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Relocation Exemption Applications Posted For Review

Forms

  • CON Application
  • Affadavits
  • Reports
  • Other Applicable Forms

If requesting 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.

 

All documents must be received by Health Services and Development Agency during normal business hours (8am to 4:30pm Central Time).

 

CON Applicant Self Check List  (Optional)

Instructions for Completing Certificate of Need Application

Letter of Intent/Publication of Intent   (Revised May 2022)

Certificate of Need Application   (Updated)

Attachment-Bed Count

Attachment-Licensed County

Attachment-Medical Equipment

Attachment-Tennessee County Map

 

Letter of Intent/Publication of Intent-Relocation Exemption

Relocation Exemption Request

Affadavit for CON Application

Affadavit for Supplemental Responses

Affadavit for Lost Certificate of Need Certificate

Annual Progress Report

Final Project Report

Quality Measure Report

Link to Medical Equipment Forms

Speaker's Form

Intent to Alter Existing Bed Capacity  (For Hospital and Nursing Home)

Copy Request Form

Public Records Request Form

Special Hearings

  • Emergency CON
  • Public Hearings

Quick Links

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Who Are We?

  • Board Members
  • HSDA Executive Director
  • Agency Staff/Contact Information

Important Notice

Tennessee Health Services And Development Agency
Logan Grant

502 Deaderick Street, Andrew Jackson Bldg., 9th Floor
Nashville, TN 37243
(615) 741-2364
logan.grant@tn.gov
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