Centralized Credentialing Library

This page provides a central repository of forms used by TDI customers, each accessible by clicking its respective form.

Application(s) for Appointment

Application Package - Texas Standardized Credentialing (PDF Format)

Application Package - Texas Standardized Credentialing (Web Enterable)

Application Package - Texas Standardized Credentialing (Web Enterable)

Other Professional Degrees (PDF Format) Attachment A

Other Professional Degrees (Web Enterable) Attachment A

Other Professional Degrees (Web Enterable) Attachment A

Other Post Graduate Education (PDF) Attachment B

Other Post Graduate Education (Web Enterable) Attachment B

Other Post Graduate Education (Web Enterable) Attachment B

Addendum to the TSCA form

Other Work History Attachment C (PDF Format)

Other Work History Attachment C (RTF Format)

Other Work History Attachment C (Word Format)

Other Current Hospital Affiliations Attachment D (PDF Format)

Other Current Hospital Affiliations Attachment D (RTF Format)

Other Current Hospital Affiliations Attachment D (Word Format)

Other Previous Hospital Affiliations Attachment E (PDF Format)

Other Previous Hospital Affiliations Attachment E (RTF Format)

Other Previous Hospital Affiliations Attachment E (Word Format)

Other Practice Locations Attachment F (PDF Format)

Other Practice Locations Attachment F (RTF Format)

Other Practice Locations Attachment F (Word Format)

Malpractice Claims History Attachment G (PDF Format)

Malpractice Claims History Attachment G (RTF Format)

Malpractice Claims History Attachment G (Word Format)

Credentialing Requirements Checklist
Health Care Facilities (PDF Format)

Credentialing Requirements Checklist
Health Care Facilities (Word Format)

HMO Credentialing File Review Checklist
Used to review HMO credentialing files

Source: Centralized Credentialing Services

Genesis Medical Foundation of Texas was established in 2009 as the philanthropic component of Genesis Physicians Group, the largest IPA in North Texas.

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Genesis Physicians Group and ProSperus have come together to offer practice management services that dramatically enhance the financial and clinical performance of member practices.

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