Get Pasrr Utah Level 1

The Pasrr Utah Level 1 form is an essential document for evaluating individuals seeking admission to nursing facilities under Medicaid. Completing this form accurately is crucial to ensure proper assessment and admission. This guide provides comprehensive and user-friendly instructions on how to fill out the Pasrr Utah Level 1 online.

Follow the steps to fill out the Pasrr Utah Level 1 form with ease.

1. Press the ‘Get Form’ button to access the Pasrr Utah Level 1 form and open it in the editor.
2. Begin filling out the applicant's personal information, including their name, date of birth, and social security number. Ensure this information is accurate and matches official documents.
3. Provide details of the nursing facility the applicant is seeking admission to, including the facility’s name and address.
4. Complete the Current Medical Diagnosis section, listing all relevant diagnoses, including their corresponding ICD-9 codes.
5. Fill out the Psychiatric Diagnosis section with any applicable conditions, ensuring to include ICD-9 codes as required.
6. Respond to the questions regarding serious mental illness. Mark 'Yes' or 'No' accordingly to indicate whether the applicant has a diagnosis or treatment history that requires further evaluation.
7. If applicable, indicate whether the applicant has a diagnosis of mental retardation or developmental disability. Provide necessary details and mark the appropriate options.
8. Complete the certification section by having a licensed health professional confirm that the provided information is true and correct.
9. Review all sections accurately to confirm that no information is missing or erroneous before submission.
10. Once the form is completely filled out, download a copy for your records, and submit it as directed on the form.

Start filling out the Pasrr Utah Level 1 form online today to facilitate timely admission processing.