Transcription of Section A - TMHP
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Section A - TMHP
PASRR Level 1 screening , September, 2017, 1 of 12 DLNI ndividualA0800. Position/TitleA0400. Provider StatePASRR Level 1 ScreeningA0600. Date of AssessmentA0700A. First NameA0700B. Middle InitialA0200B. CityA0200D. ZIP CodeA0500. Vendor NPI/APIA0510. CountyA0700C. Last NameA0700D. SuffixA0900B. Other Type of EntityA0900A. Type of EntitySection A1. Acute Care 2. Psychiatric Hospital 3. ICF/IID 4. Family Home 5. Nursing Facility 6. Physician (MD/DO) 7. OtherA0900C. Physician First NameA0900D. Physician Middle InitialA0900E. Physician Last NameA0900F. Physician Suffix A0100. NameSubmitter Information (NF/LA only)A0200A.
PASRR Level 1 Screening, September, 2017, V.2. Page 1 of 12 DLN Individual A0800. Position/Title A0400. Provider No. A0200C. State. PASRR Level 1 Screening
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