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  1. Click ‘Get Form’ to open the pasrr2 document in the editor.
  2. Begin by entering the patient's last name, first name, middle initial, sex, and Medicaid number in the designated fields.
  3. Provide the present address of the patient. Ensure all information is accurate for proper identification.
  4. In section II, authorize the release of medical information by printing your name and signing as either the patient or legal guardian. Include the date and mailing address of the legal guardian.
  5. For section III, select the appropriate diagnosis from the options provided and indicate any other relevant conditions.
  6. Complete section IV by assessing physical examination details. Check each item under normal or abnormal categories based on evaluations.
  7. In section V, evaluate functional assessment by determining if assistance is needed and whether training may benefit the individual.
  8. Fill out sections VI and VII regarding behaviors and psychosocial evaluation, ensuring to specify frequencies where applicable.

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The PASRR Level I Screening is a preliminary assessment completed for all individuals prior to admission to a Medicaid-certified Nursing Facility in order to determine whether an individual might have a mental illness or intellectual disability.
Level 2 care includes Intensive Outpatient (IOP), followed closely by Partial Hospitalization Program (PHP). Usually PHP and IOP programs are both provided at the same location. This may be separate or attached to another level of care.
Level 2: Moderate Level of Care The types of aging adults in these assisted living levels of care can typically function independently in some aspects but may need help with certain ADLs. For example, your loved one may be able to feed themselves without an issue but need help getting on or off the toilet.
A Level 2 Evaluation is a person-centered evaluation that is completed for anyone identified by the Level 1 Screening as having, or suspected of having, a PASRR condition, i.e., serious mental illness (SMI), intellectual disability (ID), developmental disability (DD), or related condition (RC).
In brief, the PASRR process requires that all applicants to Medicaid-certified nursing facilities be given a preliminary assessment to determine whether they might have SMI or ID. This is called a Level I screen. Those individuals who test positive at Level I are then evaluated in depth, called Level II PASRR.
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The patient is then categorized based on the Emergency Severity Index: Level 1 Immediate: life-threatening. Level 2 Emergency: could be life-threatening. Level 3 Urgent: not life-threatening. Level 4 Semi-urgent: not life-threatening.

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