Transcription of MARYLAND DEPARTMENT OF HEALTH PREADMISSION …
{{id}} {{{paragraph}}}
Example: marketing
MARYLAND DEPARTMENT OF HEALTH PREADMISSION …
MARYLAND DEPARTMENT OF HEALTHPREADMISSION SCREENING AND RESIDENT REVIEW (PASRR) LEVEL I ID SCREEN FOR MENTAL ILLNESS AND INTELLECTUAL DISABILITY OR RELATED CONDITIONS Note: This form must be completed for all applicants to nursing facilities (NF) which participate in the MARYLAND Medical Assistance Program regardless of applicant s payment source. Last Name_____ First Name_____ MI_____ Date of Birth_____ SSN_____ Sex M___ F___ Actual/Requested Nursing Facility Adm Date_____ Current Location of Individual_____ Address_____ City/State_____ ZIP_____ Contact Person_____ Title/Relationship_____ Tel#_____ HOSPITAL the individual admitted to a NF directly from a hospital after receivingacute inpatient care?Yes [ ] No [ ] the individual require NF services for the condition for which hereceived care in the hospital?Yes [ ] No [ ] the attending physician certified before admission to the NF thatThe resident is likely to require less than 30 days NF services?
more intensive than outpatient care more than once (e.g., partial hospitalization) or inpatient hospitalization; or experienced an episode of significant disruption to the normal living situation for which supportive services were required to maintain
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document: