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ATTACHMENT B Nebraska Level 1 Form - PASRR RFP 5165Z1

ATTACHMENT B Nebraska Level 1 Form - PASRR RFP 5165Z1 2025

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The document is a Nebraska Level 1 Form for the Preadmission Screening and Resident Review (PASRR) process, which collects personal and medical information about individuals seeking admission to nursing facilities. It includes sections on mental illness, substance abuse, symptoms, psychiatric treatment history, and categorical determinations for eligibility based on serious mental illness or intellectual disabilities. The form aims to assess the need for nursing facility care and ensure appropriate services are provided.

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