1. UPA Provider Onboarding Form
   
   

   The MedAptus and Infinity paper forms used when onboarding providers have been replaced by one single online form. This form has been intuitively designed to collect the information needed based on the type of Provider and Department they will be working in.

2. Provider Change Request Form
   
   

   A Provider Change request form has been created to capture the information needed when a Provider leaves a Department or a change occurs in their employment status (e.g. change to Volunteer status).

Once you submit a form your information will be reviewed by UPA Provider Enrollment and circulated to all UPA Departments, Change Healthcare, NJMS Clinical Affairs, and NJMS Managed Care. The person submitting the form will also be included in the email circulation so that any clarifying questions can be answered once and seen by everyone.

Note: You must be logged in to your Rutgers Connect account to access and submit these forms.