You won't be sent a credential showing your new name until your next renewal has been processed. Please mail, email, or fax a copy of your certified marriage certificate, divorce decree or court order showing your name change to the Customer Service Office. For medical cannabis consultants ONLYĬontact/Address Change To change my name on my credential ONLY You may use these instructions to update your contact information online. If you have questions regarding EMS certification, please call Customer Service at 36 For allopathic physicians and physician assistants ONLYĬontact Information Change For ARNPs, RNs, LPNs, and nursing technicians ONLY Step 2: Provide the information to this office This form MUST be printed out to complete and to obtain the necessary signatures. Step 1: Complete the Personal Status Change Application (PDF) Please print out the form, complete the application and obtain the required signatures. Note: Application forms provided can no longer be filled out on the computer and printed. Changes can be made on the paper application or through the Online Renewal process. The Personal Status Change Application provides the process for updating an EMS certification record when a person's name, address or agency changes. Mail – to the address at the bottom of the formįor allopathic physicians and physician assistants ONLY: Contact Information Change Form For EMS providers ONLY.Email – select the 'Email' button on the contact information change form, it'll be sent automatically.

If your contact information isn't current in our system, please complete and submit the contact information change form.Ĭontact our staff members if you have any questions.Īfter completing the form submit it to the Department of Health by: Postal Service doesn't forward Department of Health mail so it's your responsibility to inform the Customer Service Office of an address change. This is especially important because we mail your courtesy renewal notice and updated credential to the address on file. We must have your current mailing address in our system.

Change license address