HFC Forms

NOTE: All forms are in PDF format unless otherwise annotated. If you need a Word version of the following files, please email your request to hsda.staff@tn.gov .

Versions of the following forms dated prior to September 1, 2021 will not be accepted.

CON Applicant Self Check List (Optional)

Instructions for Completing Certificate of Need Application

Certificate of Need Application (Revised December 2022)

Attachment-Bed Count

Attachment-Licensed County

Attachment-Medical Equipment

Attachment-Tennessee County Map

Letter of Intent/Publication of Intent-Relocation Exemption (Revised)

Relocation Exemption Request (Updated)

Temporary Exemption from Voiding CON

Economic Distressed Counties-CON Exemption

All documents must be received by Health Facilities Commission during normal business hours (8am to 4:30pm Central Time).