Get Pasrr Screening Document Level I - Mercy Maricopa Integrated Bb

Completing the PASRR Screening Document Level I is an essential step for evaluating individuals prior to their admission to Medicaid-certified nursing facilities. This guide provides a clear and supportive approach to help you accurately fill out the form online.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to access and open the PASRR Screening Document Level I - Mercy Maricopa Integrated Bb in your preferred online editor.
2. Begin by filling in the member information section (Section A). Provide the person's full name, date of birth, AHCCCS ID number (if applicable), their current address, and the name of the receiving facility.
3. In Section B, exempt individuals by circling the relevant answers to questions 6 through 10 based on the current medical condition. If any questions prompt a 'yes' response, proceed directly to Section E.
4. Complete Section C by answering questions 11 to 15 to identify potential mental retardation. Circle the answers that apply. If any responses indicate a 'yes,' move to Section E.
5. Proceed to Section D and address question 16 for potential mental illness identification. Similar to previous steps, circle applicable answers and transition to Section E if needed.
6. In Section E, indicate the necessary referral action by circling the appropriate option between questions 17 to 20.
7. Sign Section F either by the member or their representative to consent to the Level II evaluation, and ensure to check the acknowledgment box regarding the information accuracy.
8. Finally, complete Section G by having the medical professional sign and enter their name, title, telephone number, and the date of completion. Ensure all fields are correctly filled before submission.
9. Once the form is completed, you can save changes, download, print, or share it as needed for further processing.

Complete your PASRR Screening Document Level I online today to ensure timely processing.