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DLN Individual PASRR Level 1 Screening Section A Submitter Information (NF/LA only) A0100

DLN Individual PASRR Level 1 Screening Section A Submitter Information (NF/LA only) A0100 2026

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The document is a PASRR Level 1 Screening form from May 2013, designed to collect personal and medical information about individuals being assessed for potential placement in nursing facilities. It includes sections for personal details, previous residence, mental health indicators, and preferences for living arrangements. The form aims to determine the individual's needs and eligibility for services related to mental illness or intellectual disabilities.

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How to use or fill out DLN Individual PASRR Level 1 Screening Section A Submitter Information (NF/LA only) A0100

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Click ‘Get Form’ to open it in the editor.
Begin with Section A, where you will enter the submitter's information. Fill in your name, title, and contract number as required.
Complete the address fields including street address, city, state, and ZIP code. Ensure accuracy for proper communication.
Provide details about the referring entity by filling out their name, address, and phone number in the Referring Entity Information section.
In the Personal Information section for the individual being screened, input their first name, last name, social security number, and other relevant personal details.
Review all entries for completeness and accuracy before proceeding to sign and certify the information provided.

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What is a pssar?

PERSONNEL SECURITY SYSTEM ACCESS REQUEST (PSSAR)

What is the meaning of Pasrr Level 1?

The PASRR Level I Screening is a preliminary assessment completed for all individuals prior to admission to a Medicaid-certified Nursing Facility in order to determine whether an individual might have a mental illness or intellectual disability.

What is the meaning of the Pasrr letter?

The Pre-Admission Screening and Resident Review (PASRR) is a federally required screening of any individual who applies to or resides in a Medicaid-certified nursing facility, regardless of the source of payment.

What is a PASRR screening?

Preadmission Screening and Resident Review (PASRR) is a federal requirement to help ensure that individuals are not inappropriately placed in nursing homes for long term care.