---
title: Healthcare professional profile form
description: Access and update confidential HR data of an healthcare professional, such as name, personal contact information, email addresses, professional liability insurance details, and medical degree, using the Healthcare professional profile form.
locale: en-US
canonical_url: https://www.servicenow.com/docs/r/australia/employee-service-management/hr-service-delivery-for-healthcare/hr-service-healthcare.html
release: australia
product: HR Service Delivery for Healthcare
classification: hr-service-delivery-for-healthcare
topic_type: reference
last_updated: "2026-03-12"
reading_time_minutes: 2
breadcrumb: [HR Service Delivery for Healthcare reference, HR Service Delivery for Healthcare, HR Service Delivery, Employee Service Management]
---

# Healthcare professional profile form

Access and update confidential HR data of an healthcare professional, such as name, personal contact information, email addresses, professional liability insurance details, and medical degree, using the Healthcare professional profile form.

<table id="table_qvq_3sj_jbc"><thead><tr><th>

Field

</th><th>

Description

</th></tr></thead><tbody><tr><td>

User

</td><td>

Name of the healthcare professional.

</td></tr><tr><td>

Employee profile

</td><td>

Employee profile that is associated to the healthcare professional.

</td></tr><tr><td>

HR profile

</td><td>

HR profile that is associated with the healthcare professional.

</td></tr><tr><td>

First name

</td><td>

First name of the healthcare professional.

</td></tr><tr><td>

Middle name

</td><td>

Middle name of the healthcare professional.

</td></tr><tr><td>

Last name

</td><td>

Last name of the healthcare professional.

</td></tr><tr><td>

Gender

</td><td>

Gender of the healthcare professional.

</td></tr><tr><td>

Primary education

</td><td>

Education details of the healthcare professional.

</td></tr><tr><td>

Uniform size

</td><td>

Uniform size of the healthcare professional.

</td></tr><tr><td>

Active

</td><td>

Option to make the healthcare professional profile record available to use across workflows and teams.

</td></tr><tr><td>

Locked

</td><td>

Option to disable re-editing of profile fields by healthcare professional once the profile intake forms are submitted.**Note:** By default, this option is enabled. An HR agent can disable the option to edit the record details.

</td></tr><tr><td>

Professional type

</td><td>

Type of profession: healthcare professional.

</td></tr><tr><td>

Provider type

</td><td>

Type of degree awarded to the healthcare professional. For example, MD, DMD, or DPM.

</td></tr><tr><td>

Other provider type

</td><td>

Option to specify other type of degree that is not listed in the **Provider type** field.

</td></tr><tr><td>

CAQH provider ID

</td><td>

CAQH ID of the healthcare professional issued by Council for Affordable Quality Healthcare \(CAHQ\).

</td></tr><tr><td>

Preferred contact medium

</td><td>

Mode of communication that is preferred by the healthcare professional. For example, email, telephone or fax.

</td></tr><tr><td>

Mobile phone

</td><td>

Mobile number of the healthcare professional.

</td></tr><tr><td>

Email

</td><td>

Email address of the healthcare professional.

</td></tr><tr><td>

Fax

</td><td>

Fax number of the healthcare professional.

</td></tr></tbody>
</table>**Parent Topic:**[HR Service Delivery for Healthcare reference](https://raw.githubusercontent.com/ServiceNow/ServiceNowDocs/australia/markdown/australia/employee-service-management/hr-service-delivery-for-healthcare/reference-hr-healthcare.md)

**Related topics**  


[Installed with HR Service Delivery for Healthcare]()

[Professional ID form]()

[Professional liability Insurances form]()

[Professional reference form]()

[Professional speciality form]()

[Malpractice history form]()

[Education and Training form]()

[Practice location form]()

[Employment history form]()

[Languages Spoken form]()

[Hospital Affiliations form]()

[Payers Enrollment form]()

[Healthcare Employee Onboarding form]()