PA PASRR MA 376 2018-2026 free printable template

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PENNSYLVANIA READMISSION SCREENING RESIDENT REVIEW (PARR) IDENTIFICATION LEVEL I FORM (Revised 9/1/2018) This process applies to all nursing facility (NF) applicants, regardless of payer source. All

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How to fill out pa pasrr form

How to fill out PA PASRR MA 376

01

Obtain the PA PASRR MA 376 form from the appropriate state agency or download it from their website.

02

Complete the identification section with the individual's personal information, including name, address, date of birth, and Medicaid number.

03

Provide information about the individual's disability, including details of their diagnosis, assessment results, and functional limitations.

04

Fill out the section regarding the individual's current placement or living situation.

05

Include documentation and relevant medical records that support the information provided regarding the individual's mental and physical health.

06

Sign and date the form to attest that all information is accurate and complete.

07

Submit the form to the designated state agency or healthcare provider as instructed.

Who needs PA PASRR MA 376?

01

Individuals who are applying for or currently receiving Medicaid and are being considered for nursing facility placement.

02

Individuals with serious mental illness, intellectual disability, or related conditions that may require specialized care in a nursing facility.

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What is PA PASRR MA 376?

PA PASRR MA 376 is a form used in Pennsylvania for the Pre-Admission Screening and Resident Review (PASRR) process, which assesses individuals with mental illness or developmental disabilities before they are admitted to a nursing facility.

Who is required to file PA PASRR MA 376?

Providers who are seeking admission for individuals with mental health or developmental disabilities into nursing facilities are required to file PA PASRR MA 376.

How to fill out PA PASRR MA 376?

To fill out PA PASRR MA 376, providers need to provide comprehensive information about the individual’s medical history, mental health diagnosis, and relevant supporting documentation as guided by the state's instructions.

What is the purpose of PA PASRR MA 376?

The purpose of PA PASRR MA 376 is to ensure that individuals with mental health or developmental disabilities receive appropriate evaluations and services prior to their admission to a nursing facility.

What information must be reported on PA PASRR MA 376?

PA PASRR MA 376 must report personal identification details, assessment results, diagnosis, functional status, behavioral health history, and any specific needs or accommodations for the individual.

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