• Provider Update Request

Provider Update Request Form

Provider data from various sources is displayed on osfhealthcare.org in the provider directory. Use this form to request corrections to a provider's directory profile.

Submitter Details

Please use your OSF email.

Provider Information

Personal Information

Name changes can only take place if the medical license is up to date and must follow our standard HR name change process. Any updates in this section must match the provider's medical license.

Please provide a valid phone number in the provided format.

Location Information

Use this form to report incorrect or missing location details. If the location is an Epic department, provide the Epic Department ID in your details.

Enter the incorrect location, the correct location, and the correct order. Include the location name and Epic Department ID to ensure the correct changes are applied.

Enter the location that should be linked and the correct order. Include the location name and Epic Department ID to ensure the correct changes are applied.

Enter the location that needs to be removed. Use this option if the provider is no longer billing or scheduled to see patients at this location. Include the location name and Epic Department ID to ensure the correct changes are applied.

Is this provider covering or on call at the location you're asking to remove?

Enter the location that should not be publicly visible. The existing location(s) will be retained for billing and on call scheduling purposes. Include the location name and Epic Department ID to ensure the correct changes are applied.

Enter the locations and their correct order. Include the location name and Epic Department ID to ensure the correct changes are applied.

Provide the incorrect phone number and the correct phone number. Include the location name and Epic Department ID to ensure the correct changes are applied.

Marketable Information

For any field you want to update, enter the new information that should be in the profile.

Photo must be at least 1200x1200 pixels.