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This document contains the HTML code for the login page of an online healthcare claims processing system called ECLAIM. The page includes fields for username, password, a captcha, and a sign in button. It also has links to reset the password or login via a branch office instead of a healthcare facility.

Uploaded by

Aric Piet Afiananta
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
80 views12 pages

CreatePDF 3

This document contains the HTML code for the login page of an online healthcare claims processing system called ECLAIM. The page includes fields for username, password, a captcha, and a sign in button. It also has links to reset the password or login via a branch office instead of a healthcare facility.

Uploaded by

Aric Piet Afiananta
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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<style>

div.fake-input {
display: block;
width: 100%;
height: 31px;
padding: 6px 12px;
font-size: 12px;
line-height: 1.42857143;
color: #7a7a7a;
background-image: none;
border: 1px solid #ccc;
position: absolute;
top: -1px;
}

input.real-input {
opacity: 0;
background-color: transparent;
display: block;
width: 100%;
height: 31px;
padding: 6px 12px;
font-size: 12px;
line-height: 1.42857143;
}

[contentEditable=true]:empty:not(:focus):before {
content: attr(data-text);
}
</style>
<!DOCTYPE html>
<html>
<head>

<meta charset="utf-8" />


<meta http-equiv="X-UA-Compatible" content="IE=edge">
<!-- Tell the browser to be responsive to screen width -->
<meta content="width=device-width, initial-scale=1, maximum-scale=1, user-
scalable=no" name="viewport">
<title>ECLAIM - Primary Care</title>
<link rel="shortcut icon" href="images/favicon.ico" type="image/x-icon">

<link href="/eclaim/Content/css?v=OXKa952VFzqBgDDLz4ZH2nJOwlte05BoaUm1TZ_GOXI1"
rel="stylesheet"/>

<script src="/eclaim/bundles/modernizr?v=wBEWDufH_8Md-
Pbioxomt90vm6tJN2Pyy9u9zHtWsPo1"></script>

<script src="/eclaim/bundles/jquery?
v=IhVciU0ASMG6ebzHY28hoPeAnupKH2KBKdrysO3YcSo1"></script>

<script src="/eclaim/bundles/jqueryval?v=hEGG8cMxk9p0ncdRUOJ-
CnKN7NezhnPnWIvn6REucZo1"></script>

<script src="/eclaim/bundles/bootstrap?v=9jg5izrLDKry7gRagGj7Qwka5wOhnwT-
matToxrLtLM1"></script>

<script src="/eclaim/bundles/Config?v=rq_kmO-
O65tJgHVrtTaXv147nbDmpdFYd8Mk7aRIcPg1"></script>

<script src="/eclaim/bundles/SharedJS?v=GRVwVda9Soh5bepypcyX6fkqpFi6OVK-
DNWb9VPpfLk1"></script>

<script src="/eclaim/bundles/js?
v=Su3eq8mS1nuBTAy7Z64bH7zVR2NnAuKUKCt_lj2zkQA1"></script>

<script src="/eclaim/bundles/Login?
v=LY5gchYA3goLlaNb7rgZicKokND5fLK1kIaZvyGx5mY1"></script>

<link href="/eclaim/BotDetectCaptcha.ashx?get=layout-
stylesheet&amp;amp;t=1635166800" rel="stylesheet" type="text/css" />
<script>
var base_url = "https://pcarejkn.bpjs-kesehatan.go.id/eclaim";
var URLUbah =
"https://registrasi.bpjs-kesehatan.go.id/registrasi/ubahpassword.zul";
</script>
</head>
<body class="hold-transition login-page">
<div class="loading-container" id="loading-container" name="loading-container"
style="width:100%; height:0px;"></div>
<div class="login-box">
<!-- /.login-logo -->
<div class="login-box-body">
<div class="login-box-msg">
<img src="/eclaim/images/Logo BPJS.png" />
<h4><label>Primary</label> Care</h4>
<h4><label>- ECLAIM -</label></h4>
</div>

<div class="nav-tabs-custom">
<ul class="nav nav-tabs" style="display:none;">
<li class="active"><a href="#tab_1" data-toggle="tab">
Fasilitas Kesehatan</a></li>
<li><a href="#tab_2" data-toggle="tab">Kantor Cabang</a></li>
</ul>
<div class="tab-content">
<div class="tab-pane active" id="tab_1">
<div class="box-body">
<form role="form" autocomplete="off">

<div class="form-group has-feedback">


<input type="text" class="form-control"
placeholder="Username" id="username" name="username" readonly="readonly"
onfocus="javascript: this.removeAttribute('readonly')" autocomplete="off"
tabIndex="1">
<span class="glyphicon glyphicon-user form-
control-feedback"></span>
</div>
<div class="form-group has-feedback">
<div class="fake-input highlight"
contentEditable=true data-text="Password" tabIndex="-1"></div>
<input type="text" class="form-control real-
input" onkeyup="RemoveSavePassword()" placeholder="Password" id="password"
name="password" autocomplete="off">
<span class="glyphicon glyphicon-lock form-
control-feedback"></span>
<div class="pull-right hidden-xs"
style="cursor:pointer" data-toggle="modal" href="#modal_versi">
<b style="font-size:smaller">6.0.0</b>
</div>

</div>
<div class="form-group has-feedback">
<div class="col-md-5 col-sm-5 col-xs-12"
id="captchaContainer">

<div class="BDC_CaptchaDiv " id="AppCaptcha_CaptchaDiv" style="width: 280px !


important; height: 90px !important; "><!--
--><div class="BDC_CaptchaImageDiv" id="AppCaptcha_CaptchaImageDiv" style="width:
250px !important; height: 90px !important;"><!--
--><div class="BDC_CaptchaImageDiv" style="width:250px; height:80px;"><img
class="BDC_CaptchaImage" id="AppCaptcha_CaptchaImage"
src="/eclaim/BotDetectCaptcha.ashx?
get=image&amp;c=AppCaptcha&amp;t=e036b934369f4f23a5414ca6f59501de" alt="Retype the
CAPTCHA code from the image" style="" /></div><!--
--><a href="//captcha.org/captcha.html?asp.net" title="BotDetect CAPTCHA ASP.NET
Form Validation" style="display: block !important; height: 10px !important; margin:
0 !important; padding: 0 !important; font-size: 9px !important; line-height: 10px !
important; visibility: visible !important; font-family: Verdana, DejaVu Sans,
Bitstream Vera Sans, Verdana Ref, sans-serif !important; vertical-align: middle !
important; text-align: center !important; text-decoration: none !important;
background-color: #f8f8f8 !important; color: #606060 !important;">BotDetect CAPTCHA
ASP.NET Form Validation</a><!--
--></div><!--
--><div class="BDC_CaptchaIconsDiv" id="AppCaptcha_CaptchaIconsDiv" style="width:
24px !important;"><!--
--><a class="BDC_ReloadLink" id="AppCaptcha_ReloadLink" href="#" title="Change
the CAPTCHA code"><img class="BDC_ReloadIcon" id="AppCaptcha_ReloadIcon"
src="/eclaim/BotDetectCaptcha.ashx?get=reload-icon" alt="Change the CAPTCHA
code" /></a><!--
--><a class="BDC_SoundLink" id="AppCaptcha_SoundLink"
href="/eclaim/BotDetectCaptcha.ashx?
get=sound&amp;c=AppCaptcha&amp;t=e036b934369f4f23a5414ca6f59501de&amp;s=Y7FLNCCoBj1
1v1fBs6bCVXvYI2QgJ5ZtyoL8bOkFyhb%2flokED%2bpf63dBJoFsZJtjZCBx0swPcWrZyHlMj3dmWw%3d
%3d" title="Speak the CAPTCHA code" rel="nofollow"><img class="BDC_SoundIcon"
id="AppCaptcha_SoundIcon" src="/eclaim/BotDetectCaptcha.ashx?get=sound-icon"
alt="Speak the CAPTCHA code" /></a><!--
--><div class="BDC_Placeholder"
id="AppCaptcha_AudioPlaceholder">&nbsp;</div><!--
--></div>
<script src="/eclaim/BotDetectCaptcha.ashx?get=script-
include&amp;c=AppCaptcha&amp;t=e036b934369f4f23a5414ca6f59501de"
type="text/javascript"></script>
<input type="hidden" name="BDC_VCID_AppCaptcha" id="BDC_VCID_AppCaptcha"
value="e036b934369f4f23a5414ca6f59501de" />
<input type="hidden" name="BDC_BackWorkaround_AppCaptcha"
id="BDC_BackWorkaround_AppCaptcha" value="0" />
<input type="hidden" name="BDC_Hs_AppCaptcha" id="BDC_Hs_AppCaptcha"
value="372a8f64c972b7365744f439eea923952befd118" />
<input type="hidden" name="BDC_SP_AppCaptcha" id="BDC_SP_AppCaptcha"
value="917872806" />
</div>

<input id="CaptchaInputText"
name="CaptchaInputText" type="text" value="" />
</div>
</div>

<div class="row">
<div class="col-xs-8">
</div>
<!-- /.col -->
<div class="col-xs-4">
<button type="button" class="btn btn-danger
btn-flat" id="btnLogin"><span class="fa fa-key"></span> Sign In</button>
</div>
<!-- /.col -->
</div>
<div class="row">
<div class="col-xs-12">
<a href="https://registrasi.bpjs-
kesehatan.go.id/registrasi/lupapassword.zul">Lupa Password..?</a>
</div>
</div>
<div class="row hidden">
<div class="col-xs-12">
<span class="hidden"
id="CaptchaMode">1</span>
</div>
</div>
</form>

</div>

</div>
<div class="tab-pane" id="tab_2">
<form class="form-horizontal">
<div class="box-body">
<div class="form-group">
<div class="col-md-12">
<button class="btn btn-primary"
type="button" id="btnLoginKC" style="width:100%"><i class="fa fa-key"></i> Login
Kantor Cabang</button>
</div>
</div>
</div>
</form>
</div>
</div>
</div>
</div>
<!-- /.login-box-body -->
</div>

<!DOCTYPE html>
<html>
<head>
<style>
* {
box-sizing: border-box;
}

.main_container {
background-color: #474e5d !important;
font-family: Helvetica, sans-serif;
}

/* The actual timeline (the vertical ruler) */


.Mytimeline {
position: relative;
max-width: 1200px;
margin: 0 auto;
}

/* The actual timeline (the vertical ruler) */


.Mytimeline::after {
content: '';
position: absolute;
width: 6px;
background-color: white;
top: 0;
bottom: 0;
left: 50%;
margin-left: -3px;
}

/* Container around content */


.Mycontainer {
padding: 10px 40px;
position: relative;
background-color: inherit;
width: 50%;
margin-right: unset !important;
margin-left: unset !important;
}

/* The circles on the timeline */


.Mycontainer::after {
content: '';
position: absolute;
width: 25px;
height: 25px;
right: -12px;
background-color: white;
border: 4px solid #FF9F55;
top: 15px;
border-radius: 50%;
z-index: 1;
margin-left: 2px !important;
}

/* Place the container to the left */


.left {
left: 0;
}

/* Place the container to the right */


.right {
left: 50%;
}

/* Add arrows to the left container (pointing right) */


.left::before {
content: " ";
height: 0;
position: absolute;
top: 22px;
width: 0;
z-index: 1;
right: 30px;
border: medium solid white;
border-width: 10px 0 10px 10px;
border-color: transparent transparent transparent white;
}

/* Add arrows to the right container (pointing left) */


.right::before {
content: " ";
height: 0;
position: absolute;
top: 22px;
width: 0;
z-index: 1;
left: 30px;
border: medium solid white;
border-width: 10px 10px 10px 0;
border-color: transparent white transparent transparent;
}

/* Fix the circle for containers on the right side */


.right::after {
left: -16px;
}

/* The actual content */


.Mycontent {
padding: 20px 30px;
background-color: white;
position: relative;
border-radius: 6px;
}

.dateVersion {
font-size: 14px;
vertical-align: middle;
}
</style>
</head>
<body>
<div class="modal fade modal-full" id="modal_versi">
<div class="modal-dialog modal-lg">
<div class="modal-content">
<div class="modal-header" style="padding-top: 5px;padding-bottom:
5px;">
<button type="button" class="close" data-dismiss="modal" aria-
label="Close">
<span aria-hidden="true">&times;</span>
</button>
<h4 class="modal-title">Versi Aplikasi</h4>
</div>
<div class="main_container">
<div class="modal-body">
<div class="Mytimeline">
<div class="Mycontainer right">
<div class="Mycontent">
<h2>Versi 4.9.0 <span class="dateVersion">- [25
Juni 2020]</span></h2>
<ul>
<li>Penambahan Tanggal Entri pada Halaman
Lihat Data Kunjungan Sehat</li>
<li>Penambahan Tanggal Entri pada Halaman
Lihat Data Kunjungan Sakit</li>
<li>Penambahan Filter Kunjungan Sakit by No
Kunjungan</li>
<li>Penyesuaian Menu Entri Data Pelayanan –
Data Peserta</li>
<li>Penyesuaian Menu Entri Data Pelayanan –
Data Perawatan</li>
<li>Penyesuaian No. Antrian Pendaftaran
Bersumber Dari Aplikasi Antrean</li>
</ul>
</div>
</div>
<div class="Mycontainer left">
<div class="Mycontent">
<h2>Versi 4.8.0 <span class="dateVersion">- [15
Juni 2020]</span></h2>
<ul>
<li>Penjaminan Kacamata di FKTP</li>
</ul>
</div>
</div>
<div class="Mycontainer right">
<div class="Mycontent">
<h2>Versi 4.7.0 <span class="dateVersion">- [05
Juni 2020]</span></h2>
<ul>
<li>Penambahan Validasi Multiple Login
Akses</li>
<li>Penambahan Pengamanan Password
Login</li>
</ul>
</div>
</div>
<div class="Mycontainer left">
<div class="Mycontent">
<h2>Versi 4.6.0 <span class="dateVersion">- [29
April 2020]</span></h2>
<ul>
<li>Poli KIA dan KB otomatis muncul pada
Bidan Jejaring</li>
</ul>
</div>
</div>
<div class="Mycontainer right">
<div class="Mycontent">
<h2>Versi 4.5.0 <span class="dateVersion">- [10
April 2020]</span></h2>
<ul>
<li>Pencatatan Pelayanan Konsultasi Online
selama Pandemi Covid-19</li>
<li>Implementasi Bidan Jejaring Skala
Nasional</li>
</ul>
</div>
</div>
<div class="Mycontainer left">
<div class="Mycontent">
<h2>Versi 4.4.0 <span class="dateVersion">- [18
Februari 2020]</span></h2>
<ul>
<li>Perubahan Validasi Suntik KB</li>
<li>Perubahan Validasi Pra Rujukan</li>
<li>Penambahan Validasi Multiple Login
Akses</li>
<li>Penambahan Pengamanan Password
Login</li>
</ul>
</div>
</div>
<div class="Mycontainer right">
<div class="Mycontent">
<h2>Versi 4.3.2 <span class="dateVersion">- [10
Januari 2020]</span></h2>
<ul>
<li>Format Baru Capaian KBK</li>
</ul>
</div>
</div>
<div class="Mycontainer left">
<div class="Mycontent">
<h2>Versi 4.3.0 <span class="dateVersion">- [1
Oktober 2019]</span></h2>
<ul>
<li>Pencarian Rujukan Kacamata</li>
<li>Validasi diagnosa rujukan kacamata</li>
<li>Surat Rujukan Kacamata</li>
</ul>
</div>
</div>
<div class="Mycontainer right">
<div class="Mycontent">
<h2>Versi 4.2.0 <span class="dateVersion">- [23
September 2019]</span></h2>
<ul>
<li>
Rujukan Horizontal:
<ol>
<li>Mekanisme Pendaftaran
Peserta</li>
<li>Pembacaan Data Rujukan</li>
<li>Rujukan Horizontal</li>
<li>Pembacaan Faskes Rujukan</li>
<li>Cetak Rujukan</li>
</ol>
</li>
</ul>
</div>
</div>
<div class="Mycontainer left">
<div class="Mycontent">
<h2>Versi 4.1.0 <span class="dateVersion">- [1
September 2019]</span></h2>
<ul>
<li>Early Warning System SIOP</li>
<li>Early Warning System SIP</li>
<li>Flagging Potensi Penyakit Akibat
Kerja</li>
<li>Info Peserta Prolanis Pada Report
Daftar Kunjungan Sehat</li>
<li>Info Peserta Prolanis Pada Report
Daftar Kunjungan Sakit</li>
<li>Job Otomasi Pendaftaran Prolanis Bagi
Peserta PRB DM dan HT</li>
<li>Early Warning System Pengisian Pakta
Integritas</li>
<li>Penyesuaian Persalinan Normal Emergensi
Dasar Disamakan Dengan Persalinan Normal</li>
<li>Laporan Capaian KBK</li>
<li>Update NIK Ke Kepesertaan</li>
<li>Pendaftaran Peserta Prolanis di
FKTP</li>
<li>Perbaikan dan saran masukan hasil
evaluasi PCare Eclaim</li>
</ul>
</div>
</div>
<div class="Mycontainer right">
<div class="Mycontent">
<h2>Versi 4.0.0 <span class="dateVersion">- [1
Agustus 2019]</span></h2>
<ul>
<li>Fitur Pendaftaran : Penambahan No HP
dan Rekam Medis </li>
<li>
Fitur Entry Kunjungan terdapat
penambahan inputan :
<ol>
<li>Jam pada tanggal masuk dan
pulang</li>
<li>Riwayat alergi, Anamnesa,
Prognosa</li>
<li>Terapi Medikamentosa, Terapi
Non Medikamentosa</li>
<li>BMHP, Suhu, Inputan Jenis
Pelayanan Non Kapitasi</li>
<li>Pelayanan Tindakan
Kapitasi</li>
<li>Pemeriksaan Generalis
Tubuh</li>
<li>Cetak SPP, FKPP dan Riwayat
Pelayanan</li>
</ol>
</li>
</ul>
</div>
</div>
<div class="Mycontainer left">
<div class="Mycontent">
<h2>Versi 3.4.1 <span class="dateVersion">- [19
Juni 2019]</span></h2>
<ul>
<li>Login Bidan Jejaring, Faskes asal
perujuk terisi otomatis sesuai dengan Faskes terdaftar.</li>
<li>Pada menu verifikasi KC, ketika
pencarian FPK ditarik berdasarkan kode FKTP Induk.</li>
<li>Validasi Jenis Kelamin Laki-Laki pada
login Bidan Jejaring.</li>
<li>Rujuk lanjut melalui bidan jejaring
hanya dibuka untuk rujuk lanjut alih rawat.</li>
</ul>
</div>
</div>
<div class="Mycontainer right">
<div class="Mycontent">
<h2>Versi 3.4.0 <span class="dateVersion">- [21
Mei 2019]</span></h2>
<ul>
<li>Penagihan Klaim Bidan Jejaring</li>
</ul>
</div>
</div>
<div class="Mycontainer left">
<div class="Mycontent">
<h2>Versi 3.3.0 <span class="dateVersion">- [20
Mei 2019]</span></h2>
<ul>
<li>Tambahan Form kolom entry Lingkar Perut
dan IMT pada pendaftaran</li>
<li>Tambahan Form kolom entry Lingkar Perut
dan IMT pada pelayanan</li>
<li>Validasi Skrining Sekunder dan
IVA/Papsmear</li>
<li>Penambahan Tindakan SADANIS Skrining
Sekunder</li>
<li>Penambahan No.Legalisasi Skrining
Sekunder Jika Terdapat Tindakan SADANIS</li>
</ul>
</div>
</div>
<div class="Mycontainer right">
<div class="Mycontent">
<h2>Versi 3.2.0 <span class="dateVersion">- [06
Mei 2019]</span></h2>
<ul>
<li>Pembukaan Akses PCare sebagai Bidan
Jejaring</li>
</ul>
</div>
</div>
<div class="Mycontainer left">
<div class="Mycontent">
<h2>Versi 3.1.0 <span class="dateVersion">- [01
April 2019]</span></h2>
<ul>
<li>Login SSO Kantor Cabang</li>
<li>Penyesuaian input hasil tindakan dengan
nilai minimal 0.01</li>
<li>Penyesuaian PDF surat
kunjungan/pelayanan peserta</li>
<li>Perbaikan lihat riwayat pada menu
verifikasi FPK</li>
</ul>
</div>
</div>
<div class="Mycontainer right">
<div class="Mycontent">
<h2>Versi 3.0.0 <span class="dateVersion">- [29
Jan 2019]</span></h2>
<ul>
<li>Info Peserta PRB dapat tampil di semua
Faskes</li>
<li>Tambahan Fitur PRB-MTM</li>
<li>Data Pemeriksaan Fisik dapat diisi
bilangan berkoma</li>
<li>Data Hasil suatu tindakan dapat diisi
bilangan berkoma</li>
<li>Perbaikan bug perubahan data kunjungan
saat sudah diajukan klaimnya</li>
<li>Pengelompokan Tenaga Medis berdasarkan
jenisnya</li>
<li>Tambahan field No Surat Meninggal</li>
</ul>
</div>
</div>
<div class="Mycontainer left">
<div class="Mycontent">
<h2>Versi 2.0.1 <span class="dateVersion">- [07
Jan 2019]</span></h2>
<ul>
<li>Penambahan versi aplikasi pada form
login</li>
<li>Perbaikan Bug fitur ANC </li>
<li>Penyempurnaan menu detail tagihan FPK
saat verifikasi dengan bug fitur riwayat kunjungan peserta </li>
</ul>
</div>
</div>
<div class="Mycontainer right">
<div class="Mycontent">
<div class="Mycontent">
<h2>Versi 2.0.0 <span class="dateVersion">-
[15 Nov 2018]</span></h2>
<ul>
<li>Perubahan Tampilan PCare</li>
</ul>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<!-- /.modal-content -->
</div>
<!-- /.modal-dialog -->
</div>

</body>
</html>

</body>
</html>

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