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Credentialing Forms Listing

Managed Care Quality Assurance Main Forms Listing

Help for Texas Standardized Credentialing Application

Credentialing Forms Listing
TDI Form Number Description File FormatLanguage
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

 

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