14 300 2026

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The document outlines the requirements for the Level 1 Pre-Admission Screening and Resident Review (PASRR) process for individuals seeking admission to Medicaid-Certified nursing facilities. It emphasizes that no admissions can occur before completing the PASRR process, which assesses whether individuals have serious mental illness or intellectual disabilities. The nursing facility is responsible for ensuring accurate completion of the screening form, retaining it in resident records, and conducting further evaluations if significant changes in condition occur.

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Click ‘Get Form’ to open the 14 300 in the editor.
Begin by filling in the personal details such as NAME, ADSA ID, and DATE OF BIRTH. Ensure accuracy as this information is crucial for processing.
In Section I, indicate if there are any indicators of Serious Mental Illness (SMI) or Intellectual Disability (ID). Check 'YES' or 'NO' for each question and provide DSM codes if applicable.
Complete Section II regarding Exempted Hospital Discharge or Categorical Determination. Mark all relevant boxes based on the individual's situation.
In Section III, document the basis for any determinations made in previous sections. This includes signatures from authorized personnel.
Review all entries for completeness and accuracy before saving your work. Utilize our platform's features to easily edit any mistakes.

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Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (127 Votes)
2017	4.3 Satisfied (295 Votes)
2015	4.2 Satisfied (51 Votes)

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