Domain > forms.gundersenhealth.org

More information on this domain is in AlienVault OTX

DNS Resolutions

Date	IP Address
2023-06-13	104.18.39.219 (ClassC)
2026-02-19	104.18.17.195 (ClassC)

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!DOCTYPE html>html langen>	head>		title>Gundersen Health System - Gundersen Health System/title>		meta charsetUTF-8>		meta nameviewport contentwidthdevice-width, initial-scale1.0, maximum-scale1.0, user-scalableno>		!--if IE>meta http-equivX-UA-Compatible contentIEedge,chrome1>!endif-->				!-- Favicons -->				link relapple-touch-icon-precomposed sizes144x144 hrefResource/MonarchUI/production/assets-minified/images/icons/apple-touch-icon-144-precomposed.png>		link relapple-touch-icon-precomposed sizes114x114 hrefResource/MonarchUI/production/assets-minified/images/icons/apple-touch-icon-114-precomposed.png>		link relapple-touch-icon-precomposed sizes72x72 hrefResource/MonarchUI/production/assets-minified/images/icons/apple-touch-icon-72-precomposed.png>		link relapple-touch-icon-precomposed hrefResource/MonarchUI/production/assets-minified/images/icons/apple-touch-icon-57-precomposed.png>		link relstylesheet typetext/css 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typetext/javascript srcResource/MonarchUI/production/assets-minified/js-core/jquery-ui-core.js>/script>		script typetext/javascript srcResource/MonarchUI/production/assets-minified/js-core/jquery-ui-widget.js>/script>		script typetext/javascript srcResource/MonarchUI/production/assets-minified/js-core/jquery-ui-mouse.js>/script>		script typetext/javascript srcResource/MonarchUI/production/assets-minified/js-core/jquery-ui-position.js>/script>		script typetext/javascript srcResource/MonarchUI/production/assets-minified/js-core/modernizr.js>/script>				script typetext/javascript srcResource/MonarchUI/production/assets-minified/js-core/jquery-cookie.js>/script>		 -->		link relstylesheet typetext/css hrefResource/MonarchUI/production/assets-minified/icons/typicons/typicons.css/>		link relstylesheet typetext/css hrefResource/MonarchUI/production/assets-minified/icons/elusive/elusive.css>				style typetext/css>			/* Loading Spinner */			.spinner{margin:0;width:70px;height:18px;margin:-35px 0 0 -9px;position:absolute;top:50%;left:50%;text-align:center}.spinner > div{width:18px;height:18px;background-color:#333;border-radius:100%;display:inline-block;-webkit-animation:bouncedelay 1.4s infinite ease-in-out;animation:bouncedelay 1.4s infinite ease-in-out;-webkit-animation-fill-mode:both;animation-fill-mode:both}.spinner .bounce1{-webkit-animation-delay:-.32s;animation-delay:-.32s}.spinner .bounce2{-webkit-animation-delay:-.16s;animation-delay:-.16s}@-webkit-keyframes bouncedelay{0%,80%,100%{-webkit-transform:scale(0.0)}40%{-webkit-transform:scale(1.0)}}@keyframes bouncedelay{0%,80%,100%{transform:scale(0.0);-webkit-transform:scale(0.0)}40%{transform:scale(1.0);-webkit-transform:scale(1.0)}}			.login-box .user-img {height:100px;}			.fixed-sidebar #page-header {padding-left:10px;}			#header-nav-left {white-space: nowrap;}		/style>				script typetext/javascript>			$(window).on(load, function() {		        setTimeout(function() {		            $(#loading).fadeOut( 400, linear );		        }, 300);		    });		/script>		!-- Uniform -->				!--link relstylesheet typetext/css hrefResource/MonarchUI/production/assets-minified/widgets/uniform/uniform.css>-->		script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/uniform/uniform.js>/script>						!-- Parsley -->				script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/parsley/parsley.js>/script>				!-- background image should be 1600 px wide -->		style typetext/css>			.foundation_bg {			    background-image: url(/images/medEd.jpg);			}														/style>		script typetext/javascript srcResource/Scripts/json2-min.js>/script>			script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/chosen/chosen.js>/script>				!-- JQuery Date Picker -->		script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/datepicker-ui/datepicker.js>/script>		!-- Uniform -->				!--link relstylesheet typetext/css href../../assets/widgets/uniform/uniform.css>-->		script typetext/javascript srcResource/MonarchUI/assets/widgets/uniform/uniform.js>/script>		script typetext/javascript srcResource/MonarchUI/assets/widgets/uniform/uniform-demo.js>/script>		style typetext/css>			.ui-datepicker{width: 200px;}			/style>/head>	body >script>window.history.go(1);	if(top ! self) top.location  self.location/script>div classmain-header bg-header wow fadeInDown>    div classcontainer>	     	/div>!-- .container -->/div>!-- .main-header -->div classhero-box hero-box-smaller fixed-bg foundation_bg font-inverse>    div classcontainer>        h1 classhero-heading wow fadeInDown data-wow-duration0.6s>Gundersen Health System/h1>        p classhero-text wow bounceInUp data-wow-duration0.9s data-wow-delay0.2s>COVID-19 Vaccine Status/p>    /div>    div classhero-overlay bg-black>/div>/div>div classpanel>	div classpanel-body>				h4 classtitle-hero idGroupTitle>COVID-19 Vaccine Status/h4>	    div classexample-box-wrapper>	        form namefrmUpload idfrmUpload  methodpost roleform classform-horizontal  bordered-row enctypemultipart/form-data actionmvc/covidUploadData >								div classalert alert-danger collapse rolealert iddiagAlertDec1>Please Answer Yes or No/div>				div classform-group>					div classcol-sm-12 text-left>						Gundersen Health System (GHS) requires COVID-19 vaccination of all staff regardless of work location. This means that all employee and non-employee personnel, volunteers, residents, fellows, trainees, clinical and non-clinical contracted staff, students, researchers, temporary workers, contractors, and vendors at any work site or remote location, regardless of clinical responsibility or patient contact, are required to comply.br/>br/>						Please complete the below information and upload your COVID-19 Vaccination card/proof of immunization in the Attachments section                       					/div>				/div>				div classform-group>	                 label classcol-sm-3 control-label>I certify that I have been fully vaccinated against COVID-19./label>	                 div classcol-sm-9>	                     div classrow>	                         div classcol-md-6>	                             div class radio-primary>	                                 label>	                                     div classradio iduniform-radDeclinationY1>span>input typeradio idradDeclination1 nameradDeclination1 value1 classcustom-radio radDeclination>i classglyph-icon icon-circle>/i>/span>/div>	                                     Yes	                                 /label>	                             /div>	                             div class radio-danger>	                                 label>	                                     div classradio iduniform-radDeclinationN1>span>input typeradio idradDeclination1 nameradDeclination1 value2 classcustom-radio radDeclination>i classglyph-icon icon-circle>/i>/span>/div>	                                     No	                                 /label>	                             /div>	                         /div>	                     /div>	                 /div>	                 input typehidden namecovidReasonNo idcovidReasonNo1 value1 >				 	 input typehidden classcovidAnswerNo namecovidAnswerNo  title idcovidAnswerNo1 value data-declination1>					 input typehidden namecovidComment idcovidComment1 value>	             /div>							h4 classtitle-hero idGroupTitle>Attachments/h4>				             div classalert alert-danger collapse rolealert iddiagAlertAttach>You are required to upload your COVID-19 Vaccination card/proof of immunization./div>	             div classform-group>	             	div classrow>						label classcol-sm-2 control-label>File/label>								div classcol-sm-2>													  						  	span classbtn btn-blue-alt btn-file>										  	  		                         span classfileinput-new> i classglyph-icon icon-plus>/i>Add Files/span>		                         input typefile idcovidFiles namecovidFiles classform-control accept.jpg, .doc, .docx, .pdf  multiplemultiple  />		                     /span>    						/div>											div class divSelectedFiles col-sm-8>							label classcol-sm-2 control-label>Selected File(s)/label>									div classcol-sm-6 iddivFiles>							/div>						/div>					/div>					div classrow>						label classcol-sm-2 control-label>File/label>								div classcol-sm-2>													  						  	span classbtn btn-blue-alt btn-file>										  	  		                         span classfileinput-new> i classglyph-icon icon-plus>/i>Add Files/span>		                         input typefile idcovidFiles2 namecovidFiles2 classform-control accept.jpg, .doc, .docx, .pdf  multiplemultiple  />		                     /span>    						/div>											div class divSelectedFiles2 col-sm-8>							label classcol-sm-2 control-label>Selected File(s)/label>									div classcol-sm-6 iddivFiles2>							/div>						/div>					/div>									/div>				h4 classtitle-hero idGroupTitle>Electronic Signature/h4>				div classform-group>					div classcol-sm-12 text-left>						By typing your name below, you are signing this form electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form.					/div>				/div>								div classalert alert-danger collapse rolealert iddiagAlertSig>Signature is Required/div>				div classform-group >										label classcontrol-label col-sm-1 > Signature/label>					div classcol-sm-3>						input classform-control typetext namecontingentSignature idcontingentSignature value maxlength50 autocompleteoff  titleEmployee Signature/>												/div>					div classcol-sm-2>						div classinput-group datepicker ui-datepicker-inline >	                 		input typetext readonlyreadonly classform-control value02/19/2026 idsignatureDate namesignatureDate autocompleteoff>                           	                        span classadd-on input-group-addon idspanStartCal>	                            i classglyph-icon icon-calendar>/i>	                        /span>	               		/div>						/div>				/div>					div classalert alert-danger collapse rolealert iddiagAlertId>Gundersen ID Number is Required/div>				div classform-group >										label classcontrol-label col-sm-1 >Gundersen ID Number/label>					div classcol-sm-3>						input classform-control typetext namecontingentId idcontingentId value maxlength8 autocompleteoff  titleGundersen Id/>												/div>				/div>					div classform-group >										label classcontrol-label col-sm-1 >Phone Number/label>					div classcol-sm-3>						input classform-control typetext namecontingentPhone idcontingentPhone value maxlength12 autocompleteoff  titlePhone Number/>												/div>				/div>										    				div classform-group>					div classcol-sm-offset-2 col-sm-10>						button typebutton idbtnSave onclickapp.saveData(); classbtn btn-primary>Save/button>							button typebutton idbtnCencel onclickapp.cancelForm(); classbtn btn-default>Cancel/button>														/div>				/div>				div classalert   rolealert>label idlblMessages>/label>/div>											/form>		/div>	/div>               /div>script typetext/javascript>var appapp||{};app.saveData  function(){	var pgAlert  0, pgMsg  ;		if(!$(#covidAnswerNo1).val()){		pgAlert  1;		$(#diagAlertDec1).show();		}	var fp  $(#covidFiles);    var lg  fp0.files.length;    if(lg  0){    	pgAlert  1;    	$(#diagAlertAttach).show();    }else{    	$(#diagAlertAttach).hide();	    }		if(!$(#contingentSignature).val()){		pgAlert  1;    	$(#diagAlertSig).show();    }else{    	$(#diagAlertSig).hide();	    }	if(!$(#contingentId).val()){		pgAlert  1;    	$(#diagAlertId).show();    }else{    	if(!$.isNumeric($(#contingentId).val())){        	pgAlert  1;    		$(#diagAlertId).show();	    	}else{    		$(#diagAlertId).hide();    	}    }		if(pgAlert  0){		$(#frmUpload).submit();		}	};//end app.saveDataapp.cancelForm  function(){	window.location.replace(COVIDForm);}$(document).ready(function(){	$( #signatureDate ).datepicker() ;	$(#spanStartCal).click(function(){		$(#signatureDate).focus();		});		$(.covidDeclination).each(function(){		$(this).hide();	});		$(#covidFiles).change(function(){		var names  ;			for (var i  0; i  $(inputnamecovidFiles).get(0).files.length; ++i) {		        names.push($(inputnamecovidFiles).get(0).filesi.name+ br/> );    			        			    };//end of file loop		    $(.divSelectedFiles).show();		    $(#divFiles).html(names);		    		    	});	$(#covidFiles2).change(function(){		var names  ;			for (var i  0; i  $(inputnamecovidFiles2).get(0).files.length; ++i) {		        names.push($(inputnamecovidFiles2).get(0).filesi.name+ br/> );    			        			    };//end of file loop		    $(.divSelectedFiles2).show();		    $(#divFiles2).html(names);		    		    	});		$(.radDeclination).click(function(c){		//console.log(Click+$(this).val());		var strId  this.id;		strId  strId.substring(14);		console.log(Click+$(this).val()+ STR: +strId);		$(#covidAnswerNo+strId).val(this.value);		$(#diagAlertDec+strId).hide();					if(strId  1){			if($(this).val()  2){				$(.covidDeclination).each(function(){					$(this).show();				})				$(#covidStatus).val(1);				$(#covidAttestationYes).hide();				$(#uniform-radDeclination2>span.checked).removeClass(checked);				$(#covidAnswerNo2).val();			}else{				$(#covidAttestationYes).show();				$(.covidDeclination).each(function(){					$(this).hide();				})				$(#covidStatus).val(5);				$(.radDeclination).each(function(){					if($(this).attr(id)!radDeclination1){						var tmpID  $(this).attr(id).substring(14);						$(#uniform-radDeclination+tmpID+>span.checked).removeClass(checked);						$(#covidAnswerNo+tmpID).val();	    				$(#divDeclination+tmpID).hide();	    				$(#covidComment+tmpID).val();					}				});				$(#txtComment).val();			}					}else{			if(this.value  1){				$(#divDeclination+strId).show();			}else{				$(#divDeclination+strId).hide();			}			if(strId  99){				if(this.value  1){					$(#divOther).show();				}else if(this.value  2){					$(txtComment).val();					$(#divOther).hide();				}			}		}	});		$(#covidFiles).change(function(){				var fp  $(#covidFiles);	    var lg  fp0.files.length;	    if(lg  0){	    	$(#diagAlertAttach).show();	    }else{	    	$(#diagAlertAttach).hide();		    }	});		$(#contingentSignature).change(function(){			if(!$(#contingentSignature).val()){	    	$(#diagAlertSig).show();	    }else{	    	$(#diagAlertSig).hide();		    }	});	$(#contingentId).change(function(){		if(!$(#contingentId).val()){	    	$(#diagAlertId).show();	    }else{	    	if(!$.isNumeric($(#contingentId).val())){	        	pgAlert  1;	    		$(#diagAlertId).show();		    	}else{	    		$(#diagAlertId).hide();	    	}	    }	});});$(function(){	use strict;$(inputtypecheckbox.custom-checkbox).uniform(),	$(inputtyperadio.custom-radio).uniform(),	$(.custom-select).uniform(),	$(.selector).append(i classglyph-icon icon-caret-down>/i>),	$(.checker span).append(i classglyph-icon icon-check>/i>),	$(.radio span).append(i classglyph-icon icon-circle>/i>)});function limitText(limitField, limitNum) {    if (limitField.value.length > limitNum) {        limitField.value  limitField.value.substring(0, limitNum);    } } /script>br>br>	div classpage-footer>	    div classfooter-pane>	        	    /div>    /div>	!-- FRONTEND ELEMENTS -->	!-- Skrollr -->	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/skrollr/skrollr.js>/script>	!-- Owl carousel -->	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/owlcarousel/owlcarousel.js>/script>	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/owlcarousel/owlcarousel-demo.js>/script>	!-- HG sticky -->	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/sticky/sticky.js>/script>	!-- WOW -->	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/wow/wow.js>/script>	!-- VideoBG -->	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/videobg/videobg.js>/script>	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/videobg/videobg-demo.js>/script>	!-- Mixitup -->	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/mixitup/mixitup.js>/script>	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/mixitup/isotope.js>/script>		!-- WIDGETS -->	!-- Bootstrap Dropdown -->	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/dropdown/dropdown.js>/script>	!-- Bootstrap Progress Bar -->	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/progressbar/progressbar.js>/script>	!-- Bootstrap Buttons -->	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/button/button.js>/script>	!-- Bootstrap Collapse -->	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/collapse/collapse.js>/script>	!-- Superclick -->	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/superclick/superclick.js>/script>	!-- Input switch alternate -->	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/input-switch/inputswitch-alt.js>/script>	!-- Slim scroll -->	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/slimscroll/slimscroll.js>/script>	!-- Content box -->	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/content-box/contentbox.js>/script>	!-- Overlay -->	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/overlay/overlay.js>/script>	!-- Theme layout -->	script typetext/javascript srcResource/MonarchUI/production/assets-minified/themes/frontend/layout.js>/script>	!-- Theme switcher -->	script typetext/javascript srcResource/MonarchUI/production/assets-minified/widgets/theme-switcher/themeswitcher.js>/script>script>(function(){function c(){var ba.contentDocument||a.contentWindow.document;if(b){var db.createElement(script);d.innerHTMLwindow.__CF$cv$params{r:9d081f0a7898debd,t:MTc3MTUyODgyMw};var adocument.createElement(script);a.src/cdn-cgi/challenge-platform/scripts/jsd/main.js;document.getElementsByTagName(head)0.appendChild(a);;b.getElementsByTagName(head)0.appendChild(d)}}if(document.body){var adocument.createElement(iframe);a.height1;a.width1;a.style.positionabsolute;a.style.top0;a.style.left0;a.style.bordernone;a.style.visibilityhidden;document.body.appendChild(a);if(loading!document.readyState)c();else if(window.addEventListener)document.addEventListener(DOMContentLoaded,c);else{var edocument.onreadystatechange||function(){};document.onreadystatechangefunction(b){e(b);loading!document.readyState&&(document.onreadystatechangee,c())}}}})();/script>/body>/html>

Subdomains

Date	Domain	IP
mail1.gundersenhealth.org	2025-08-05	204.69.147.17
forms.gundersenhealth.org	2026-02-19	104.18.17.195
providers.gundersenhealth.org	2025-08-18	45.60.233.26

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Domain > forms.gundersenhealth.org

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Port 443

Subdomains