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4 forms found in the DOM

Name: generate_public_qrcode — POST https://www.broscode.com/print-pandemic

<form action="https://www.broscode.com/print-pandemic" name="generate_public_qrcode" id="generate_public_qrcode" enctype="multipart/form-data" method="post">
  <div class="row">
    <div class="col-md-12 formValid" style="display: none;">
      <p style="color: red;">All * fields are required.</p>
    </div>
    <div class="col-md-3">
      <label>Quantity Requested*</label>
      <input type="number" class="form-control form-field" id="numberofbroscode" name="numberofbroscode" placeholder="Quantity Requested" value="1" required="">
    </div>
    <div class="col-md-3 hideshowemail" style="display:none;">
      <label>E-Mail*</label><br>
      <input type="email" class="form-control form-field" id="email_address" name="email_address" placeholder="Email Address" required="">
    </div>
    <div class="col-md-3">
      <div class="form-group">
        <input type="hidden" name="borderid" id="borderid" value="1">
        <input type="hidden" name="typeofduration" id="typeofduration" value="LT">
        <input type="button" class="btn btn-primary btn-sm" id="generatebroscode" name="generatebroscode" value="Submit" style="margin-top: 25px;">
      </div>
    </div>
    <div class="col-md-3 appendCSV"></div>
  </div>
</form>

Name: ajax_login_form —

<form name="ajax_login_form" class="modal-content animate" action="">
  <div class="imgcontainer">
    <span onclick="document.getElementById('loginpopup').style.display = 'none'" class="close" title="Close Modal">×</span>
  </div>
  <div class="login-popup">
    <div class="alert alert-danger fade in login_error" style="display:none"></div>
    <div class="alert alert-success fade in login_success" style="display:none"></div>
    <label for="uname"><b>Username</b></label>
    <input type="text" id="uname" placeholder="Enter Username" name="uname" required="">
    <label for="psw"><b>Password</b></label>
    <input type="password" placeholder="Enter Password" name="psw" id="psw" required="">
    <button type="button" id="wplogin">Login</button>
  </div>
  <div class="login-popup login-popup-bottom" style="background-color:#f1f1f1;">
    <span><a href="https://www.qi-code.com/register-user/" class="bottom-txt">Register User</a></span>
    <span><a href="https://www.qi-code.com/network-register/" class="bottom-txt">Network Register</a></span>
    <span><a href="https://www.qi-code.com/aco-user/" class="bottom-txt">ACO User</a></span>
    <span class="psw"><a href="javascript:void(0)" class="bottom-txt"> Forgot password? </a></span>
  </div>
</form>

<form class="modal-content animate" action="">
  <div class="alert alert-danger forg_error_msg" style="display:none"></div>
  <div class="alert alert-success forg_success_msg" style="display:none"></div>
  <div class="imgcontainer">
    <span onclick="document.getElementById('forgotpsw').style.display = 'none'" class="close" title="Close Modal">×</span>
  </div>
  <div class="">
    <label for="uname"><b>Enter username or email</b></label>
    <input type="text" id="forgotemail" placeholder="Enter username or email" name="uname" required="">
    <button type="button" id="firebaseforgotpsw">Submit</button>
  </div>
</form>

Name: ajax_login_form —

<form name="ajax_login_form" class="modal-content animate" action="">
  <div class="imgcontainer">
    <span onclick="document.getElementById('pandemic_modal').style.display = 'none'" class="close" title="Close Modal">×</span>
  </div>
  <div class="login-popup">
    <h3>Broselow Emergency and Telemedicine Safety Card offered world-wide at no charge during the COVID-19 pandemic</h3> During the COVID-19 pandemic, unprecedented numbers of people will be seeking healthcare. Many will be receiving care away from
    their medical home – the emergency room, medical tents, and telemedicine visits – where clinicians will not have access to the important details in the medical record necessary to provide safe and effective care.<br>
    <b>The Broselow Institute at Catawba Valley CC has partnered with the American Osteopathic Association on an exclusive patient safety initiative to provide free Emergency and Telemedicine Safety Cards world-wide at no charge during the pandemic.</b>
    This innovative technology attaches vital medical information to the code easily and is designed to be carried conveniently by the patient, allowing the health care team instant access to the information they need to provide the very best
    care.<br> Once scanned with any QR reader or the camera on a smart phone, entering the medications, allergies, emergency contact information and more into the labeled fields is as easy as sending a text. To view the information, simply scan with
    a QR reader or the camera on a smart phone, either in person or via webcam during a telemedicine visit.<br> Each Emergency and Telemedicine Safety Card is valid for 6 months. For instructions and to print codes for yourself, family, friends,
    employees, residents, customers and clients <a class="changeurl" href="https://www.qi-code.com/pandemic">Click Here</a> <br>
    <br> Have questions? Please visit our FAQ page <a class="changeurl" href="https://www.qi-code.com/frequently-asked-questions-broscode">here</a> or contact us at <a href="mailto:info@broscode.com">info@broscode.com</a> for additional information.
  </div>
</form>

Text Content

Pandemic – QI CODE
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PANDEMIC

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>
Pandemic


PANDEMIC


GENERATING AND PRINTING EMERGENCY AND TELEMEDICINE SAFETY CARD

The Emergency and Telemedicine Safety Card allows you to carry your basic
medical information with you and share it with the healthcare team anywhere you
seek care.  

The Card is not integrated with any electronic medical record system; it is
completely managed by you.  Only the information you choose to add to the Card
will be included. If there is any information you do not feel comfortable
sharing when seeking care, do not enter it on your card.  

The only people that have access to your information are those that you choose
to allow to scan your Card.  Your information is not accessible any other way,
and neither the Broselow Institute nor the American Osteopathic Association can
identify your information or use it for any purpose. 

Make a copy or take a photo of your Card.  This will allow a trusted family
member or friend to make updates to your Card on your behalf, and will allow you
to delete the information in the event you lose your Card.

Please note, each Emergency and Telemedicine Safety Card is unique and designed
for use by one individual. Each person must have their own Emergency and
Telemedicine Safety Card, not a shared copy. Print as many codes as you need
from this system.

To print cards, enter the desired quantity below and a file will be generated
for printing on your local computer. You can print up to 50 cards at a time and
may request additional sets of 50 as often as you wish.

All * fields are required.

Quantity Requested*
E-Mail*




Are you sure you want to submit this form?

A .csv file of the Requested PersonalMedical Codes will be sent via E-Mail.

Cancel Submit

Note: For printing in very large quantities using an industrial printing
service, please contact us at info@broscode.com for assistance.


×

Username Password Login
Register User Network Register ACO User Forgot password?
×
Enter username or email Submit
×


BROSELOW EMERGENCY AND TELEMEDICINE SAFETY CARD OFFERED WORLD-WIDE AT NO CHARGE
DURING THE COVID-19 PANDEMIC

During the COVID-19 pandemic, unprecedented numbers of people will be seeking
healthcare. Many will be receiving care away from their medical home – the
emergency room, medical tents, and telemedicine visits – where clinicians will
not have access to the important details in the medical record necessary to
provide safe and effective care.
The Broselow Institute at Catawba Valley CC has partnered with the American
Osteopathic Association on an exclusive patient safety initiative to provide
free Emergency and Telemedicine Safety Cards world-wide at no charge during the
pandemic. This innovative technology attaches vital medical information to the
code easily and is designed to be carried conveniently by the patient, allowing
the health care team instant access to the information they need to provide the
very best care.
Once scanned with any QR reader or the camera on a smart phone, entering the
medications, allergies, emergency contact information and more into the labeled
fields is as easy as sending a text. To view the information, simply scan with a
QR reader or the camera on a smart phone, either in person or via webcam during
a telemedicine visit.
Each Emergency and Telemedicine Safety Card is valid for 6 months. For
instructions and to print codes for yourself, family, friends, employees,
residents, customers and clients Click Here

Have questions? Please visit our FAQ page here or contact us at
info@broscode.com for additional information.
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HEAD OFFICE

 * Hickory, NC 28602, USA
   info@broscode


© 2024 QI CODE. All Rights Reserved.
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