Get the free PH-3203 (Rev. 01/17) RDA S836-1 STATE OF ... - TN.gov
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STATE OF TENNESSEE
DEPARTMENT OF HEALTH
DIVISION OF HEALTH LICENSURE AND REGULATION
OFFICE OF HEALTH CARE FACILITIES
665 MAINSTREAM DRIVE, SECOND FLOOR
NASHVILLE, TENNESSEE 37243
(615) 7417221
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How to fill out ph-3203 rev 0117 rda
01
To fill out the PH-3203 Rev 0117 RDA form, follow these steps:
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Review the form instructions to ensure you understand the purpose and requirements of the form.
03
Begin by entering the relevant information in Section A, including the full name and contact details of the person completing the form.
04
In Section B, provide the details of the individual or organization requesting the use of the RDA (Record Destruction Authorization). This includes their name, address, and contact information.
05
Proceed to Section C and specify the records for which the RDA is being sought. Include detailed information such as the type of records, date range, and any additional relevant details.
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If applicable, complete Section E by attaching any supporting documents or references that further justify the request.
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Sign and date the form in Section F to certify the accuracy of the information provided.
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What is ph-3203 rev 0117 rda?
ph-3203 rev 0117 rda is a form used for reporting certain information to the relevant authority.
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The purpose of ph-3203 rev 0117 rda is to gather necessary information for regulatory or compliance purposes.
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ph-3203 rev 0117 rda requires specific information as specified by the authority, which may include financial data, operational details, or compliance information.
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