Do I need new hoses and clamps to install this?

Your existing hoses may reuse depending on their condition. Inspect them during install—if they're cracked or brittle, grab new ones. Clamps typically reuse fine unless damaged.

Will this bolt straight into my truck without drilling?

Yes. This radiator mounts at factory points with no modification needed. Line everything up and bolt it down.

Should I flush the cooling system before installing this?

Smart move. Old coolant can contain sediment that clogs a new core. Flush the system, then fill with fresh coolant rated for your vehicle.