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Z204 security clearance form

Dhs 1178 form-2025

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The document outlines the Preadmission Screening Resident Review (PASRR) process for individuals seeking admission to nursing facilities in Hawaii. It includes a Level I screening form that assesses whether an individual has serious mental illness (SMI) or developmental/intellectual disabilities (DD/ID). The form requires information about the patient's mental health status, medication history, and specific conditions that may exempt them from further evaluation. If any criteria are met, additional assessment is required; otherwise, the patient may be admitted.

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