password" required="">
    </div>
  </div>
  <div class="form-group">
    <div class="col-md-6 col-md-offset-4">
      <div class="checkbox">
        <label>
          <input type="checkbox" name="remember"> Remember Me </label>
      </div>
    </div>
  </div>
  <div class="form-group">
    <div class="col-md-8 col-md-offset-4">
      <button type="submit" id="submit-btn" class="btn btn-primary"> Login </button>
    </div>
  </div>
</form>

Text Content

E-REKAM MEDIS



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