/* * Generated by the Jasper component of Apache Tomcat * Version: Apache Tomcat/8.0.32 * Generated at: 2018-04-20 13:43:19 UTC * Note: The last modified time of this file was set to * the last modified time of the source file after * generation to assist with modification tracking. */ package org.apache.jsp.pages; import javax.servlet.*; import javax.servlet.http.*; import javax.servlet.jsp.*; public final class registration_jsp extends org.apache.jasper.runtime.HttpJspBase implements org.apache.jasper.runtime.JspSourceDependent, org.apache.jasper.runtime.JspSourceImports { private static final javax.servlet.jsp.JspFactory _jspxFactory = javax.servlet.jsp.JspFactory.getDefaultFactory(); private static java.util.Map _jspx_dependants; private static final java.util.Set _jspx_imports_packages; private static final java.util.Set _jspx_imports_classes; static { _jspx_imports_packages = new java.util.HashSet<>(); _jspx_imports_packages.add("javax.servlet"); _jspx_imports_packages.add("javax.servlet.http"); _jspx_imports_packages.add("javax.servlet.jsp"); _jspx_imports_classes = null; } private volatile javax.el.ExpressionFactory _el_expressionfactory; private volatile org.apache.tomcat.InstanceManager _jsp_instancemanager; public java.util.Map getDependants() { return _jspx_dependants; } public java.util.Set getPackageImports() { return _jspx_imports_packages; } public java.util.Set getClassImports() { return _jspx_imports_classes; } public javax.el.ExpressionFactory _jsp_getExpressionFactory() { if (_el_expressionfactory == null) { synchronized (this) { if (_el_expressionfactory == null) { _el_expressionfactory = _jspxFactory.getJspApplicationContext(getServletConfig().getServletContext()).getExpressionFactory(); } } } return _el_expressionfactory; } public org.apache.tomcat.InstanceManager _jsp_getInstanceManager() { if (_jsp_instancemanager == null) { synchronized (this) { if (_jsp_instancemanager == null) { _jsp_instancemanager = org.apache.jasper.runtime.InstanceManagerFactory.getInstanceManager(getServletConfig()); } } } return _jsp_instancemanager; } public void _jspInit() { } public void _jspDestroy() { } public void _jspService(final javax.servlet.http.HttpServletRequest request, final javax.servlet.http.HttpServletResponse response) throws java.io.IOException, javax.servlet.ServletException { final java.lang.String _jspx_method = request.getMethod(); if (!"GET".equals(_jspx_method) && !"POST".equals(_jspx_method) && !"HEAD".equals(_jspx_method) && !javax.servlet.DispatcherType.ERROR.equals(request.getDispatcherType())) { response.sendError(HttpServletResponse.SC_METHOD_NOT_ALLOWED, "JSPs only permit GET POST or HEAD"); return; } final javax.servlet.jsp.PageContext pageContext; javax.servlet.http.HttpSession session = null; final javax.servlet.ServletContext application; final javax.servlet.ServletConfig config; javax.servlet.jsp.JspWriter out = null; final java.lang.Object page = this; javax.servlet.jsp.JspWriter _jspx_out = null; javax.servlet.jsp.PageContext _jspx_page_context = null; try { response.setContentType("text/html;charset=windows-1252"); pageContext = _jspxFactory.getPageContext(this, request, response, null, true, 8192, true); _jspx_page_context = pageContext; application = pageContext.getServletContext(); config = pageContext.getServletConfig(); session = pageContext.getSession(); out = pageContext.getOut(); _jspx_out = out; out.write("\r\n"); out.write("\r\n"); out.write("\r\n"); out.write("\r\n"); out.write("\r\n"); out.write("\r\n"); out.write("\r\n"); out.write("\r\n"); out.write("\r\n"); out.write("\r\n"); out.write(" "); org.apache.jasper.runtime.JspRuntimeLibrary.include(request, response, "inc/head.jsp", out, false); out.write("\r\n"); out.write("\r\n"); out.write(" \r\n"); out.write("\r\n"); out.write(" \r\n"); out.write("\r\n"); out.write(" \r\n"); out.write("\r\n"); out.write(" "); org.apache.jasper.runtime.JspRuntimeLibrary.include(request, response, "inc/header.jsp", out, false); out.write(" \r\n"); out.write("\r\n"); out.write("
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Welcome to COMPLIANCE REWARDSTM

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\r\n"); out.write("\r\n"); out.write(" COMPLIANCE REWARDSTM REGISTRATION\r\n"); out.write("\r\n"); out.write("

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\r\n"); out.write("\r\n"); out.write(" Revonox® offers a comprehensive Compliance REWARDSTM program which offers resources and support services to help patient stay on track with the treatment and management of their Yulanie's disease. \r\n"); out.write("\r\n"); out.write("

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\r\n"); out.write("\r\n"); out.write(" Sign up today to see if you're eligible for Revonox Compliance REWARDSTM card and to receive comprehensive patient informational resources, instructions, nurse support, treatment and medication reminders in addition to inspirational messages and compliance assistance delivered discreetly through our innovative Mobile Application.\r\n"); out.write("\r\n"); out.write("

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\r\n"); out.write("\r\n"); out.write(" Do You have a Revonox® prescription for Yulanie's Disease?\r\n"); out.write("\r\n"); out.write(" \r\n"); out.write("\r\n"); out.write(" \r\n"); out.write("\r\n"); out.write(" Please check prescription option.\r\n"); out.write("\r\n"); out.write(" \r\n"); out.write("\r\n"); out.write("

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\r\n"); out.write("\r\n"); out.write(" In addition to educational and inspirational multimedia content, nurse support and benefit assistance, Revonox® Compliance REWARDSTM offers other useful services to help on your path to dramatically improve your success of treatment with Revonox® \r\n"); out.write("\r\n"); out.write("

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\r\n"); out.write("\r\n"); out.write(" answer a few multiple-choice questions to see if you eligible for co-pay card\r\n"); out.write("\r\n"); out.write("

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\r\n"); out.write("\r\n"); out.write(" receive a courtesy supply of disposable, non-powdered, nitrile gloves for use with your daily exercises exercises\r\n"); out.write("\r\n"); out.write("

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\r\n"); out.write("\r\n"); out.write(" give reminders when it's time to return to your physician's office or to refill your prescription\r\n"); out.write("\r\n"); out.write("

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\r\n"); out.write("\r\n"); out.write(" answer a few multiple-choice questions to see if you eligible for co-pay card\r\n"); out.write("\r\n"); out.write("

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\r\n"); out.write("\r\n"); out.write(" receive a courtesy supply of disposable, non-powdered, nitrile gloves for use with your daily exercises exercises\r\n"); out.write("\r\n"); out.write("

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\r\n"); out.write("\r\n"); out.write(" give reminders when it's time to return to your physician's office or to refill your prescription\r\n"); out.write("\r\n"); out.write("

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\r\n"); out.write("\r\n"); out.write(" TELL US ABOUT YOURSELF\r\n"); out.write("\r\n"); out.write("

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\r\n"); out.write("\r\n"); out.write(" In addition to the below Privacy Pledge consent, I understand that by checking this box, I am also enrolling in the Revonox® Compliance REWARDS patient support and compliance program. I am also green, checking this box to allow ingenious mobility to furnish a mobile application for my mobile device, calling and or texting me at the phone numbers I have provided with promotional communications relating to Revonox® or other ExtraPharm products and services that may be of use or complementary in my treatment for Yulanie's Disease. IngeniousMobility may use automatic dialing machines or artificial or prerecorded messages to contact me and may leave a voicemail or SMS/text message (standard text messaging rates may apply). I understand that I am not required to provide this consent as a condition of purchasing any goods or service.\r\n"); out.write("\r\n"); out.write("

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\r\n"); out.write("\r\n"); out.write(" TELL US ABOUT YOUR DOCTOR (optional)\r\n"); out.write("\r\n"); out.write("

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\r\n"); out.write("\r\n"); out.write(" Privacy Plegde\r\n"); out.write("\r\n"); out.write("

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\r\n"); out.write("\r\n"); out.write(" Please read and accept the ExtraPharm privacy pledge\r\n"); out.write("\r\n"); out.write("

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\r\n"); out.write("\r\n"); out.write(" IngeniousMobility & ExtraPharm's Privacy Pledge to Patients\r\n"); out.write("\r\n"); out.write("

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\r\n"); out.write("\r\n"); out.write(" in the respects patients and customers and takes the protection of the privacy very seriously. ExtraPharm pledges the following:\r\n"); out.write("\r\n"); out.write("

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  • ExtraPharm does not and will not sell or rent your information to marketing companies for mailing list brokers
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  • ExtraPharm is careful to only collect and/or use personal identifiable information for the purposes stated in this authorization and as necessary to provide the services and/or programs the patient or customer chooses to enroll into.
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  • ExtraPharm practices are consistent with the federal and state privacy laws, including HIPAA
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  • ExtraPharm program enrollment is voluntary and always provides patients with an easy option to cancel participation.
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    \r\n"); out.write("\r\n"); out.write(" I give IngeniousMobility / ExtraPharm permission to contact me by email, phone, mail, and/or SMS/text message for the purposes detailed in the privacy notice above, and to provide me with informational and marketing communications in the future.\r\n"); out.write("\r\n"); out.write("

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    \r\n"); out.write("\r\n"); out.write(" By checking the \"I Agree\" box, I am electronically signing this form indicating I am at least 18 years old and authorize ExtraPharm and its contractors to use and disclose my personal information for the programs and purposes described above\r\n"); out.write("\r\n"); out.write("

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    \r\n"); out.write("\r\n"); out.write(" Please check Age Agreement option.\r\n"); out.write("\r\n"); out.write("
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    \r\n"); out.write("\r\n"); out.write(" ExtraPharm or IngeniousMobility may contact me using the contact information provided in this form for participation in market research activities associated with ExtraPharm's products, services and/or my condition or treatment. Please check one of the boxes below\r\n"); out.write("\r\n"); out.write("

    \r\n"); out.write("\r\n"); out.write(" \r\n"); out.write("\r\n"); out.write(" \r\n"); out.write("\r\n"); out.write(" \r\n"); out.write("\r\n"); out.write("\r\n"); out.write("\r\n"); out.write(" Please check one of the option for notification agreement.\r\n"); out.write("\r\n"); out.write("
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    IMPORTANT SAFETY INFORMATION FOR Revonox® - Yulanie's DISEASE
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  • have been told by your healthcare provider that the plaque to be treated involves the \"tube\" that your urine passes through
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  • are allergic to collagenase clostridium histolyticum or any of the ingredients in Revonox®, or to any other collagenase product. See the Medication Guide for a complete ingredients in Revonox®
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    \r\n"); out.write("\r\n"); out.write(" Your enrollment is complete - Confirmation code __Code__ You will receive a SMS with a link to download the secure, personalized application with all this information prepopulated to your mobile application \r\n"); out.write("\r\n"); out.write("

    \r\n"); out.write("\r\n"); out.write(" \r\n"); out.write("\r\n"); out.write("
    \r\n"); out.write("\r\n"); out.write(" Thank You!\r\n"); out.write("\r\n"); out.write("
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