Get the free EXHIBIT 1220-1 PASRR SCREENING D LEVEL I A MEMBER - azdhs

EXHIBIT 12201 STATE OF ARIZONA INSTRUCTIONS (OVER) ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM PARR SCREENING DOCUMENT LEVEL I Am. MEMBER INFORMATION B. EXEMPTIONS (circle answer) 1) NAME: last, first

How to fill out exhibit 1220-1 pasrr screening

How to fill out exhibit 1220-1 pasrr screening:

1. Start by carefully reading the instructions provided on the form.
2. Begin by entering the necessary personal information of the individual undergoing the screening, such as their name, date of birth, and social security number.
3. Next, document any known diagnoses or medical conditions of the individual. This could include mental health disorders, intellectual disabilities, or developmental disabilities.
4. Provide information about any medications the individual is currently taking or has taken in the past. Include the dosages, frequency, and duration of use.
5. Indicate if the individual has a history of any psychiatric hospitalizations or involuntary commitments.
6. Document any substance abuse history, including current or past use of alcohol, drugs, or other controlled substances.
7. If the individual has received any specialized services or therapies, such as behavioral health or speech therapy, specify the type and duration of these services.
8. Provide information about any previous placements the individual has had, including nursing homes, hospitals, or residential treatment facilities.
9. Finally, sign and date the form, indicating that all the information provided is accurate and complete.

Who needs exhibit 1220-1 pasrr screening:

1. Individuals who are seeking admission or placement in a nursing home or skilled nursing facility usually require exhibit 1220-1 pasrr screening.
2. Individuals who may have a history of mental illness, intellectual disabilities, or developmental disabilities are typically subject to this screening.
3. Certain Medicaid beneficiaries, including those with disabilities, may also need to undergo exhibit 1220-1 pasrr screening in order to access services and supports.

Please note that the specific requirements for exhibit 1220-1 pasrr screening may vary depending on the jurisdiction and the purpose of the screening. It is always advisable to consult the relevant authorities or seek professional guidance to ensure accurate completion of the form.

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What is exhibit 1220-1 pasrr screening?

Exhibit 1220-1 pasrr screening is a form used for screening individuals for mental illness or intellectual disability prior to admission to certain facilities.

Who is required to file exhibit 1220-1 pasrr screening?

Healthcare providers and facilities are required to file exhibit 1220-1 pasrr screening for individuals seeking admission to designated facilities.

How to fill out exhibit 1220-1 pasrr screening?

Exhibit 1220-1 pasrr screening should be completed by a qualified healthcare professional following the instructions provided on the form.

What is the purpose of exhibit 1220-1 pasrr screening?

The purpose of exhibit 1220-1 pasrr screening is to identify individuals with mental illness or intellectual disability who may require specialized care and services.

What information must be reported on exhibit 1220-1 pasrr screening?

Exhibit 1220-1 pasrr screening requires information on the individual's medical history, mental health status, and any previous diagnoses or treatments.