Pasrr level 1 2026

1. Click ‘Get Form’ to open the PASRR Level 1 form in the editor.
2. Begin by filling out the Nursing Facility Provider Information section. Enter the provider number, MassHealth ID or SSN, name, address, city, ZIP code, and telephone number.
3. Next, complete the Nursing Facility Applicant Information section. Provide the applicant's name, address, city, ZIP code, date of birth, and gender.
4. Proceed to Section 1 regarding Mental Retardation or Developmental Disability. Answer each question by selecting 'yes' or 'no' based on the applicant's history.
5. If applicable, continue to Section 2 for Convalescent Care and answer accordingly.
6. In Section 3, check all statements that apply regarding Level I Determination for Mental Retardation or Developmental Disability.
7. Complete Sections 4 through 6 similarly for Mental Illness and Primary Diagnoses/Conditions as required.
8. Finally, ensure all signatures are obtained and dates are filled in before saving your completed form.

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