Follow the steps to successfully complete the OH PASRR Evaluation Summary.

1. Press the ‘Get Form’ button to access the OH PASRR Evaluation Summary and open it in the online editor.
2. Begin by entering the individual's last name, first name, and middle name or initial in the appropriate fields.
3. Provide the date of birth using the format MM/DD/YYYY and select the gender from the options given (M or F).
4. Fill in the County Board Completing Assessment and the individual’s Social Security Number.
5. Include the guardian’s name, street address, telephone number (with area code), city, state, and zip code.
6. Document the Nursing Facility County, admission date, and the nursing facility's street address, name, city, state, and zip code.
7. Indicate the county of residence prior to hospital or nursing facility placement, and select the current living arrangement from the provided options.
8. Answer the question regarding the individual's qualifying condition by selecting 'Yes' or 'No'. If the answer is 'No', complete the section below and submit the form.
9. If the answer is 'Yes', proceed with the local evaluation and submit all necessary supporting documentation as listed.
10. Fill out the local evaluator’s details, including their title, signature, date, email address, and phone number.
11. Finally, ensure that all information is accurate, then save your changes, download the completed form, print it if needed, or share it with the relevant parties as required.

Get started with completing the OH PASRR Evaluation Summary online today!