Home medical equipment renewal application - the Tennessee - health tn 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Name of the Facility/Agency' and 'Facility License Number' in the designated fields. Ensure accuracy as this information is crucial for processing your application.
3. Fill in the 'Location of the Facility' section, including street address, city, county, state, zip code, and phone number. If applicable, provide a fax number and a 24-hour emergency phone number.
4. Complete the 'Ownership of Building' section with relevant details about ownership and contact information. Specify if your facility is accredited by a federally approved body and provide expiration dates if applicable.
5. In the 'Ownership of Business' section, check the appropriate legal entity type and indicate whether it is for-profit or non-profit. Provide names and addresses of individual owners or partners as needed.
6. Finally, review all entered information for accuracy before signing at the bottom of the form. Ensure that you date your signature to validate your application.

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