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Texas Department of Insurance
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Credentialing Forms Listing

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TDI Form Number Description File Format Language
LHL234 Application Package - Web Enterable
WORD English
LHL234 Application Package
PDF English
LHL234a Other Professional Degrees - Web Enterable
A
WORD English
LHL234a Other Professional Degrees
A
PDF English
LHL234a Other Professional Degrees - Web Enterable
A
RTF English
LHL234 Application Package - Web Enterable
RTF English
LHL234b Other Post-Graduate Education - Web Enterable
B
PDF English
LHL234b Other Post-Graduate Education
B
PDF English
LHL234b Other Post-Graduate Education - Web Enterable
B
RTF English
LHL234c Other Work History - Web Enterable
C
WORD English
LHL234c Other Work History
C
PDF English
LHL234c Other Work History - Web Enterable
C
RTF English
LHL234d Other Current Hospital Affiliations - Web Enterable
D
WORD English
LHL234d Other Current Hospital Affiliations
D
PDF English
LHL234d Other Current Hospital Affiliations - Web Enterable
D
RTF English
LHL234e Other Previous Hospital Affiliations - Web Enterable
E
WORD English
LHL234e Other Previous Hospital Affiliations
E
PDF English
LHL234e Other Previous Hospital Affiliations - Web Enterable
E
RTF English
LHL234f Other Practice Locations - Web Enterable
F
WORD English
LHL234f Other Practice Locations
F
PDF English
LHL234f Other Practice Locations - Web Enterable
F
RTF English
LHL234g Malpractice Claims History - Web Enterable
G
WORD English
LHL234g Malpractice Claims History
G
PDF English
LHL234g Malpractice Claims History - Web Enterable
G
RTF English

For more information, contact: MCQA@tdi.texas.gov