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.
Resign or Retire Your Membership
Resign membership and privileges at all PHSOR ministries. To be completed by practitioner only.