Description | File Format |
---|---|
Workers' Compensation Complaint Form | HTML |
Employee Acknowledgment Form Samples | HTML |
Workers' Compensation Health Care Networks Forms
If the form is a fillable PDF, learn how to enable all fillable form features.
TDI form number | Description | Format | Language |
---|---|---|---|
LHL705 |
Workers’ Compensation Health Care Network Application |
English | |
LHL708 |
Workers' Compensation Network Access Plan Checklist WC Network Access Plan Checklist |
English | |
LHL720 |
Workers' Compensation Health Care Network Provider Contract Checklist |
English | |
LHL721 |
Workers’ Compensation Network Contract with Insurance Carrier Contract Requirements Checklist |
English | |
LHL722 |
Workers' Compensation Health Care Network Management Contract Checklist |
English | |
SN003 |
Workers Comp Network Sample Contingency Plan |
English | |
SN008 |
Workers Comp Network Sample QI Report |
English |
For more information, contact: MCQA@tdi.texas.gov