Get Tn Ph-4001 2016-2026

The TN PH-4001 is a vital form for nursing home renewal applications in Tennessee. This guide will provide clear instructions for users on how to effectively complete the form online, ensuring all necessary details are accurately captured.

Follow the steps to successfully complete the TN PH-4001 online.

1. Click 'Get Form' button to obtain the TN PH-4001 and open it in your editor.
2. Fill out the name of the facility or agency in the designated field. Ensure the facility license number is entered accurately to avoid any delays in processing.
3. Provide the location information of the facility, including street address, city, county, state, zip code, and phone number. Include the fax number and twenty-four hour emergency phone number if applicable.
4. Indicate the total number of licensed beds and whether the facility has a secured unit or an Alzheimer’s unit by checking the appropriate response. If applicable, provide the number of secured beds and Alzheimer beds.
5. Respond to whether the facility has a ventilator unit, as well as the number of ventilator beds available. Indicate if adult day care services or outpatient therapy services are provided.
6. Enter the administrator's name and license number. If the mailing address differs from the facility location, complete the section with the necessary details.
7. Fill in the ownership information of the building and the business. Specify the legal entity type, selecting from options including individual, partnership, corporation, or other. Also, indicate if the business is for profit or non-profit.
8. List the names and addresses of individual owners, partners, or directors if necessary. If you need more space, use a separate sheet to provide additional information.
9. Answer questions about accreditation status and chain affiliation, providing expiration dates as needed.
10. Complete the fees section by reviewing the attached fee renewal invoice, remembering that fees are non-refundable.
11. Finally, sign the verification section of the application, confirming your responsible character and compliance with Tennessee regulations. Include your title or position and the date of signing.
12. After completing the TN PH-4001, you can save your changes, download, print, or share the form as needed.

Start completing your TN PH-4001 online today to ensure smooth processing of your nursing home renewal application.