For Current Members and Other Practitioners
Changes to Your Contact or Practice Information
Use our online form to notify the Regional Credentialing Office (RCO) of:
- Change to personal or office practice information
- Change to professional practice (i.e. relinquish privileges)
- Change to primary practice site
- Take a leave of absence
- Request addition of privileges
- Request authorization to practice at an additional PHSOR hospital site
- Any other change to status (i.e. transition from Active to Inactive)
Changes to Your Provider Directory Profile
Submit a request to change your information in the provider directory.
Submit an update to the Provider Directory
Resign or Retire Your Membership
Resign membership and privileges at all PHSOR ministries. To be completed by practitioner only.