PASRR LEVEL I APPLICATION 2025

1. Click ‘Get Form’ to open the PASRR LEVEL I APPLICATION in the editor.
2. Begin by entering the applicant's name and sex. Ensure that all personal information, including date of birth and social security number, is accurately filled out.
3. In the section regarding the physician’s recommendation, confirm that a DMA-6 form has been certified by the physician. If not, do not proceed with the application.
4. Indicate the current location of the applicant by selecting from options such as 'Home', 'Acute hospital', or 'Residential Nursing Facility'.
5. Check all applicable boxes under 'Nursing Facility Services' to indicate any diagnoses or conditions relevant to the applicant's mental health status.
6. Complete any additional comments or notes in the provided space to clarify specific circumstances related to the applicant’s condition.
7. Finally, ensure that both the physician's signature and date are included before submitting your application for processing.

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