Form referral pasarr template 2026

1. Click ‘Get Form’ to open the form referral pasarr template in the editor.
2. Begin by filling out Section 1: Identifying Information. Enter the applicant's full name, Social Security number or date of birth, and Medicaid number if applicable. Also, provide the current location address including the name of the facility.
3. In Section 2, input the CMHC name and address. Ensure you include at least the city where the CMHC is located.
4. Proceed to Section 3: Purpose of Referral. Check either PAS or ARR based on your case and specify if it’s a routine or non-routine ARR.
5. In Section 4: Reason for Decision, enter the date when the referral was received and check all applicable reasons for deeming a Level II assessment inappropriate. Provide any additional information as necessary.
6. Finally, complete Section 5 by having a qualified mental health professional sign and date the form, including their title and contact number.

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