HFC 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 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-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


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 hsda.staff@tn.gov .