If requesting a Word version of the following files, please email your request to firstname.lastname@example.org .
Versions of the following forms dated prior to September 1, 2021 will not be accepted.
All documents must be received by Health Facilities Commission 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 (Revised December 2022)
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
Intent to Alter Existing Bed Capacity (For Hospital and Nursing Home)
Licensure and Regulation Forms
Hospital Bed Capacity Changes (Revised 2022)
Dialysis Service Request Form (2023)
Ventilator Unit Request Form (2022)
Home Health Accreditation Reporting Forms
Home Health Accreditation of CON Exempt Economic Distressed Counties
Home Health Agencies Exempted Due To Serving Pediatrics
Home Health Agencies Exempted Due to Serviing EEOICPA
If you need a Word version of the above forms, please email the request to email@example.com .