Get Preadmission Screening (pas) / Annual Resident Review

Completing the PREADMISSION SCREENING (PAS) / ANNUAL RESIDENT REVIEW (ARR) form is essential for assessing the needs of individuals seeking admission to a nursing facility. This guide provides step-by-step instructions to assist users in filling out the form accurately and efficiently online.

Follow the steps to complete the PREADMISSION SCREENING (PAS) / ANNUAL RESIDENT REVIEW form online.

1. Press the ‘Get Form’ button to access the form and open it within your online environment.
2. In Section I, begin by entering the patient's full name (first, middle initial, last) and date of birth (month, day, year). Specify the gender and address details, including the street number, county, and residential ZIP code. Provide the patient's Social Security Number, MEDICAID Beneficiary ID Number, and MEDICARE ID Number.
3. Indicate whether the patient has a court-appointed guardian or other legal representative by selecting 'YES' or 'NO'. If 'YES', include the name of the guardian, the county where they were appointed, their address, and telephone number.
4. Fill in the referring agency name and their telephone number. Specify the nursing facility's name (either proposed or actual), county name, and its complete address along with the admission date (either actual or proposed).
5. Proceed to Section II, ensuring that a registered nurse, certified or registered social worker, psychologist, physician’s assistant, or physician completes it. Answer all six screening criteria with 'YES' or 'NO', circling 'mental illness' or 'dementia' as applicable based on your responses to questions 1 and 2.
6. If you answer 'YES' to any question from 1 to 6, provide an explanation for each 'YES' response in the designated area.
7. Once all sections are completed, Section III requires a clinician's statement certifying that the information provided is accurate. The clinician must sign and date the form, and include their name (typed or printed), degree or license, address, and telephone number.
8. After reviewing all information for accuracy and completeness, you may choose to save your changes, download a copy of the completed form, print it, or share it with the relevant parties.

Begin completing the PREADMISSION SCREENING (PAS) / ANNUAL RESIDENT REVIEW form online today!