Get Joint Annual Report Form: Home Health - Tn

Filling out the Joint Annual Report Form for Home Health in Tennessee may seem daunting, but this guide is designed to help you navigate the process with ease. Follow the steps outlined below to ensure a complete and accurate submission of your report.

Follow the steps to complete the form accurately and efficiently.

1. Press the ‘Get Form’ button to access the Joint Annual Report Form: Home Health - Tn and open it in your preferred online editor.
2. Begin with Schedule A – Identification. Fill in your agency's state ID, legal name, and determine if the agency's name changed during the reporting period. If applicable, provide the prior name. Include the agency's contact information.
3. In Schedule B – Organization Structure, select the type of legal entity for your organization from the options provided. Ensure you correctly list the name and address of the owner or governing body.
4. Proceed to Schedule C – Licensure, Accreditations, Memberships, and Participations. Report your agency's licensing status, accreditation status, and memberships. Fill in relevant details such as license numbers and survey dates.
5. For Schedule D – Finances, enter the gross revenue from various sources during the reporting period. Carefully check through the categories provided to ensure accurate reporting of income.
6. In Schedule E – Utilization, list the number of discharges by reason and provide patient statistics including race and gender breakdowns. This section must reflect the total discharges accurately.
7. Next, complete Schedule F – Personnel by reporting the number of employees by service type as of the last day of the reporting period. Include full-time, part-time, and contractual personnel details.
8. Fill out Schedule G – Branch Offices if applicable, providing names and addresses of up to 12 branch offices your agency operates.
9. Finally, the administrator must declare the report's accuracy by signing off on the report with their declaration date.
10. Once all information is complete, remember to save your changes! You should be able to download, print, or share the form if needed.

We encourage you to complete the Joint Annual Report Form online today to ensure timely submission and compliance with state requirements.