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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.

F0200. Expedited Admission Does this individual meet any of the following categories for an expedited admission into the nursing facility?

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