Get Tn Ph-3998 2019-2026

The TN PH-3998 is an essential renewal application for assisted care living facilities in Tennessee. This guide provides clear, step-by-step instructions on how to fill out the form online, ensuring a smooth and efficient process.

Follow the steps to successfully complete the TN PH-3998 online.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Enter the facility or agency name in the designated field, followed by the facility license number. Provide the complete location details, including street address, city, county, state, and zip code.
3. Fill in the contact information for the facility, including phone number, fax number, and a valid twenty-four-hour emergency phone number. Don’t forget to include an email address for communication.
4. Indicate the total number of licensed beds at the facility. Answer whether the facility provides a secured unit and, if applicable, specify the number of secured beds.
5. Indicate whether the facility offers Adult Day Care Services and provide the number of beds available if the answer is 'yes.' Similarly, specify if pet therapy is provided.
6. Complete the administrator’s name and certification number. If the mailing address differs from the facility's location, provide it in the respective fields.
7. Provide ownership details by checking the type of legal entity that applies and indicating if it is for-profit or non-profit. Fill in the name and contact information of the legal entity.
8. List the names and addresses of individual owners, partners, or directors associated with the legal entity, ensuring to include all necessary parties.
9. Address the accreditation status of the facility by checking the appropriate boxes and providing expiration dates if applicable.
10. Indicate if the facility is chain-affiliated, including the name and contact information of the parent company if applicable.
11. If a corporation, confirm whether there is a holding company and provide its details if applicable.
12. Answer whether any owners of the entity are also owners of other healthcare facilities and provide their details if applicable.
13. Indicate whether there is a contract with a management firm, specifying the dates and name of the firm if applicable.
14. Refer to the enclosed fee renewal invoice for applicable fees, noting that they are non-refundable.
15. Complete the verification section by signing the application, including your title or position and the date.
16. Once all fields are filled out, save your changes. You can then download, print, or share the completed form as needed.

Complete the TN PH-3998 online today to ensure your facility's licensing remains current.