Practice location form

---
title: Practice location form
description: Access, update, and validate the practice location details of a healthcare professional in the Practice location form.
locale: en-US
canonical_url: https://www.servicenow.com/docs/r/employee-service-management/hr-service-delivery-for-healthcare/hr-prac-loc.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: 3
breadcrumb: [HR Service Delivery for Healthcare reference, HR Service Delivery for Healthcare, HR Service Delivery, Employee Service Management]
---

# Practice location form

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

<table id="table_l3d_s5j_jbc"><thead><tr><th>

Field

</th><th>

Description

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

Professional profile

</td><td>

Professional profile of the healthcare professional.

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

Practice name \(in Directory\)

</td><td>

Practice name of the healthcare professional.

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

Corporation name \(in W-9 form\)

</td><td>

Name of the corporation in \(W-9 format\) to verify name, address, and tax ID.

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

Primary tax ID type

</td><td>

Type of tax ID: Primary or Individual.

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

Individual tax ID

</td><td>

Individual Tax ID number against which taxes are collected from the healthcare professional.

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

Group tax ID

</td><td>

Group tax ID \(Employer Tax ID\) against which taxes are collected.

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

Credentialing reference

</td><td>

Option to add a professional reference.

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

Office schedule

</td><td>

Working schedules of the health care professional, for example, 24 X 7.

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

Accept new patients

</td><td>

Option to indicate that the healthcare professional can accept new patients.

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

Accept new medicaid patients

</td><td>

Option to indicate that the healthcare professional can accept new medicaid patients.

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

Accept new medicare patients

</td><td>

Option to indicate that the healthcare professional can accept new medicare patients.

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

Active

</td><td>

Option to indicate that the practice location record is available to use.

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

Is current location

</td><td>

Option to indicate that this is the current practice location of the health care professional.

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

Is billing electronic

</td><td>

Option to indicate that electronic billing is generated at the affiliated hospital for the services rendered by healthcare professional.

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

Send correspondence here

</td><td>

Option to indicate that any correspondence \(examples: letters\) to the healthcare professional can be sent to the affiliated hospital.

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

Status

</td><td>

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.

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

Address

</td><td>

Address of practice location.

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

City

</td><td>

City in which practice location is situated.

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

State/province

</td><td>

State in which practice location is situated.

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

Zip/postal code

</td><td>

Postal code of area in which the practice location is situated.

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

Country

</td><td>

Country in which the practice location is situated.

</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]()

[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]()