Find a Provider Change Request

Standard service levels

Most requests will be completed within 10 working days, dependent upon level of effort and scope. Requests should be submitted with this timeframe of two business weeks in mind.

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 gather more information before beginning work.

Some examples of changes

Routine requests: Edits to text content; new content to be added to existing pages; updates to existing forms (completed within 10 working days)
Emergency requests: Regulatory or compliance-related changes; staff changes due to termination (completed within 5 business days)
Major functionality changes: New pages; new forms; large documents to be converted to web format; significant changes to images (timelines to be determined based on level of effort; requesters will be contacted with details if this applies, generally within a month)

This form is used to update your provider profile at 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 5 business days)

Time Sensitivity

Is the update time-sensitive?

YesNo

What is the requested date?

Please explain why this is time-sensitive

Additional comments

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

Provider Main Phone Number

Please list main clinic number

Provider Direct Phone Number

Please list direct clinic phone number if applicable

Request Description

Please note: changes to Credentials, Professional Education or Specialties will need to be handled directly with the Medical Staff Office. Please do not add this information to this form. Please reach out to them directly.

Update Biography

Please note: changes to Credentials, Professional Education or Specialties will need to be handled directly with the Medical Staff Office. Please do not add this information. Do not add this information to the Biography section.

Updated Publication link (url only)

My Practice Location (please use correct name and URL from our website

Academic Interests

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 (please only upload if you would like your CV visible online)

Contact Information