Form LHL234 Texas Standardized Credentialing Application - Texas
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What Is a Texas Standardized Credentialing Application?
Form LHL234, Texas Standardized Credentialing Application, is a form that should be completed by a physician, which applies to practice within a hospital in the state of Texas. This form is used by hospitals for verification of physician credentials. Credentialing is a process of assessing the background and legitimacy of medical professionals. No physician is allowed to practice within a hospital without clinical privileges.
This form was released by the Texas Department of Insurance and the latest version was issued on . A Texas Standardized Credentialing Application (PDF) is available for download below.
Texas Standardized Credentialing Application Instructions
The instructions for filling in an LHL234 are the following:
- Section I contains individual information of the applicant, including their name, mailing address, and phone number.
- The applicant has to provide information about their education, including professional degree, all licenses and certifications received. Professional/specialty information should be indicated as well.
- A chronological work history of the physician should be provided. If the applicant was unemployed for more than six months, the reasons for such a gap must be given.
- The hospitals where the physician has their admitting privileges should be indicated.
- Provide three peer references, which have the same specialty. It is not allowed to indicate a relative of the applicant in this section.
- Information about professional liability insurance coverage and call coverage should be entered.
- The medical professional has to answer questions regarding their practice location.
- Section II contains a list of disclosure questions. The applicant has to answer them "Yes" or "No". In case of answering "Yes" to any question except #16, the filer should explain such an answer on the space provided on page 10.
- Section III contains provisions regarding standard authorization, attestation, and release. The applicant should sign the form; print their name and the date of completing.
Download Form LHL234 Texas Standardized Credentialing Application - Texas