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The Colorado Post Admission Level 1 Passr form is a comprehensive document designed to review and evaluate the needs of individuals seeking admission to nursing facilities, ensuring they receive care that matches their medical and psychological requirements. It diligently gathers information about an individual's mental health, physical health, and overall well-being through various sections that cover a wide range of considerations from mental illness diagnoses, symptoms, and psychiatric treatment history to the need for specialized services for conditions like dementia, mental retardation, and developmental disabilities. Furthermore, the form assesses the appropriate payment method and includes critical sections for documenting the use of psychotropic medications and assessing the need for further screening based on the initial findings. Notably, it also addresses exemptions and categorical decisions crucial for the admission process, including determinations for hospital exemption, terminal illness, and severity of illness. By incorporating detailed questions about an individual’s health history and current condition, the Colorado Post Admission Level 1 Passr form plays a vital role in ensuring that individuals entering nursing facilities in Colorado are evaluated comprehensively for special needs that may affect their care plan, promoting a tailored approach to each individual's care.

Colorado Post Admission Level 1 Passr Example

COLORADO LE VE L I F ORM

PRE-ADMISSION AND RESIDENT REVIEW (PASRR)

First Name:

 

 

Middle Initial:

 

 

Last Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing Address:

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

 

 

 

 

 

 

 

State:

Zip:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone:

 

 

Social Security #:

 

-

 

 

 

 

-

 

 

 

Date of Birth:

/

 

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gender: c Male c Female Race: c Caucasian c African American c Asian c Hispanic c Other:

 

 

 

 

 

 

 

Current Location: c*Medical Facility c*Psychiatric Facility c *Nursing Facility c Community c Other:

*Provide Admission Date:

 

 

 

 

 

 

 

 

 

 

Receiving Nursing Facility:

 

 

 

 

 

 

 

 

 

 

Receiving Nursing Facility Address:

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

State:

 

Zip:

 

 

 

 

 

 

Payment Method: c Medicare c Private Pay c Medicaid c Medicaid Pending c Medicaid #

 

 

 

 

 

 

 

 

 

c Hospice c PACE c 30 Day PACE Respite

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

** Provide ULTC Scores if Medicaid or Medicaid Pending:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bathing

 

Dressing

 

 

 

Toileting

 

 

Mobility

 

 

 

Transfer

 

 

 

 

 

 

 

 

 

 

 

Eating

Supervision Behaviors

 

Supervision Memory/Cognition

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section I: MENTAL ILLNESS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Does the individual have any of the

 

2.

Does the individual have any of the

 

3. Does the individual have a diagnosis of

following Major Mental Illnesses

 

 

following mental disorders?

 

 

 

 

 

 

 

 

a mental disorder that is not listed in

(MMI)?

 

 

 

 

 

 

c No

 

 

 

 

 

 

 

 

 

 

 

 

#1 or #2? (do not list dementia here)

c No

 

 

 

 

 

 

c Suspected: One or more of the

 

 

 

c No

 

 

 

 

 

 

 

 

 

c Suspected: One or more of the

 

 

 

 

following diagnosis is suspected

 

 

 

c Yes (if yes, enter the diagnosis(es)

 

following diagnoses is suspected

 

 

 

 

(check all that apply)

 

 

 

 

 

 

 

 

below):

 

 

 

 

 

 

 

 

 

 

(check all that apply)

 

 

 

 

 

 

c Yes: (check all that apply)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c Yes: (check all that apply)

 

 

 

c Personality Disorder

 

 

 

 

 

 

 

 

c Diagnosis 1:

 

 

 

 

 

 

 

 

 

c Schizophrenia

 

 

 

 

 

 

c Anxiety Disorder

 

 

 

 

 

 

 

 

 

 

 

c Diagnosis 2:

 

 

 

 

 

 

 

 

 

c Schizoaffective Disorder

 

 

 

c Panic Disorder

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c Major Depression

 

 

 

 

 

 

c Depression (mild or situational)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c Psychotic/Delusional Disorder

 

 

 

 

(provide GDS Score:

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c Bipolar Disorder (manic depression)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c Paranoid Disorder

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section II: SYMPTOMS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Interpersonal—Currently or within the past 6 months, has the

 

5. Concentration/Task related symptoms—Currently or within

individual exhibited interpersonal symptoms or behaviors [not

 

 

the past 6 months, has the individual exhibited any of the

due to a medical condition]?: c No c Yes

 

 

 

 

 

 

 

 

 

 

 

following symptoms or behaviors [not due to a medical

c Serious difficulty interacting with others

 

 

 

 

 

 

 

 

 

 

condition]? c No

c Yes

 

 

 

 

 

 

 

 

 

c Altercations, evictions, or unstable employment

 

 

c Serious difficulty completing tasks that she/he should be

c Frequently isolated or avoided others or exhibited signs

 

 

capable of completing

 

 

 

 

 

 

 

 

 

 

suggesting severe anxiety or fear of strangers

 

 

c Required assistance with tasks for which she/he should be

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

capable

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c Substantial errors with tasks in which she/he completes

 

 

 

 

 

 

Adaptation to change —Currently or within the past 6 months, has the individual exhibited any symptoms in #6, 7 or 8 related to

adapting to change? c No (proceed to Section III) c Yes (complete 6-8)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6. c Self injurious or self

7. c Severe appetite disturbance

 

8.

c Other major mental health symptoms (this may include

mutilation

c Hallucinations or delusions

 

 

 

 

recent symptoms) that have emerged or worsened as a result

c Suicidal talk

c Serious loss of interest in things

 

 

 

 

of recent life changes as well as ongoing symptoms.

c History of suicide

c Excessive tearfulness

 

 

 

 

 

 

 

 

Describe symptoms:

 

 

 

 

 

 

 

 

 

attempt or gestures

c Excessive irritability

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c Physical violence

c Physical threats (no potential for

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c Physical threats (with

harm)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

potential for harm)

GDS Score:

 

 

 

(if any areas in #7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

are marked)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Masspro s 245 Winter St. s Waltham, MA 02451 s Phone: 855-222-3112 s Fax: 855-222-3114

The attending physician has certified prior to NF admission the individual will require less than 30 calendar days of NF services and the individual’s symptoms or behaviors are stable.
Physician Name:
Physician Phone: Physician License #:

 

COLORADO LE VE L I F ORM

 

PRE-ADMISSION AND RESIDENT REVIEW (PASRR)

Patient Last Name:

 

Patient First Name:

 

Section III: HISTORY OF PSYCHIATRIC TREATMENT

9. Currently or within the past 2 years , has the individual received any of the followingmental health services?

cNo

cYes (the individual has received the following service[s]): c Inpatient psychiatric hospitalization (if yes, provide

date: )

c Partial hospitalization/ day treatment (if yes, provide

date:

 

)

 

 

 

 

cResidential treatment (if yes, provide date:

 

)

c Other:

 

 

 

(if yes,

 

provide date:

 

 

)

 

 

 

10.Currently or within the past 2 years, has the individual

experienced significant life disruption because of mental health symptoms? c No c Yes (check all that apply):

c Legal intervention due to mental health symptoms

(date:)

cHousing change because of mental illness

(date:

 

)

 

 

 

 

c Suicide attempt or ideation (date[s]:

)

c Other:

 

(date:

 

 

)

 

11.

Has the individual had a recent psychiatric/behavioral evaluation? c No c Yes (date:

 

)

Section IV: DEMENTIA

12.Does theindividual have a diagnosis

of dementia or Alzheimer’s disease? c No (proceed to 15) c Yes

13.If yes to #12, is corroborative testing or other information available to verify the presence

or progression of the dementia? c No c Yes (check all that apply)

c Dementia work up c Comprehensive Mental Status Exam c Other (specify):

14.If yes to12, list currently prescribed antidepressant or antipsychotic medications listed on the Beer’s List.

 

 

 

 

 

 

Medication

Dosage MG/Day

Refer to Beer’s List

 

 

 

 

Does dosage exceed Beer’s List? cNo cYes

 

 

 

 

 

 

 

 

 

Does dosage exceed Beer’s List? cNo cYes

 

 

 

 

 

 

 

 

 

Does dosage exceed Beer’s List? cNo cYes

 

 

 

 

 

Section V: PSYCHOTROPIC MEDICATIONS

15.Has the individual been prescribed psychoactive (mental health) medications now or within the past 6 months other than those listed in question 14? c No c Yes (list below) [use separate sheet if necessary] *Do not list medications if used for a medical diagnosis.

Medication

Dosage MG/Day

Diagnosis

Started

Ended

Section VI: MENTAL RETARDATION & DEVELOPMENTAL DISABILITIES

16.

Does the individual have a diagnosis of mental retardation

17.

Does the individual have any history of MR or DD? c No c Yes

 

(MR) or developmental disability (DD)? c No c Yes

 

 

 

 

 

 

 

 

18.

Is there presenting evidence of a cognitive or behavioral

19.

Has the individual ever received services from an agency that

 

impairment prior to age 22 or suspicion of MR condition that

 

serves people affected by MR/DD? c No

 

occurred prior to age 18? c No c Yes

 

c Yes—agency:

 

 

 

 

 

 

Section VII: EXEMPTION AND CATEGORICAL DECISIONS

(MASSPRO MUST APPROVE USE OF CATEGORIES AND EXEMPTION PRIOR TO ADMISSION)

20. Does the admission meet criteria for Hospital Exemption? c No

c Yes (meets all the following andhas a known or suspected MMI or MR/DD):

·

Admission to NF directly from hospital after

 

·

receiving acute medical care, and

 

Need for NF is required for the condition treated in

 

the hospital (specify condition:

 

, )

 

and

 

·

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22.Does the admission meet the criteria for Terminal Illness? c No

c Yes (Has a known or suspected MMI or MR/DD and MD has certified in writing that the patient has 6 months or less to live. The physician signed certification must be submitted to Masspro via facsimile within 6 business hours of submission of this form)

23.Does the admission meet the criteria for Severity of Illness?

cNo

cYes (Has a known or suspected MMI or MR/DD and is ventilator dependent or comatose unresponsive)

24.Does the admission meet criteria for 60 day Convalescence? c No

c Yes (meets all the following and has a known or suspected MMI or MR/DD): c Admission to NF directly from hospital after receiving acute medical care; and c Need for NF is required for the condition treated in the hospital, and cThe attending physician has certified prior to NF admission the individual will require less than 60 calendar days of NF services.

21. Additional Comments:

Masspro s 245 Winter St. s Waltham, MA 02451 s Phone: 855-222-3112 s Fax: 855-222-3114

c No c Yes
c No c Yes
c No c Yes

COLORADO LE VE L I F ORM

PRE-ADMISSION AND RESIDENT REVIEW (PASRR)

Patient Last Name:

 

Patient First Name:

Section VIII: OUTCOME

25. Are any of the following numbers marked yes or, if applicable, suspected 1, 3, 6, 7, 8, 9, 10, 14, 15, 16, 17, 18,or 19?

26. Check yes if #2 is marked yes or suspected and any areas in #4-8 are marked

27. Check yes if #4 or 5 or (any areas in) #7 are marked affirmatively and #12 is no

28. Are any of the #25-27 marked yes?

cNo (if No, NO further screening is required. Proceed to Section IX)

cYes (Screening information must be submitted to Masspro via fax at 1-855-222-3114 for a determination of whether further screening is

required).

Provide a copy of this form to the individual and, if applicable, guardian.

Does the individual have a legal guardian? c No legal guardian c Yes, legal guardian information is below:

Guardian Last Name:

 

 

 

First Name:

 

 

 

Street:

 

 

City:

 

 

 

State:

 

Zip:

 

Section IX: SOURCE SIGNATURE

Print Name:

Signature:

Date:

/

/

 

 

 

 

 

Agency/Facility:

Phone:

Fax:

 

 

 

 

 

 

 

Section X: MASSPRO OUTCOME: MASSPRO USE ONLY

Date:

Non-Cert c

Level I Approved:

PASRR Authorization #:

 

 

 

c No MMI/DD

 

 

 

 

 

 

c Follow-up next qtr.

c PACE Respite

 

c 30 Day Exemption

c Hospice

 

 

c Convalescent Care

 

c Terminal

c Severity of Illness

 

 

 

 

 

 

 

c Provisional-Out of state Adm.

 

 

 

c Provisional-Emergency Adm.

Level II Referred:

 

c MI

c MR/DD

c Dual

 

 

Comments:

Masspro s 245 Winter St. s Waltham, MA 02451 s Phone: 855-222-3112 s Fax: 855-222-3114

Click for PDF Form

Document Properties

Fact Detail
Purpose of the Form Pre-Admission and Resident Review (PASRR) to evaluate the needs of individuals entering or residing in nursing facilities.
Governing Law Federal Law mandates PASRR under the Nursing Home Reform Act, 1987, applied state-specifically here in Colorado.
Main Sections Covers major areas: Mental Illness, Dementia, Psychotropic Medications, Mental Retardation & Developmental Disabilities, Symptomatology, Psychiatric Treatment History, and Exemption/Categorical Decisions.
Special Focus Assesses major mental illnesses, developmental disabilities, and the necessity for psychotropic medication, ensuring residents' needs are appropriately met.
Outcome Determination The form guides through various considerations to determine whether further screening (Level II) is required for the individual.
Integration with Medicaid Includes details relevant to Medicaid or Medicaid pending statuses, emphasizing the financial aspect of care.
Role of Masspro Masspro is involved for screening determinations, marked uniquely for oversight in Colorado's PASRR process.

Guide to Writing Colorado Post Admission Level 1 Passr

Filling out the Colorado Post Admission Level 1 PASSR form is an important step in ensuring that individuals receive the appropriate care and services they need. This document captures crucial information about a person's mental and physical health status prior to their admission to a nursing facility. It helps in identifying whether further assessment is needed for mental illness, developmental disability, or both. The process can seem daunting at first, but by following these step-by-step instructions, it can be completed accurately and efficiently.

  1. Start by entering the individual's complete name (First Name, Middle Initial, Last Name) in the designated fields.
  2. Fill in the Mailing Address, including City, State, Zip, and provide the Phone number and Social Security number.
  3. Specify the Date of Birth, select the Gender, and indicate the Race of the individual. For race, check the appropriate box or specify under "Other" if not listed.
  4. Indicate the Current Location of the individual by checking the appropriate box. If the location is a facility, provide the Admission Date.
  5. Enter the name and address (Receiving Nursing Facility Address, City, State, Zip) of the nursing facility that will receive the individual.
  6. Select the Payment Method by checking the appropriate box. If Medicaid or Medicaid Pending, provide the Medicaid number and complete the ULTC Scores section specifying abilities in various daily activities.
  7. In Section I: MENTAL ILLNESS, answer questions 1, 2, and 3 regarding the presence of any major mental illnesses, other mental disorders, and specific diagnoses, respectively.
  8. In Section II: SYMPTOMS, address interpersonal, concentration/task-related symptoms, adaptation to change, and provide details in the fields provided.
  9. Complete Section III: HISTORY OF PSYCHIATRIC TREATMENT by answering questions about mental health services, significant life disruption, and recent psychiatric/behavioral evaluations.
  10. For Section IV: DEMENTIA, fill in information regarding dementia diagnosis, corroborative testing, and prescribed medications if applicable.
  11. In Section V: PSYCHOTROPIC MEDICATIONS, list any psychoactive medications prescribed within the last six months excluding those listed in Section IV.
  12. Address the presence of developmental disabilities in Section VI:
  13. MENTAL RETARDATION & DEVELOPMENTAL DISABILITIES by answering relevant queries.
  14. Decide on exemptions and categorical decisions in Section VII, checking boxes appropriately based on the individual’s condition and anticipated care length.
  15. In Section VIII: OUTCOME, respond to the checklist to determine if further screening is required.
  16. Finally, in Section IX: SOURCE SIGNATURE, print your name, sign, and date the form. Include the Agency/Facility contact information.
  17. Fax the completed form to Masspro at 1-855-222-3114 if further screening is indicated or as required.

Once the form is submitted, it's essential to wait for feedback from Masspro or the receiving facility. This feedback will guide the next steps in the admission process. Understanding and completing the PASSR form accurately is crucial in ensuring individuals receive appropriate care tailored to their specific needs.

Your Questions, Answered

What is the purpose of the Colorado Post Admission Level 1 PASRR form?

The Colorado Post Admission Level 1 Pre-Admission Screening and Resident Review (PASRR) form is designed to assess whether individuals seeking admission to nursing facilities have mental illness, developmental disabilities, or related conditions. Its goal is to ensure that these individuals receive the appropriate level of care in the most fitting setting, whether that's a nursing facility or an alternative care environment that can meet their needs more effectively.

Who needs to complete the Colorado Level 1 PASRR form?

This form must be completed for individuals applying for admission to a nursing facility in Colorado, especially those who have a known or suspected serious mental illness (SMI), developmental disability (DD), or related conditions. This includes those transferring from hospitals, other nursing facilities, or coming from the community.

What happens if the Level 1 PASRR indicates a need for further evaluation?

If the Level 1 PASRR screening suggests that the individual has a mental illness, developmental disability, or related condition, a more comprehensive Level 2 PASRR evaluation will be required. This in-depth assessment determines the specific service and care needs of the individual, evaluating if those needs can be met in a nursing facility or if alternative community-based services are more appropriate.

What should be done if an individual does not have major mental illness or developmental disabilities?

If the Level 1 PASRR form indicates that the individual does not have major mental illness or developmental disabilities, and no further screening is required, the individual can be admitted to the nursing facility without a Level 2 evaluation. However, the facility must still meet the resident's needs and comply with federal and state regulations.

How is the information from the Level 1 PASRR used?

Information collected through the Level 1 PASRR screening is used to make informed decisions about the most appropriate and least restrictive setting for the individual's long-term care. It ensures that persons with mental illness or developmental disabilities are not inappropriately placed in nursing facilities when their needs could be better served elsewhere.

What is included in the Mental Illness (MI) and Mental Retardation/Developmental Disabilities (MR/DD) sections?

The Mental Illness section assesses the presence of major mental illnesses, while the Mental Retardation/Developmental Disabilities section evaluates cognitive or behavioral impairments. Both sections are crucial to understanding the individual's condition and determining the necessity for specialized services or adaptations.

What happens after the Level 1 PASRR screening is submitted to Masspro?

After submission, Masspro reviews the Level 1 PASRR form to verify if the screening was accurately completed and if further evaluation with a Level 2 screening is needed. Masspro will then provide directives on the next steps, which may include proceeding to admit the individual to the nursing facility or conducting a Level 2 evaluation.

Is the individual or their guardian informed about the results of the Level 1 PASRR screening?

Yes, a copy of the completed Level 1 PASRR form, along with information about the determined need for further screening (if any), must be provided to the individual and, if applicable, their guardian. This ensures transparency and allows for informed decisions about care and placement.

Who can perform the Level 1 PASRR screening?

The Level 1 PASRR screening is typically completed by health care professionals who are involved in the admission process to nursing facilities. This may include social workers, nurses, or other designated staff members trained in the PASRR process.

How often must the PASRR evaluation be reviewed?

The need for a PASRR re-evaluation depends on changes in the individual’s condition or if there is a significant change in the level of care required. Regular reviews are also necessary to ensure that the resident's placement continues to be appropriate and that they are receiving all necessary services to meet their needs.

Common mistakes

Filling out the Colorado Post Admission Level 1 PASRR form thoroughly and accurately is crucial to ensure the appropriate level of care and support for individuals. However, mistakes can occur, leading to delays or incorrect services. Here are nine common mistakes made when completing the form:

  1. Not providing complete contact information, including a full mailing address and phone number. This makes communication and necessary follow-ups challenging.
  2. Failing to check the appropriate boxes regarding the individual's current location, such as a medical facility, psychiatric facility, or community setting. This detail is vital for understanding the individual's current care context.
  3. Overlooking the payment method section or not indicating whether Medicaid is pending. Accurate payment information is essential for planning and provision of care.
  4. Skipping mental illness and disorder questions by not indicating whether the individual has a Major Mental Illness (MMI) or any other mental disorders. This information is crucial for determining the level of care needed.
  5. Omitting or incorrectly noting the ULTC scores if Medicaid or Medicaid pending is selected. These scores help in evaluating the needed level of care and services.
  6. Providing incomplete information on symptoms exhibited by the individual or not specifying the severity and frequency of these symptoms.
  7. Forgetting to include a recent psychiatric/behavioral evaluation date, if applicable. This omission can delay the review process.
  8. Misreporting or omitting medications, especially failing to indicate if any are psychoactive medications not listed in question 14. Accurate medication information is critical for assessing the individual's health status and needs.
  9. Incorrectly answering or leaving blank questions related to dementia, including diagnosis confirmation, corroborative testing, and prescribed medications. Accurate dementia-related information supports appropriate care planning.

Avoiding these mistakes ensures a smoother review process and helps in securing the necessary care and support services for the individual. Ensuring all sections are filled out with attention to detail and accuracy can significantly impact the quality of care that is ultimately provided.

Documents used along the form

When handling the Colorado Post Admission Level 1 PASRR (Pre-Admission Screening and Resident Review) process, several additional forms and documents are commonly utilized to ensure a thorough assessment and compliance with regulatory requirements. These materials support the detailed review process necessary for individuals with mental illness, intellectual disabilities, or related conditions considering placement in nursing facilities. Understanding each document's purpose can streamline the PASRR process and ensure comprehensive care planning.

  • Comprehensive Mental Status Exam: A detailed assessment that evaluates an individual's cognitive and emotional functioning.
  • Psychiatric Evaluation: A report generated by a psychiatrist detailing the individual's mental health status, including diagnoses and recommendations for treatment.
  • Medical History and Physical Examination Report: A document summarizing an individual's medical history and results from a physical examination, providing a baseline of physical health.
  • Medication Administration Record (MAR): A record tracking prescribed medications, dosages, and administration times, critical for monitoring psychotropic medication use.
  • Behavior Support Plan: A plan developed for individuals displaying challenging behaviors, outlining strategies to manage these behaviors effectively.
  • Social History: A record that contains information about the individual's personal, familial, and social background, offering insights into their support system and potential needs.
  • Recent Laboratory Test Results: Documents providing crucial data on the individual's physical health status, including any recent changes that could impact their care plan.
  • Neurological Evaluation: A report providing detailed information on an individual's neurological functioning, which may be essential for those with conditions affecting the brain.
  • Level II Evaluation and Determination Report: For individuals flagged during the Level I screening, this report contains a more in-depth assessment conducted by a team of health professionals to determine the need for specialized services or placements.

Altogether, these documents play a vital role in crafting a well-rounded picture of the individual's health, abilities, and needs. Proper compilation and analysis of this information ensure that individuals receive appropriate care tailored to their unique situations, facilitating their well-being and compliance with the PASRR's intent and regulations.

Similar forms

The Colorado Post Admission Level 1 Passr form is similar to other documents used in healthcare and social service settings to assess and collect vital information about individuals' needs, particularly for those requiring nursing facility services. Specifically, its design and purpose resemble forms used for comprehensive health assessments and Medicaid eligibility determinations, though each form has its unique aspects tailored to specific requirements.

One comparable document is the Comprehensive Health Assessment form often used in hospitals or primary care settings. This form collects detailed health history, including physical and mental health information, medications, and current health status. Similarly, the Colorado Post Admission Level 1 Passr form collects an array of information about an individual’s mental health, psychiatric treatment history, and current medications, crucial for determining the appropriate level of care. Both forms focus on capturing a holistic view of the individual's health but are designed for use in different contexts: one for general health assessments and the other for assessing specific needs related to long-term care facility admission.

Another related document is the Medicaid Eligibility Determination Form. This form is used to assess an individual’s financial and medical eligibility for Medicaid services. Like the Colorado Post Admission Level 1 Passr form, it gathers personal information, including social security number, financial status, and medical conditions, to evaluate eligibility for benefits. Both forms are integral in the process of ensuring individuals receive the appropriate services and support based on their needs and financial situation. The primary difference lies in their focus: financial eligibility for Medicaid versus the need for specialized services in a nursing facility.

Dos and Don'ts

Filling out forms can often seem daunting, especially when it concerns an important document like the Colorado Post Admission Level 1 PASRR (Pre-Admission Screening and Resident Review). Understanding the do’s and don’ts can help streamline the process and ensure your submission is accurate and compliant. Here are five key things to do and not to do when completing this form.

What you should do:

  1. Review the entire form before starting: Make sure you have all the necessary information at hand to complete the form. This might include medical records, legal documents, and personal identification.
  2. Answer every question: Do not leave any blanks unless the form explicitly allows it. If a question does not apply, consider writing "N/A" (Not Applicable) to indicate that you did not overlook it.
  3. Be precise: When providing information, especially regarding diagnoses, symptoms, and treatments, make sure the details are accurate and spelled correctly. This can impact the individual's eligibility and the services they receive.
  4. Use additional pages if necessary: If you run out of space on the form or have more to say, attach additional sheets. Ensure these are clearly marked with the individual's name and the section numbers they relate to.
  5. Keep a copy for your records: Before sending off the form, make a copy for your own records. This will be useful for future reference or in case of any discrepancies.

What you should not do:

  1. Guess answers: If you’re unsure about how to answer a question, seek clarification rather than guessing. Incorrect information can lead to processing delays or incorrect eligibility determinations.
  2. Use correction fluid or tape: Mistakes are best dealt with by crossing out the error neatly and writing the correction beside it. Using correction fluid or tape can make the document look tampered with.
  3. Ignore the instructions: Each section comes with specific instructions. Forgetting to follow these can result in incomplete or incorrect submissions. Pay close attention to what each part of the form is asking for.
  4. Submit the form without signing it: An unsigned form is incomplete and will not be processed. This can delay the individual’s admission and the care they need.
  5. Overlook the need for additional documentation: If the form asks for attached reports, evaluations, or other documents, make sure to include them with your submission. These are critical for a comprehensive assessment.

Taking the time to carefully complete the Colorado Post Admission Level 1 PASRR form not only ensures compliance but can also significantly impact the level of care and resources available to the individual in need. Remember, when in doubt, consulting with a professional familiar with the PASRR process can provide invaluable guidance.

Misconceptions

There are numerous misconceptions surrounding the Colorado Post Admission Level 1 (PASRR) form, which often lead to confusion among individuals and healthcare providers. Understanding these can clarify the process and requirements.

  • Misconception 1: The PASRR is only for elderly patients.

    • This is incorrect. The PASRR applies to all individuals seeking admission to a nursing facility, regardless of their age, if they have a suspected or diagnosed mental illness, intellectual disability, or related condition.

  • Misconception 2: The form is voluntary.

    • In reality, the PASRR is a federally mandated screening process required for anyone entering a Medicaid-certified nursing facility, ensuring that individuals receive the most appropriate care for their needs.

  • Misconception 3: The PASRR Level 1 form is the final step.

    • Actually, the PASRR Level 1 form is just the initial screening. Depending on the results, a more comprehensive Level 2 assessment may be required to determine the most appropriate setting and services for the individual's needs.

  • Misconception 4: Personal payment methods or insurance bypass PASRR requirements.

    • This notion is false. Regardless of payment method or insurance, the PASRR screening is obligatory for admission to a nursing facility, as it is federally mandated to ensure individuals' rights and needs are met.

  • Misconception 5: A diagnosis of dementia exempts individuals from the PASRR.

    • Not quite accurate. Individuals with dementia may still require PASRR evaluation to determine the necessity of specialized services or environments, as dementia can coexist with mental illness or intellectual disabilities.

  • Misconception 6: The PASRR only assesses mental health.

    • Contrary to this belief, the PASRR also screens for intellectual disabilities, developmental disabilities, and other conditions to ensure individuals receive appropriate care according to their comprehensive needs.

  • Misconception 7: All sections of the form must be completed for everyone.

    • This is false. Certain sections of the PASRR form are conditional and need to be completed based on previous responses, which can dictate whether further information is necessary.

  • Misconception 8: The PASRR is a one-time requirement.

    • The reality is, re-evaluation may be necessary if a resident's condition changes significantly, or if there is a transfer to another facility, ensuring ongoing appropriate care placements.

Dispelling these misconceptions is crucial for healthcare professionals, individuals, and families to navigate the PASRR process effectively, ensuring those in need receive the appropriate level of care and services.

Key takeaways

Filling out the Colorado Post Admission Level 1 PASRR form is an important process that requires attention to detail and completeness. Here are key takeaways to consider:

  1. Ensure accuracy in providing basic information such as the individual’s name, mailing address, phone number, and social security number. This information is crucial for identification and communication purposes.
  2. Be clear about the individual’s current location and admission date if applicable. This information helps in understanding the immediate care environment and needs.
  3. Indicate the payment method accurately to ensure that financial arrangements are properly handled and there is no delay in the admission process due to financial issues.
  4. For Section I dealing with Mental Illness, it is vital to check the correct boxes that apply to the individual's condition and to provide specific diagnoses if available. This impacts the care and services they will receive.
  5. Interpersonal symptoms, concentration/task-related symptoms, and adaptation to change are addressed in Section II. Honest answers here are essential for understanding the individual's current mental health state.
  6. Section III requires information on the history of psychiatric treatment and significant life disruptions due to mental health symptoms. This history is critical for planning ongoing care.
  7. If there is a diagnosis of dementia, corroborative testing or information needs to be provided in Section IV. This ensures appropriate placement and care strategies.
  8. It’s important to list all psychotropic medications the individual is currently taking or has taken in the past six months (excluding medications for medical diagnoses) in Section V.
  9. Details about mental retardation and developmental disabilities must be accurately entered in Section VI to ensure that the individual receives the necessary support and services.
  10. In Section VII, clear decisions about exemptions and categorical decisions need to be made.
  11. Contain accurate information about the screening outcome in Section VIII, particularly if further screening is required, making sure to submit all necessary information to Masspro.
  12. Ensure the form is signed by a responsible party, indicating their name, agency/facility, and contact information in Section IX for any follow-up required.
  13. Review the entire form before submission. This not only helps in avoiding any delays due to incomplete information but also ensures that the individual's care needs are fully understood and met promptly.

Completing the Colorado Post Admission Level 1 PASRR form thoroughly and accurately plays a crucial role in securing the right level of care and support for individuals. It's a responsibility that requires diligence and an understanding of the individual's current and future needs.

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