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CLINIC AND GROUP CHANGES FORM Please complete the appropriate section of this form and email the completed form to: PROVIDER.CHANGES@CHPW.ORG Please note: Incomplete information may result in a delay
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How to fill out clinic and group changes

01
Log in to the clinic or group management system
02
Navigate to the section for clinic or group changes
03
Select the specific clinic or group that needs to be updated
04
Fill out the required fields such as new contact information, address, or services offered
05
Save the changes and review them for accuracy before submitting

Who needs clinic and group changes?

01
Medical practices and healthcare facilities that have undergone changes in contact information, location, services, or staff members
02
Organizations seeking to update their clinic or group information for better organization and communication with patients
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Clinic and group changes refer to any modifications or updates made to the information of a healthcare clinic or medical group, including changes in ownership, location, provider list, or services offered.
Healthcare clinics and medical groups are required to file clinic and group changes with the appropriate regulatory authorities.
Clinic and group changes can typically be filled out online through a designated portal or submitted through specific forms provided by the regulatory authorities.
The purpose of clinic and group changes is to ensure that accurate and up-to-date information about healthcare clinics and medical groups is available to patients, regulatory authorities, and other stakeholders.
Information that must be reported on clinic and group changes may include changes in ownership, location, provider list, services offered, contact information, and any other relevant details.
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