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West Virginia Department of Health and Human ResourcesPREADMISSION SCREENING PAS Level 0 Facility/Agency/Person making referral Recontact Person First Recontact Person Last Headdress:City:State:FIFA
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It is a blank PAS form.
All individuals who are subject to PAS reporting requirements.
The form should be completed with accurate information as required by the PAS reporting guidelines.
The purpose is to report relevant information for PAS compliance.
Details as per the PAS reporting requirements.
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