FPA Network Provider Bio Submission Form Join your FPA Network colleagues on Fairview.org! Please complete this form to add or update your provider bio on Fairview.org. Please contact Lisa Rosemeyer with any questions or call 952-914-1843. Scroll down to get started. Thank you! Example: Provider Bio Page * 1. Provider information Provider Full Name Credentials (MD, PA, etc.) Medical Title (e.g., Oncologist) Specialty(s) (e.g., OBGYN) Board Certification (not board eligible) Provider Email Address Note: FPA Network does not share provider emails or post them on bios. Emails are a requirement for network communication. * 2. Practice/Clinic information Practice/Clinic Name Primary Clinic Location Address Address 2 City / Town ZIP/Postal Code Practice Website Phone Number * 3. Other locations where you see patients (city or address) * 4. Hospital Privileges (check all that apply) Bethesda Hospital Fairview Lakes Medical Center Fairview Northland Medical Center Fairview Range Hospital Fairview Ridges Hospital Fairview Southdale Hospital Grand Itasca Hospital HealthEast St. John's Hospital HealthEast St. Joseph's Hospital Maple Grove Hospital University of Minnesota Masonic Children's Hospital University of Minnesota Medical Center Woodwinds Health Campus Not applicable Other (please specify) * 5. Languages other than English (check all that apply) ASL Amharic Chinese French German Gujarati Hindi Hmong Marathi Oromo Punjabi Russian Slovene Somali Spanish Vietnamese Yoruba Other language(s) * 6. Site of Medical School * 7. Site of Residency * 8. Site of Fellowship (and area of specialty) * 9. Site of Masters (and degree earned) * 10. Site of Ph.D. (and degree earned) * 11. Other Education * 12. Philosophy of Care (one to two sentences on how the provider views his/her practice). * 13. Clinical/medical Interests (e.g., prenatal care, diabetes, sports injuries) * 14. Research Interests * 15. Honors (awarded in the past 5 years) * 16. Publications (published in the past 5 years) * 17. Other names you go by (maiden) or ways people incorrectly spell your name (for Web site keywords/search terms). Add a photo to your provider bio!Your photo must meet these requirements: Color photo with a simple gray backdrop, showing head and shoulders Photo resolution must be 300 DPI and (1650 X 2305 px) Business attire (avoid lab coat, scrubs, large jewelry, seasonal/holiday clothing) * 18. Upload your provider bio portrait for our website (see instructions) GIF, JPEG, JPG file types only. Choose File No file chosen Remove File Choose file for question 22 Upload your provider bio portrait for our website <em>(<a href="https://images.magnetmail.net/images/clients/FairviewPA/attach/FPA_Instructions_Business_Photos.pdf" rel="nofollow" target="_blank">see instructions</a>)</em> Replace file for question 22 Upload your provider bio portrait for our website <em>(<a href="https://images.magnetmail.net/images/clients/FairviewPA/attach/FPA_Instructions_Business_Photos.pdf" rel="nofollow" target="_blank">see instructions</a>)</em> Remove file for question 22 Upload your provider bio portrait for our website <em>(<a href="https://images.magnetmail.net/images/clients/FairviewPA/attach/FPA_Instructions_Business_Photos.pdf" rel="nofollow" target="_blank">see instructions</a>)</em> Don't have a photo that meets the requirements? No worries! FPA Network will reimburse FHN providers for the cost of portraits, up to $50 each, with receipt. If your practice is not part of FHN, we can help you update your portraits at your expense. See below for options. * 19. Please select one of these photo options and we will contact you to make arrangements: JCPenney portrait studio - $49.99 for one high-res digital image. (A limited number of pre-paid portrait certificates are available at no charge for FHN independent member providers.) Request a photographer - FPA will send a photographer to your location to photograph five or more providers, schedule permitting. (Fairview Health Network member independent practices will not be billed.) * 20. Please enter your contact information (if different from provider). Full name Title Email Phone Number * 21. Additional comments, questions or requests? Done
