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State of Florida Agency for Health Care Administration Pre-Admission Screening and Resident Review PASRR Level I Screening for Serious Mental Illness SMI / Intellectual Disability or Related Conditions ID Use for Medicaid Certified Nursing Facility NF Only Present Location of Individual Being Evaluated NF Hospital Home -- SSN DOB mm/dd/yyyy Male Name of Individual Being Evaluated print Age Female Street Address City Assisted Living Facility State Zip Group Home Other Individual s or Residency Phone Number // Legal Representative s Name if applicable Representative s Phone Number // Screening Date mm/dd/yyyy Medicaid Number if Applicable Other Health Insurance Name and Number if Applicable WHY ARE WE ASKING FOR YOUR SOCIAL SECUITY NUMBER Federal law permits the State to use your social security number for screening and referral to programs or services that may be appropriate for you 42 CFR 435. 910. You do not have to fill in your Social Security number but if you do it will remain conf....

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Related content

Preadmission Screening and Resident Review |...
PASRR requires that Medicaid-certified nursing facilities: Evaluate all applicants for...
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PASRR should always be completed prior to admission. Appropriately credentialed nursing facility staff are able to complete the screening anywhere, including at a hospice home, an assisted living facility, or even a hospital setting.

Preadmission Screening and Resident Review (PASRR) is a federal requirement to help ensure that individuals are not inappropriately placed in nursing homes for long term care.

Welcome to the FL PASRR Website. Kepro's PASRR program provides protections that align with federal and state laws under the Americans with Disabilities Act (ADA) to ensure that anyone with a serious mental illness, intellectual disability or a related condition is served in the least restrictive setting.

PASRR Level II referrals are made by Georgia Medical Care Foundation/Alliant (GMCF) to The Georgia Collaborative ASO if there is evidence of a mental illness, an intellectual/developmental disability, or a related condition during the Level I process. This referral initiates the Level II process.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232