TDI Forms Menu

• Agent / Adjuster
• Business
• Consumer
• Financial Regulation
• Forms
• Fraud
• Health Provider
• Industry
• Information Center
• Licensing
• Title
• Types of Insurance
• Windstorm Inspections

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 Format	Language
LHL234	Application Package	PDF	English
LHL234	Application Package - Web Enterable	RTF	English
LHL234	Application Package - Web Enterable	WORD	English
LHL234a	Other Professional Degrees A	PDF	English
LHL234a	Other Professional Degrees - Web Enterable A	WORD	English
LHL234a	Other Professional Degrees - Web Enterable A	RTF	English
LHL234b	Other Post-Graduate Education B	PDF	English
LHL234b	Other Post-Graduate Education - Web Enterable B	RTF	English
LHL234b	Other Post-Graduate Education - Web Enterable B	WORD	English
LHL234c	Other Work History C	PDF	English
LHL234c	Other Work History - Web Enterable C	RTF	English
LHL234c	Other Work History - Web Enterable C	WORD	English
LHL234d	Other Current Hospital Affiliations D	PDF	English
LHL234d	Other Current Hospital Affiliations - Web Enterable D	WORD	English
LHL234d	Other Current Hospital Affiliations - Web Enterable D	RTF	English
LHL234e	Other Previous Hospital Affiliations E	PDF	English
LHL234e	Other Previous Hospital Affiliations - Web Enterable E	RTF	English
LHL234e	Other Previous Hospital Affiliations - Web Enterable E	WORD	English
LHL234f	Other Practice Locations F	PDF	English
LHL234f	Other Practice Locations - Web Enterable F	RTF	English
LHL234f	Other Practice Locations - Web Enterable F	WORD	English
LHL234g	Malpractice Claims History G	PDF	English
LHL234g	Malpractice Claims History - Web Enterable G	WORD	English
LHL234g	Malpractice Claims History - Web Enterable G	RTF	English
LHL396	Credentialing Requirements Checklist Individual Health Care Providers	WORD	English
LHL396	Credentialing Requirements Checklist Individual Health Care Providers	PDF	English
LHL397	Credentialing Requirements Checklist Health Care Facilities	WORD	English
LHL397	Credentialing Requirements Checklist Health Care Facilities	PDF	English