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Release: Australia · Updated: 2026-03-12 · Official documentation · View source

Practice location form

Access, update, and validate the practice location details of a healthcare professional in the Practice location form.

Field	Description
Professional profile	Professional profile of the healthcare professional.
Practice name \(in Directory\)	Practice name of the healthcare professional.
Corporation name \(in W-9 form\)	Name of the corporation in \(W-9 format\) to verify name, address, and tax ID.
Primary tax ID type	Type of tax ID: Primary or Individual.
Individual tax ID	Individual Tax ID number against which taxes are collected from the healthcare professional.
Group tax ID	Group tax ID \(Employer Tax ID\) against which taxes are collected.
Credentialing reference	Option to add a professional reference.
Office schedule	Working schedules of the health care professional, for example, 24 X 7.
Accept new patients	Option to indicate that the healthcare professional can accept new patients.
Accept new medicaid patients	Option to indicate that the healthcare professional can accept new medicaid patients.
Accept new medicare patients	Option to indicate that the healthcare professional can accept new medicare patients.
Active	Option to indicate that the practice location record is available to use.
Is current location	Option to indicate that this is the current practice location of the health care professional.
Is billing electronic	Option to indicate that electronic billing is generated at the affiliated hospital for the services rendered by healthcare professional.
Send correspondence here	Option to indicate that any correspondence \(examples: letters\) to the healthcare professional can be sent to the affiliated hospital.
Status	Status of the practice location record: - New: When profile intake form is sent to the healthcare professional for filling. - Pending validation: When data is filled in by healthcare professional and sent for credentialing and validation to HR agents. - Invalid: When HR agents review the data and reject due to insufficient or invalid details. - Valid: When HR agents validate and approve the information provided by the healthcare professional.
Address	Address of practice location.
City	City in which practice location is situated.
State/province	State in which practice location is situated.
Zip/postal code	Postal code of area in which the practice location is situated.
Country	Country in which the practice location is situated.

Parent Topic:HR Service Delivery for Healthcare reference

Healthcare professional profile form

Professional ID form

Professional liability Insurances form

Professional reference form

Professional speciality form

Malpractice history form

Education and Training form

Employment history form

Languages Spoken form

Hospital Affiliations form

Payers Enrollment form

Healthcare Employee Onboarding form