Get Indiana Passr Agents Email Form

Filling out the Indiana Passr Agents Email Form is an essential step for those looking to assess mental health needs under the PASRR program. This guide will provide you with clear and straightforward instructions to help you complete the form accurately online.

Follow the steps to complete the Indiana Passr Agents Email Form online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the Social Security number field. While providing this number is optional under IC 4-1-8, it can assist in processing the form more efficiently.
3. Next, enter the name of the individual the form pertains to, ensuring that the correct spelling is used.
4. Provide the date of birth for the individual. This information helps to identify and verify the records of the person.
5. Respond to each question in the screening section regarding symptoms of depression. Mark 'Yes' or 'No' based on the individual’s experiences.
6. If any symptoms of depression have been present, indicate the duration by selecting from 30 days, 60 days, 90 days, or more than 90 days.
7. In the determination section, indicate whether a PASRR/MI Level II assessment is needed by selecting 'Yes' or 'No'.
8. Complete the additional comments or summary section if necessary to provide any pertinent extra information about the individual's condition.
9. Finally, ensure that the evaluator's name is printed, the relationship to the applicant is specified, and a contact telephone number is provided.
10. Once all fields are filled out, save changes. You can then download or print the form for your records or share it as required.

Start completing the Indiana Passr Agents Email Form online now.