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Credentialing Forms Listing

This is one of several pages linking to a central repository of forms used by TDI customers. Use the search or Forms by Type links on the Forms Home Page or scan through our form listings.

Managed Care Quality Assurance Main Forms Listing

Help for Texas Standardized Credentialing Application

 

Texas Standardized Credentialing Application
TDI Form Number Description File FormatLanguage
LHL234 Application Package
PDFEnglish
LHL234 Application Package - Web Enterable
RTFEnglish
LHL234 Application Package - Web Enterable
WORDEnglish
LHL234a Other Professional Degrees
A
PDFEnglish
LHL234a Other Professional Degrees - Web Enterable
A
WORDEnglish
LHL234a Other Professional Degrees - Web Enterable
A
RTFEnglish
LHL234b Other Post-Graduate Education
B
PDFEnglish
LHL234b Other Post-Graduate Education - Web Enterable
B
RTFEnglish
LHL234b Other Post-Graduate Education - Web Enterable
B
WORDEnglish
LHL234c Other Work History
C
PDFEnglish
LHL234c Other Work History - Web Enterable
C
WORDEnglish
LHL234c Other Work History - Web Enterable
C
RTFEnglish
LHL234d Other Current Hospital Affiliations
D
PDFEnglish
LHL234d Other Current Hospital Affiliations - Web Enterable
D
RTFEnglish
LHL234d Other Current Hospital Affiliations - Web Enterable
D
WORDEnglish
LHL234e Other Previous Hospital Affiliations
E
PDFEnglish
LHL234e Other Previous Hospital Affiliations - Web Enterable
E
RTFEnglish
LHL234e Other Previous Hospital Affiliations - Web Enterable
E
WORDEnglish
LHL234f Other Practice Locations
F
PDFEnglish
LHL234f Other Practice Locations - Web Enterable
F
RTFEnglish
LHL234f Other Practice Locations - Web Enterable
F
WORDEnglish
LHL234g Malpractice Claims History
G
PDFEnglish
LHL234g Malpractice Claims History - Web Enterable
G
RTFEnglish
LHL234g Malpractice Claims History - Web Enterable
G
WORDEnglish

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