chartswap.my.salesforce-sites.com Open in urlscan Pro
13.110.56.57  Public Scan

Form analysis
1 forms found in the DOM

Name: Registration:TemplateCompactRegister:j_id9 — POST /register1

<form id="Registration:TemplateCompactRegister:j_id9" name="Registration:TemplateCompactRegister:j_id9" method="post" action="/register1" enctype="application/x-www-form-urlencoded">
  <input type="hidden" name="Registration:TemplateCompactRegister:j_id9" value="Registration:TemplateCompactRegister:j_id9">
  <span id="Registration:TemplateCompactRegister:j_id9:j_id10">
    <div class="row" style="display: table;width: 90%;">
      <div style="display: table-cell;width: 25%; vertical-align: middle">
      </div>
      <div style="display: table-cell;width: 50%">
        <div class="panel panel-default" style="width:100%">
          <div>
          </div>
          <div class="panel-body" style="padding: 10px;font-size: 110% "> Whether you are a records retrieval company, insurance company, law firm, or any other business that requests records with a signed patient HIPAA authorization, you can
            register for ChartSwap as a <strong>Requestor</strong> and: </div>
          <ul class="list-group">
            <li class="list-group-item"><i class="glyphicon glyphicon-ok-circle"></i>Send requests electronically</li>
            <li class="list-group-item"><i class="glyphicon glyphicon-ok-circle"></i>Track requests progress online</li>
            <li class="list-group-item"><i class="glyphicon glyphicon-ok-circle"></i>Pay for records and download immediately </li>
            <li class="list-group-item"><i class="glyphicon glyphicon-ok-circle"></i>Save on scanning and postage costs</li>
          </ul>
          <div class="panel-heading" style="padding: 10px">
            <p style="font-weight: 600;font-size:13px;text-align: center">CHARTSWAP IS ALWAYS OPTIONAL. If your firm is unable or not interested in registering for ChartSwap, please click the Decline button below</p>
          </div>
          <div style="margin-left: 50px;margin-top: 10px">
            <script type="text/javascript" language="Javascript">
              function dpf(f) {
                var adp = f.adp;
                if (adp != null) {
                  for (var i = 0; i < adp.length; i++) {
                    adp[i].parentNode.removeChild(adp[i]);
                  }
                }
              };

              function apf(f, pvp) {
                var adp = new Array();
                f.adp = adp;
                var ps = pvp.split(',');
                for (var i = 0, ii = 0; i < ps.length; i++, ii++) {
                  var p = document.createElement("input");
                  p.type = "hidden";
                  p.name = ps[i];
                  p.value = ps[i + 1];
                  f.appendChild(p);
                  adp[ii] = p;
                  i += 1;
                }
              };

              function jsfcljs(f, pvp, t) {
                apf(f, pvp);
                var ft = f.target;
                if (t) {
                  f.target = t;
                }
                f.submit();
                f.target = ft;
                dpf(f);
              };
            </script>
            <a href="#" style="width:45%;color:white" onclick="if(typeof jsfcljs == 'function'){jsfcljs(document.getElementById('Registration:TemplateCompactRegister:j_id9'),'Registration:TemplateCompactRegister:j_id9:j_id14,Registration:TemplateCompactRegister:j_id9:j_id14,accountType,Requestor','');}return false" class="btn">Register</a><a href="#" style="width:45%;                                             color:white" onclick="if(typeof jsfcljs == 'function'){jsfcljs(document.getElementById('Registration:TemplateCompactRegister:j_id9'),'Registration:TemplateCompactRegister:j_id9:j_id17,Registration:TemplateCompactRegister:j_id9:j_id17','');}return false" class="btn ">Decline</a>
          </div>
        </div>
      </div>
    </div>
  </span>
  <div id="Registration:TemplateCompactRegister:j_id9:j_id39"></div>
</form>

Text Content

CONTACT US: (855) 879-7927 | INFO@CHARTSWAP.COM



Whether you are a records retrieval company, insurance company, law firm, or any
other business that requests records with a signed patient HIPAA authorization,
you can register for ChartSwap as a Requestor and:
 * Send requests electronically
 * Track requests progress online
 * Pay for records and download immediately
 * Save on scanning and postage costs

CHARTSWAP IS ALWAYS OPTIONAL. If your firm is unable or not interested in
registering for ChartSwap, please click the Decline button below

RegisterDecline



©2023 ChartSwap  |  All Rights Reserved  |  Privacy Policy |  Refund Policy  | 
Terms of Service