hutang.kliniknurjaya.com Open in urlscan Pro
103.163.230.234  Public Scan

Form analysis
1 forms found in the DOM

POST http://hutang.kliniknurjaya.com/login

<form action="http://hutang.kliniknurjaya.com/login" class="" method="post" accept-charset="utf-8">
  <div class="form-group">
    <div class="input-group">
      <span class="input-group-addon"><i class="fa fa-user"></i></span>
      <input type="text" name="login" value="" class="form-control" placeholder="" maxlength="80" size="30">
    </div>
  </div>
  <div class="form-group">
    <div class="input-group">
      <span class="input-group-addon"><i class="fa fa-lock"></i></span>
      <input type="password" name="password" value="" placeholder="" id="inputPassword" size="30" class="form-control">
    </div>
  </div>
  <div class="form-group">
    <div class="input-group">
      <span class="input-group-addon"><i class="fa fa-database"></i></span>
      <select id="database" name="database" class="form-control" style="color:#999999 !important" required="">
        <!-- <option value=""><i class="fa fa-lock"></i> Pilih Back Office</option> -->
        <option value="Back_Office_Nurjaya">Yayasan Dharma Husada Bhakti</option>
        <option value="Back_Office_Specialist_Nurjaya">DOKTER SPESIALIS</option>
        <option value="BO_KULHENNURJAYA">KULHEN NURJAYA</option>
      </select>
    </div>
  </div>
  <div class="form-group no-border margin-top-20">
    <button type="submit" class="btn btn-success btn-block">Masuk</button>
  </div>
</form>

Text Content

Klinik Nurjaya
Yayasan Dharma Husada Bhakti DOKTER SPESIALIS KULHEN NURJAYA
Masuk
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