Get G4020115/draft-screening Program. Notification Form - Tennessee

The G4020115/draft-screening Program. Notification Form is essential for health fairs and screening programs in Tennessee. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the G4020115/draft-screening Program. Notification Form.

1. Press the ‘Get Form’ button to retrieve the G4020115/draft-screening Program. Notification Form and access it in the editing tool.
2. Indicate the health fair or health screening sponsor by selecting one of the options: non-profit organization or for-profit hospital. Enter the name of the organization, its address, and contact information, including a telephone number and the contact person's name responsible for the program.
3. Provide the screening program location, including the specific address where the program will take place.
4. Enter the date of the screening program to ensure it is accurately documented.
5. List all tests performed during the screening. Include the name of each test and the methodology used. Note that results should be available immediately at the site for most tests.
6. Identify the supervising physician by providing their name, address, and telephone number. You must also include the physician’s Tennessee medical license number and its expiration date. Attach a copy of the physician’s current medical license as required.
7. Review the affirmation statement confirming that you are the supervising physician. This section emphasizes your responsibility for quality assurance of the testing, results review, and compliance with relevant guidelines.
8. Once all required fields are filled out accurately, you can save changes to the form, download a copy for your records, print it for submission, or share it as necessary.

Complete your documentation online today to ensure proper compliance with Tennessee's health regulations.