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)

Submit an Update to the RCO

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.

Submit Resignation