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Miller AM and Warren MD Tennessee Department of - TN

Miller AM and Warren MD Tennessee Department of - TN 2025

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The document outlines the compliance requirements for health care facilities in Tennessee regarding civil rights, specifically under Title VI of the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973. It includes a detailed survey form assessing various aspects such as admissions policies, non-discriminatory practices, staff characteristics, and patient demographics. The facility must demonstrate adherence to these regulations to maintain its license, with specific metrics for evaluating compliance.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the 'Name of Facility' and 'Provider #' in the designated fields. Ensure accuracy as this information is crucial for identification.
Fill in the 'License #' and 'Address' sections, including street, city, county, and zip code. This helps maintain proper records.
Complete the 'Administrator' field along with the Title VI/Section 504 Coordinator details. This ensures compliance with civil rights regulations.
Proceed to input data regarding licensed beds, average census, and patient demographics. This section is vital for assessing facility capacity.
Review each requirement under civil rights compliance carefully. Mark 'MET' or 'NOT MET' as applicable, providing explanatory statements where necessary.
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2017	4.8 Satisfied (115 Votes)

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