Create your profile

The Emory Hospitals bylaws (quoted below) require that all medical staff members maintain up-to-date contact information. The contact information required to be entered below will be used to update your contact information but does not relieve you of the responsibility to notify the medical staff office within ten days of any changes. This contact information will be available to operators and will facilitate prompt notification for patient care emergency. Hospital Bylaws require that physicians provide an email address. As email is now a major means of communication for our hospital, we are requesting that you provide a personal email address that you regularly use. Note: You also need to provide a unique identifier below. This can be either your NPI number (preferred) or the last four digits of your SSN.

"Notify the Emory Healthcare Office of System Credentialing within 10 calendar days of a change in contact information and provide in writing the updated information, which shall include an electronic mail address, office telephone number, regular mail address, and a cell or pager number. The Medical Staff Member shall designate a number through which (s)he or a covering Medical Staff Member can be contacted 24 hours per day, seven days per week. There is a presumption that a Medical Staff Member has received all notices and information directed to the contact information on file. A failure to receive information due to a failure to comply with this section shall not relieve the Medical Staff Member from any consequences of not responding to said notices"

To access this Patient Safety Module, you first need to create a profile. The key to your profile is the username, which can be anything you choose. If you have a username such as an Emory network login, or from another website or application that you already use, feel free to use that as your username here. The email address you provide here will be used to help you recover your username or PIN if you do not remember them in the future. Please make sure that the email address entered is a working email account.

* indicates a required input

Username *   Click here for help  
PIN Number *   (PIN Number must be 4 Digits in length)  
Personal Email Address *   
Re-enter your Personal Email Address *   
First Name *   
Middle Initial   
Last Name *   
Maiden Name   
Gender *   
Birthday *   (mm/dd/yyyy)  
Title *   
 NPI (10 digit number) *   Lookup or create your NPI here
  
Georgia License Number
Primary Hospital Affiliation *   
Secondary Affiliations

Check all that apply. If you have no secondary affiliations, check None		 *
 
Relationship to Emory Healthcare *   
Office Phone #: *
Cell Phone # *
PIC, pager, Answering Service # *
Home Phone # *
Which phone number do you want the Emory Healthcare operators to use when they need to contact you during weekdays? *
Which phone number do you want the Emory Healthcare operators to use when they need to contact you in the evening, at night, or on weekends? *

Please note, The home number and cell phone number that you provide here will NOT be given out by the Emory Healthcare operators