• Increase Text Icon
  • Decrease Text Icon
  • Email Icon
  • Printer Icon
You are here: www.tdi.texas.gov . forms . form9iro

Independent Review Organization (IRO) Forms

Independent Review Organization (IRO) Forms
TDI Form Number Description File FormatLanguage
FIN582
CERTIFICATION OF INDEPENDENCE AND QUALIFICATIONS OF THE REVIEWER
PDFEnglish
FIN583
Holder of Bonds or Notes Over $100,000
PDFEnglish
FIN589
Addendum to Biographical Affidavit
PDFEnglish
FIN591
IRO Notice of Decision Template - HC
PDFEnglish
FIN592
IRO Notice of Decision Template - WC
PDFEnglish
LHL006
IRO Application
Application to apply for IRO Certification, renew an IRO Certification or update an IRO Certification
PDFEnglish
LHL009
Request for Review by an IRO
Form used by Patients/Injured Employees or persons acting on their behalf or health care providers to request a review by an Independent Review Organization (IRO) for disputes of medical necessity
PDFEnglish
LHL009
Request for Review by an IRO
[ En EspaƱol ] - Form used by Patients/Injured Employees or persons acting on their behalf or health care providers to request a review by an Independent Review Organization (IRO) for disputes of medical necessity
PDFSpanish
SN013
Contract List
PDFEnglish

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.


For more information contact:

Contact Information and Other Helpful Links

Translation by WorldLingo


Translation by WorldLingo


Translation by WorldLingo