Get Tn Ph-2714 2017-2026

The TN PH-2714 is a critical form used by health care facilities in Tennessee to document compliance with civil rights regulations. This guide provides clear and concise instructions on how to fill out this form online, ensuring all required information is accurately captured.

Follow the steps to complete the TN PH-2714 form online.

1. Press the ‘Get Form’ button to obtain the TN PH-2714 form and open it in your chosen digital editor.
2. Fill in the name of the facility, provider number, and license number in the designated fields. Ensure all details are accurate for proper identification.
3. Provide the complete address of the facility, including street, city, county, and zip code. Double-check for any typos to avoid processing delays.
4. Enter the contact telephone number for the facility, ensuring you include the area code.
5. Complete the section for the administrator's details, filling in their full name and title.
6. Indicate the number of licensed beds and provide data on the average census and today’s census for accurate reporting.
7. Input the figures for Medicare, Medicaid, dually certified beds, and the number of patients discharged in the past year in their respective fields.
8. Document the number of board members, patients, and minorities in the facility as required.
9. Address the staff characteristics by entering data regarding employment status, race, and positions held by staff members.
10. Carefully review the compliance requirements section, marking 'MET' or 'NOT MET' for each requirement as applicable. Provide any explanatory statements where necessary.
11. Once all fields are completed, save your changes. You can then download, print, or share the form, ensuring you retain a copy for your records.

Start completing your TN PH-2714 form online today for seamless compliance documentation.