PREADMISSION SCREENING (PAS)/ANNUAL RESIDENT REVIEW (ARR)(Mental Illness/Intellectual Developmental Disability/Related Conditions Identification) Michigan Department of Health and Human Services Level.
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How to fill out the MI DHHS DCH-3877 online
The MI DHHS DCH-3877 is an essential form used for preadmission screening and annual resident review regarding mental illness or intellectual developmental disabilities. This guide provides a clear, step-by-step approach to effectively complete the form online, ensuring proper documentation and compliance.
Follow the steps to complete the MI DHHS DCH-3877 online.
- Click the 'Get Form' button to obtain the form and open it in your preferred editing software.
- Fill out Section I with the patient, legal representative, and agency information. This includes the patient's name, date of birth, address, social security number, Medicaid and Medicare ID numbers, and details about any court-appointed guardian or legal representative.
- In Section II, complete all six items under Screening Criteria. Each item must be addressed, indicating whether the individual has a diagnosis of mental illness or dementia, has received treatment, or presents evidence of such conditions.
- For each item answered 'Yes' in Section II, provide a brief explanation to clarify the context of the response.
- Section III requires a clinician’s statement. Ensure the clinician certifies that the information provided is accurate by signing and dating the section. Include their name, degree or license, and contact information.
- Once all sections are complete, review the entire form for accuracy and completeness.
- You can now save changes, download, print, or share the completed form as needed.
Complete your MI DHHS DCH-3877 online today to ensure timely and accurate processing.
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