103.90.85.87 Open in urlscan Pro
103.90.85.87  Public Scan

Form analysis
1 forms found in the DOM

POST ./fm_patient_report.aspx

<form method="post" action="./fm_patient_report.aspx" id="form1">
  <div class="aspNetHidden">
    <input type="hidden" name="aspScript_HiddenField" id="aspScript_HiddenField" value=";;AjaxControlToolkit, Version=3.5.7.123, Culture=neutral, PublicKeyToken=28f01b0e84b6d53e:en-US:5a4df314-b4a2-4da2-a207-9284f1b1e96c:475a4ef5:effe2a26:3ac3e789">
    <input type="hidden" name="__EVENTTARGET" id="__EVENTTARGET" value="">
    <input type="hidden" name="__EVENTARGUMENT" id="__EVENTARGUMENT" value="">
    <input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE" value="/wEPDwULLTExODcwMDY1OTJkZNEArJZ7NImKHGHqKLzM3DooKrax2WDfeT0BaNDYCLXk">
  </div>
  <script type="text/javascript">
    //<![CDATA[
    var theForm = document.forms['form1'];
    if (!theForm) {
      theForm = document.form1;
    }

    function __doPostBack(eventTarget, eventArgument) {
      if (!theForm.onsubmit || (theForm.onsubmit() != false)) {
        theForm.__EVENTTARGET.value = eventTarget;
        theForm.__EVENTARGUMENT.value = eventArgument;
        theForm.submit();
      }
    }
    //]]>
  </script>
  <script src="/ONLINE_GRANDE/WebResource.axd?d=vxgNmii0E4PvU8Vg1DaYOWIHJnVFyOxbOt0AfqYGm0ir7DAqRgCqQ3OxBFAdXain2WfXalj2HktgqhZ25xgU-iSDU4bzFEye69zr8eiIgMQ1&amp;t=637811936229275428" type="text/javascript"></script>
  <script src="/ONLINE_GRANDE/ScriptResource.axd?d=EsCojjVhVm_0RrnenYmBiWCLIAa0V1vVhjIcMStpz_7b8Zj5gFJH31vLwS6AKFSMigaMS81z3yLHm1uha9xNDwy_43P2d0Gx9icLjBkCKcdlCuIkMbX53Qlk_M-krX2Vm10c9nE9VuXf-kzASVTylg2&amp;t=ffffffffecf8d3f2" type="text/javascript">
  </script>
  <script type="text/javascript">
    //<![CDATA[
    if (typeof(Sys) === 'undefined') throw new Error('ASP.NET Ajax client-side framework failed to load.');
    //]]>
  </script>
  <script src="/ONLINE_GRANDE/ScriptResource.axd?d=xa6_gnxCqAEFj1PKjYUOjXr-OUSzPgqzLMc7OR9HQj9RZgUyREfNQKp5Lyh2GK_1ROym3cSvo-waGMMDkuFpO6KL0-U0EnOTGipIL4uGPs9EemCO4OaOrLu6zJFHlXb2f4-kwdquPAwDHZzzvy7qDw2&amp;t=ffffffffecf8d3f2" type="text/javascript">
  </script>
  <script
    src="/online_grande/forms/fm_patient_report.aspx?_TSM_HiddenField_=aspScript_HiddenField&amp;_TSM_CombinedScripts_=%3b%3bAjaxControlToolkit%2c+Version%3d3.5.7.123%2c+Culture%3dneutral%2c+PublicKeyToken%3d28f01b0e84b6d53e%3aen-US%3a5a4df314-b4a2-4da2-a207-9284f1b1e96c%3a475a4ef5%3aeffe2a26%3a3ac3e789"
    type="text/javascript"></script>
  <div class="aspNetHidden">
    <input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="BA5650D6">
    <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION" value="/wEdAATCrKc0/PMA1HHluYNOk7mrnO0CL8dIvI+phIKQg9w863Y2+Mc6SrnAqio3oCKbxYbLFfgQkq3ST9sDsNJMXNazRgeCoRx4gPB4EtuhchduOc9AoQuwFaGh4f3UEI7x6DI=">
  </div>
  <script type="text/javascript">
    //<![CDATA[
    Sys.WebForms.PageRequestManager._initialize('aspScript', 'form1', ['tUpdatePanel1', 'UpdatePanel1'], [], ['butGet_Report', 'butGet_Report'], 90, '');
    //]]>
  </script>
  <div id="UpdatePanel1">
    <h1>Patient Report </h1>
    <div>
      <input name="txtFirm_Sid" type="text" maxlength="8" id="txtFirm_Sid" placeholder="** SAMPLE NUMBER ( 01000001 ) **">
    </div>
    <div>
      <input name="txtPassword" type="password" id="txtPassword" placeholder="** Password **">
    </div>
    <div>
      <input type="submit" name="butGet_Report" value="Get Report" id="butGet_Report">
    </div>
  </div>
  <script type="text/javascript">
    //<![CDATA[
    (function() {
      var fn = function() {
        $get("aspScript_HiddenField").value = '';
        Sys.Application.remove_init(fn);
      };
      Sys.Application.add_init(fn);
    })();
    Sys.Application.add_init(function() {
      $create(Sys.Extended.UI.FilteredTextBoxBehavior, {
        "FilterType": 2,
        "id": "ftFirm_Sid"
      }, null, null, $get("txtFirm_Sid"));
    });
    //]]>
  </script>
</form>

Text Content

PATIENT REPORT






REPORT DOWNLOAD