Get Pa Pasrr Ma 376 2018-2025

Filling out the PA PASRR MA 376 form online is an important step for individuals seeking admission to a nursing facility. This guide provides clear and supportive instructions to help you navigate the process effectively.

Follow the steps to successfully complete the PA PASRR MA 376 online.

1. Press the ‘Get Form’ button to access the PA PASRR MA 376 form and open it in your preferred online editor.
2. Begin by filling out Section I – Demographics. Enter the applicant or resident's Social Security number using all nine digits, followed by the completion date of the form. Provide the full name of the applicant or resident in the format of Last, First.
3. In the communication section, indicate whether the applicant or resident requires assistance with communication, marking 'YES' or 'NO' as applicable.
4. Move to Section II – Neurocognitive Disorder (NCD)/Dementia. Respond to whether the individual has a diagnosis of Mild or Major NCD by selecting 'YES' or 'NO', and if applicable, specify the level of NCD.
5. Provide any corroborative testing or details available to confirm the NCD diagnosis, indicating all relevant tests or information.
6. In Section III – Mental Health (MH), answer whether the individual has a mental health condition or suspected condition by checking 'YES' or 'NO'. If 'YES', list relevant diagnoses.
7. Continue with Section III-B, documenting any recent treatments or history related to mental health services and indicating if a PASRR Level II evaluation is required based on responses.
8. Proceed to Section IV – Intellectual Disability/Developmental Disability (ID/DD). Indicate if there is current evidence of ID/DD and answer whether this condition occurred prior to age 18.
9. Complete Section V – Other Related Conditions (ORC) by confirming if there is a diagnosis of ORC and identifying any substantial functional limitations present prior to age 22.
10. In Section VI, answer whether the individual was informed about Home and Community Services and if they are interested in community living options.
11. Signify any exceptional admissions in Section VII if applicable, by selecting the relevant criteria.
12. Finally, review the outcome in Section VIII and ensure the signature of the individual or legal representative is obtained.
13. Complete Section IX by entering your printed name, date, and signature. Ensure the nursing facility’s stamp is affixed, if necessary.

Complete the PA PASRR MA 376 form online to ensure a smooth admission process.