---
title: Healthcare professional profile form
description: Access and update confidential HR data for a healthcare professional. This includes name, personal contact information, email addresses, professional liability insurance details, and medical degree.
locale: en-US
canonical_url: https://www.servicenow.com/docs/r/employee-service-management/hr-service-delivery-for-healthcare/hr-service-healthcare.html
release: brazil
product: HR Service Delivery for Healthcare
classification: hr-service-delivery-for-healthcare
topic_type: reference
last_updated: "2026-09-10"
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 for a healthcare professional. This includes name, personal contact information, email addresses, professional liability insurance details, and medical degree.

<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/brazil/markdown/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]()