Get the free PH-3984 (REV 07/18) RDA-10139 RESIDENTIAL ... - TN.gov
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RESIDENTIAL HOSPICES
CHANGE OF OWNERSHIP PROCEDURES
1. Submit a notarized application along with the appropriate fee and a letter of intent 60 days prior to the anticipated Change of
Ownership (CHOW)
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PH-3984 rev 0718 RDA-10139 is a specific form used for reporting certain information to regulatory authorities.
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Entities or individuals as specified by the regulatory authorities may be required to file PH-3984 rev 0718 RDA-10139.
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