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MINNESOTA UNIFORM PRACTITIONER CHANGE FORM Revised December 2017 Add Remove Change Demographic Data for Credentialed Practitioners and Specialists Not Subject to Credentialing: ER Physician, Hospitalist
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01
To fill out the Minnesota Uniform Practitioner Change form, follow these steps:
02
Download the form from the official Minnesota Department of Health website.
03
Fill out the name and contact information of the healthcare practitioner who is experiencing a change.
04
Provide the updated information regarding the change, such as new address, phone number, or email address.
05
Indicate the effective date of the change.
06
If applicable, explain the reason for the change.
07
Sign and date the form.
08
Submit the completed form to the Minnesota Department of Health according to their instructions.
09
Keep a copy of the filled-out form for your records.

Who needs minnesota uniform practitioner change?

01
Minnesota Uniform Practitioner Change form is needed by healthcare practitioners who have experienced a change in their personal or professional information that needs to be updated with the Minnesota Department of Health. This may include changes in address, contact information, or any other relevant details. It is important for practitioners to promptly notify the department regarding such changes to ensure accurate communication and documentation.
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The Minnesota uniform practitioner change is a form used to update information about a practitioner or their practice.
Practitioners in Minnesota who have made changes to their practice or personal information are required to file the uniform practitioner change form.
The form can be filled out online or submitted by mail, and requires practitioners to provide updated information about their practice and personal details.
The purpose of the uniform practitioner change form is to ensure that accurate and up-to-date information is available for all practitioners in Minnesota.
Information such as changes in contact information, practice location, specialty, or disciplinary actions must be reported on the form.
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