Provider Patient Panel/PCP/Specialist Change Form

Change in Provider Status Form Instructions

Health Center:

• To notify HMSA when adding a new physician to your health center, please complete the section, Notification of New Provider
• To notify HMSA that a provider in your health center changed status, please complete this section, Change of Provider Status
• Change in Provider Status – HMO Health Center Use Only [PDF]

Change in Provider Patient Panel and PCP Status Form Instructions

Provider:

• To notify HMSA regarding a change in your PCP status or your status about accepting new patients, please go to the Change in Provider Panel Form [PDF].

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