Find a Provider Change Request

This form is used to update your provider profile at hmc.pennstatehealth.org. If you would like to make changes to your University research profile in Pure, please visit https://research.med.psu.edu/pure.

Most requests will be completed within 10 working days, dependent upon level of effort and scope. If we are unable to meet a requested timeline, we will communicate to you the progress and expected completion date.

We understand there will be "emergency" updates requested, and we will do our best to get those in as quickly as possible.

If the request is a major change, we may need to a schedule a meeting to understand the request.

Some examples of changes

Routine requests: Edits to text content, documents or images to be added to existing pages (completed within 10 working days)
Emergency requests: Regulatory information, immediate staff changes (completed within 2 business days)

Time Sensitivity

Is the update time-sensitive?

YesNo

What is the requested date?

Please explain why this is time-sensitive

General Information

Department/Program

URL of department/program site's main page

Name of Person Submitting Form

Email address

Best Phone Number

Provider First Name

Provider Last Name

Request Description

Please note, changes to Credentials, Professional Education or Specialties will need to be handled directly with the Medical Staff Office.

Update Biography

Updated Publication link (url only)

My Practice Location

Academic Interests

Affiliations

Academic Appointment

Awards

Each award will be presented in a bullet listing.

Patient Services Provided

Each patient services provided will be presented in a bullet listing. Please keep it short. Please use terminology that patients will understand.

Honors

Each honor will be presented in a bullet listing.

Research interests:

Each research interest will be presented in a bullet listing.

Uploads

Photo

CV upload

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