apps.phoenixchildrens.com Open in urlscan Pro
74.115.70.45 Public Scan

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Submitted URL:
https://pch.care/Appointments/?M=6439113&K=69C0426&A=7441817
Effective URL:
https://apps.phoenixchildrens.com/PatientBooking/EN/Verification.aspx
Submission: On December 07 via manual (December 7th 2024, 5:58:55 am UTC) from IE — Scanned from US

Form analysis
1 forms found in the DOM

POST ./Verification.aspx

<form method="post" action="./Verification.aspx" id="form1">
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  <div class="aspNetHidden">
    <input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="B8F9DDCB">
    <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION"
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  </div>
  <div class="fixed-top">
    <div class="header-row">
      <div>
        <div class="container">
          <div class="row">
            <div class="col-12">
              <img src="../Assets/images/pchlogo.png" style="display: inline-block; margin-top:0;float:left;">
              <span style="padding-left: 0; color: #444; font-size: 18px; line-height: 38px; font-weight: normal;display:block;margin-left:120px;font-weight:bold;">Patient Booking</span>
            </div>
          </div>
        </div>
      </div>
    </div>
  </div>
  <div class="container">
    <input type="hidden" name="ctl00$HfMrn" id="HfMrn">
    <input type="hidden" name="ctl00$HfMrnHsh" id="HfMrnHsh">
    <input type="hidden" name="ctl00$HfNid" id="HfNid">
    <div class="row">
      <div class="col-12">
        <h2>Verification</h2>
        <p>Please confirm the patient's name and date of birth below to continue:</p>
        <input type="hidden" name="ctl00$ContentPlaceHolder1$HfMrnKey" id="ContentPlaceHolder1_HfMrnKey" value="6439113">
        <h5 style="text-transform:uppercase" class="my-1">Verify the patient's first name:</h5>
        <div class="btn-group-toggle" data-toggle="buttons">
          <label class="btn btn-outline-primary">
            <input id="ContentPlaceHolder1_RbName1" type="radio" name="ctl00$ContentPlaceHolder1$Names" value="RbName1"><label for="ContentPlaceHolder1_RbName1">AUBREY</label>
          </label>
          <label class="btn btn-outline-primary">
            <input id="ContentPlaceHolder1_RbName2" type="radio" name="ctl00$ContentPlaceHolder1$Names" value="RbName2"><label for="ContentPlaceHolder1_RbName2">CASSANDRA</label>
          </label>
          <label class="btn btn-outline-primary">
            <input id="ContentPlaceHolder1_RbName3" type="radio" name="ctl00$ContentPlaceHolder1$Names" value="RbName3"><label for="ContentPlaceHolder1_RbName3">JACQUELINE</label>
          </label>
          <label class="btn btn-outline-primary">
            <input id="ContentPlaceHolder1_RbName4" type="radio" name="ctl00$ContentPlaceHolder1$Names" value="RbName4"><label for="ContentPlaceHolder1_RbName4">MADISON</label>
          </label>
          <label class="btn btn-outline-primary">
            <input id="ContentPlaceHolder1_RbName5" type="radio" name="ctl00$ContentPlaceHolder1$Names" value="RbName5"><label for="ContentPlaceHolder1_RbName5">SOFIA</label>
          </label>
        </div>
        <div id="ContentPlaceHolder1_PnlMonths">
          <h5 style="text-transform:uppercase" class="my-1 mt-3">Verify the patient's birth month:</h5>
          <div class="btn-group-toggle" data-toggle="buttons">
            <label class="btn btn-outline-primary mb-2">
              <span data-month="1"><input id="ContentPlaceHolder1_RbMonth1" type="radio" name="ctl00$ContentPlaceHolder1$Months" value="RbMonth1"><label for="ContentPlaceHolder1_RbMonth1">Jan</label></span>
            </label>
            <label class="btn btn-outline-primary mb-2">
              <span data-month="2"><input id="ContentPlaceHolder1_RbMonth2" type="radio" name="ctl00$ContentPlaceHolder1$Months" value="RbMonth2"><label for="ContentPlaceHolder1_RbMonth2">Feb</label></span>
            </label>
            <label class="btn btn-outline-primary mb-2">
              <span data-month="3"><input id="ContentPlaceHolder1_RbMonth3" type="radio" name="ctl00$ContentPlaceHolder1$Months" value="RbMonth3"><label for="ContentPlaceHolder1_RbMonth3">Mar</label></span>
            </label>
            <label class="btn btn-outline-primary mb-2">
              <span data-month="4"><input id="ContentPlaceHolder1_RbMonth4" type="radio" name="ctl00$ContentPlaceHolder1$Months" value="RbMonth4"><label for="ContentPlaceHolder1_RbMonth4">Apr</label></span>
            </label>
            <label class="btn btn-outline-primary mb-2">
              <span data-month="5"><input id="ContentPlaceHolder1_RbMonth5" type="radio" name="ctl00$ContentPlaceHolder1$Months" value="RbMonth5"><label for="ContentPlaceHolder1_RbMonth5">May</label></span>
            </label>
            <label class="btn btn-outline-primary mb-2">
              <span data-month="6"><input id="ContentPlaceHolder1_RbMonth6" type="radio" name="ctl00$ContentPlaceHolder1$Months" value="RbMonth6"><label for="ContentPlaceHolder1_RbMonth6">Jun</label></span>
            </label>
            <label class="btn btn-outline-primary mb-2">
              <span data-month="7"><input id="ContentPlaceHolder1_RbMonth7" type="radio" name="ctl00$ContentPlaceHolder1$Months" value="RbMonth7"><label for="ContentPlaceHolder1_RbMonth7">Jul</label></span>
            </label>
            <label class="btn btn-outline-primary mb-2">
              <span data-month="8"><input id="ContentPlaceHolder1_RbMonth8" type="radio" name="ctl00$ContentPlaceHolder1$Months" value="RbMonth8"><label for="ContentPlaceHolder1_RbMonth8">Aug</label></span>
            </label>
            <label class="btn btn-outline-primary mb-2">
              <span data-month="9"><input id="ContentPlaceHolder1_RbMonth9" type="radio" name="ctl00$ContentPlaceHolder1$Months" value="RbMonth9"><label for="ContentPlaceHolder1_RbMonth9">Sep</label></span>
            </label>
            <label class="btn btn-outline-primary mb-2">
              <span data-month="10"><input id="ContentPlaceHolder1_RbMonth10" type="radio" name="ctl00$ContentPlaceHolder1$Months" value="RbMonth10"><label for="ContentPlaceHolder1_RbMonth10">Oct</label></span>
            </label>
            <label class="btn btn-outline-primary mb-2">
              <span data-month="11"><input id="ContentPlaceHolder1_RbMonth11" type="radio" name="ctl00$ContentPlaceHolder1$Months" value="RbMonth11"><label for="ContentPlaceHolder1_RbMonth11">Nov</label></span>
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            <label class="btn btn-outline-primary mb-2">
              <span data-month="12"><input id="ContentPlaceHolder1_RbMonth12" type="radio" name="ctl00$ContentPlaceHolder1$Months" value="RbMonth12"><label for="ContentPlaceHolder1_RbMonth12">Dec</label></span>
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          </div>
        </div>
        <input type="button" name="ctl00$ContentPlaceHolder1$BtnContinue" value="Continue" onclick="javascript:__doPostBack('ctl00$ContentPlaceHolder1$BtnContinue','')" id="ContentPlaceHolder1_BtnContinue" class="btn btn-success mt-2">
      </div>
    </div>
  </div>
  <footer class="page-footer font-small bg-light fixed-bottom d-none d-lg-block" style="border-top: 1px solid #DDD;">
    <div class="text-center py-2">
      <p style="line-height: 24px; font-size: 11px;"> Language Assistance: <a id="LbLang_English" href="javascript:__doPostBack('ctl00$LbLang_English','')">English</a> |
        <a id="LbLang_Spanish" href="javascript:__doPostBack('ctl00$LbLang_Spanish','')">Spanish</a>
        <br> © 2022 Phoenix Children's Hospital. All Rights Reserved.
      </p>
    </div>
  </footer>
  <footer class="page-footer font-small bg-light mt-5 d-lg-none" style="border-top: 1px solid #DDD;">
    <div class="text-center py-2">
      <p style="line-height: 24px; font-size: 11px;"> Language Assistance: <a id="LinkButton1" href="javascript:__doPostBack('ctl00$LinkButton1','')">English</a> | <a id="LinkButton2" href="javascript:__doPostBack('ctl00$LinkButton2','')">Spanish</a>
        <br> © 2022 Phoenix Children's Hospital. All Rights Reserved.
      </p>
    </div>
  </footer>
</form>

Text Content

Patient Booking


VERIFICATION

Please confirm the patient's name and date of birth below to continue:

VERIFY THE PATIENT'S FIRST NAME:

AUBREY CASSANDRA JACQUELINE MADISON SOFIA

VERIFY THE PATIENT'S BIRTH MONTH:

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Language Assistance: English | Spanish
© 2022 Phoenix Children's Hospital. All Rights Reserved.

Language Assistance: English | Spanish
© 2022 Phoenix Children's Hospital. All Rights Reserved.

apps.phoenixchildrens.com Open in urlscan Pro 74.115.70.45 Public Scan

Form analysis 1 forms found in the DOM

POST ./Verification.aspx

Text Content

apps.phoenixchildrens.com Open in urlscan Pro
74.115.70.45 Public Scan

Form analysis
1 forms found in the DOM