Get Pas/pasarr Level I Screening Document - Medi-cal - State Of California - Files Medi-cal Ca

The Pas/pasarr Level I Screening Document is a crucial step in ensuring that individuals receive the necessary assessments before admission to a nursing facility. This guide is designed to provide clear and user-friendly instructions for completing the form accurately and efficiently.

Follow the steps to fill out the Pas/pasarr Level I Screening Document online effectively.

1. Click ‘Get Form’ button to access the Pas/pasarr Level I Screening Document and open it in the editor.
2. Begin with Section I, Client Data. Fill in the beneficiary's last name, first name, and middle initial. Enter the 14-digit Medi-Cal ID number followed by the date of birth in the specified format.
3. Continue in Section I by entering the date of the last physical examination and the primary diagnosis for admission to the nursing facility.
4. Move to Section II to explain why community placement is not an option. Check all applicable conditions from the provided list.
5. In Section III, identifying criteria for mental illness, answer the yes or no questions regarding mental health diagnoses and difficulties experienced in the last three to six months.
6. For Section IV, identify any criteria for developmental disability. Answer the yes or no questions based on the patient's current condition.
7. Proceed to Section V to provide Level II referral data. Enter the referral date and the referral agency, if applicable.
8. Complete Section VI by entering your information as the person completing the form, including the facility name, telephone number, and date of completion.
9. In Section VII, provide details about the receiving facility including its name, address, and admission date.
10. Once all applicable sections are completed, ensure to save changes. You can then download, print, or share the form as needed.

Take action by completing and submitting your Pas/pasarr Level I Screening Document online today.