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FOR THE AGED/ACLF ADMINISTRATOR RENEWAL APPLICATION All applicable laws, rules, policies, and guidelines affecting your practice are available for viewing at www.state.tn.us/health. Please check this website periodically for updates. Full Name: Last First Middle Home Address: Street Address City Telephone Number: ( State Zip Code Email address: Certification Number ) Are you currently an administrator of (a) Home For The Aged (b) Assisted Care Living.

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