Form LHL234 Texas Standardized Credentialing Application - Texas

Texas Standardized Credentialing Application Instructions

The instructions for filling in an LHL234 are the following:

1. 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.

2. 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.

3. Section III contains provisions regarding standard authorization, attestation, and release. The applicant should sign the form; print their name and the date of completing.