HI AMHD/PASRR Form 1 2012-2026 free printable template

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State of Hawaii Department of Health Behavioral Health Administration Adult Mental Health Division Pre-Admission Screening / Resident Review DETERMINATION OF NEED FOR SPECIALIZED PSYCHIATRIC TREATMENT

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How to fill out HI AMHDPASRR Form 1

How to fill out HI AMHD/PASRR Form 1

01

Obtain the HI AMHD/PASRR Form 1 from the relevant agency or website.

02

Fill in the individual's personal information, including name, date of birth, and Medicaid number.

03

Provide information about the individual's diagnosis and any relevant medical history.

04

Indicate the type of service the individual is seeking.

05

Include information about the individual's current living situation and support systems.

06

Specify any prior hospitalizations or treatments related to mental health.

07

Review the completed form for accuracy and completeness.

08

Submit the form to the appropriate authority for processing.

Who needs HI AMHD/PASRR Form 1?

01

Individuals seeking admission to a nursing facility or who are eligible for Medicaid and have a mental illness.

02

Healthcare providers involved in the assessment and treatment of individuals with mental health conditions.

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What is HI AMHD/PASRR Form 1?

HI AMHD/PASRR Form 1 is a form used to assess individuals for potential mental illness or intellectual disability prior to admission to a nursing facility. It aids in determining if specialized services are needed.

Who is required to file HI AMHD/PASRR Form 1?

Healthcare providers, including nursing facilities, are required to file HI AMHD/PASRR Form 1 for individuals who are being considered for admission to a nursing facility.

How to fill out HI AMHD/PASRR Form 1?

To fill out HI AMHD/PASRR Form 1, one must provide detailed information about the individual’s medical history, psychiatric history, current medications, and any existing behavioral issues.

What is the purpose of HI AMHD/PASRR Form 1?

The purpose of HI AMHD/PASRR Form 1 is to ensure that individuals with mental illness or intellectual disabilities receive appropriate evaluations and services before entering a nursing facility.

What information must be reported on HI AMHD/PASRR Form 1?

The form requires reporting information such as personal identification details, medical and psychiatric history, current treatment and medications, and assessment of the individual's needs.

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