Verification Lookup Portal
Providers for Jefferson Health - Lehigh Region
Lehigh Valley Hospital
Lehigh Valley Hospital - Hazleton
Lehigh Valley Hospital - Pocono
Lehigh Valley Hospital - Schuylkill East Norwegian
Lehigh Valley Hospital - Schuylkill South Jackson
Pocono Ambulatory Surgical Center (PASC)
Provider Last Name
Last name is required.
Provider First Name
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Provider Birthdate
Birthdate is required.
Please provide a valid Date.
Required Information
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Requester Name
Name is required.
Requester Title
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Requester Organization
Organization is required.
Requester Address
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Requester City, State, Zip
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Requester Phone
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Requester Fax
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Requester Email
Email is required.
I agree and acknowledge that I possess a signed release and immunity statement signed by the clinician for which I am obtaining hospital verification information. Such signed release and immunity holds harmless and indemnifies LEHIGH VALLEY HEALTH NETWORK and individuals providing information pursuant to this request, its medical staff, board of directors and each of their respective members and designees, the administration of such LEHIGH VALLEY HEALTH NETWORK and its directors, officers, employees, representatives and agents, and each of them from any and all claims, demands or actions with respect to all acts, including without limitation, communications, reports, recommendations, or disclosures performed or made in connection with the request for the release of information pertaining to the clinician's hospital affiliation with LEHIGH VALLEY HEALTH NETWORK.
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Please Enter the Following Information:
Facility
Provider Last Name
Provider First Name
Provider Birthdate
Requester Name
Requester Title
Requester Organization
Requester Address
Requester City, State, Zip
Requester Phone
Requester Fax
Requester Email