OBH PASRR Level II Resident Review Request Form
This document contains the guidelines and requirements for submitting a Resident Review request for individuals in nursing facilities. It outlines the necessary evaluations, diagnoses, and contact information needed for proper submission. Ensuring compliance with these instructions is vital to avoid non-compliance citations.
Edit, Download, and Sign the OBH PASRR Level II Resident Review Request Form
Form
eSign
Add Annotation
Share Form
How do I fill this out?
To fill out this form, begin by reading the guidelines carefully to understand the necessary evaluations. Ensure that all required fields are completed accurately, adhering closely to any instructions provided. Finally, verify that the form is signed and dated by the appropriate licensed personnel before submission.
How to fill out the OBH PASRR Level II Resident Review Request Form?
1
Read the guidelines carefully.
2
Fill in all required fields accurately.
3
Complete any necessary evaluations.
4
Sign and date the form.
5
Submit the form to the designated office.
Who needs the OBH PASRR Level II Resident Review Request Form?
1
Nursing facility administrators need this form for compliance with resident evaluation regulations.
2
Licensed healthcare professionals require this form to submit evaluations for residents under their care.
3
Behavioral health specialists use this form to document necessary resident reviews.
4
Social workers need this document to facilitate mental health evaluations for residents.
5
Legal representatives may require this form to ensure adherence to health regulations for clients.
How PrintFriendly Works
At PrintFriendly.com, you can edit, sign, share, and download the OBH PASRR Level II Resident Review Request Form along with hundreds of thousands of other documents. Our platform helps you seamlessly edit PDFs and other documents online. You can edit our large library of pre-existing files and upload your own documents. Managing PDFs has never been easier.
Edit your OBH PASRR Level II Resident Review Request Form online.
On PrintFriendly, you can easily edit this PDF by using the intuitive editing tools available on the platform. Simply open the document within the editor and make any necessary adjustments directly in the fields provided. After editing, you can save or download the updated file.
Add your legally-binding signature.
Signing the PDF on PrintFriendly is straightforward; you can use the electronic signature tool to add your signature to the document. Just click on the signature area and follow the prompts to create your digitized signature. Once signed, you can save the changes and download the signed document.
Share your form instantly.
Sharing the PDF on PrintFriendly is effortless with the sharing features integrated into the platform. You can generate a shareable link directly to the document or share via email with colleagues. This makes it convenient to collaborate and distribute important documents.
How do I edit the OBH PASRR Level II Resident Review Request Form online?
On PrintFriendly, you can easily edit this PDF by using the intuitive editing tools available on the platform. Simply open the document within the editor and make any necessary adjustments directly in the fields provided. After editing, you can save or download the updated file.
1
Open the PDF file in PrintFriendly.
2
Select the editing tools to make necessary changes.
3
Complete all required fields with accurate information.
4
Review the edits to ensure correctness.
5
Download the edited file or save it as needed.
What are the instructions for submitting this form?
To submit the OBH PASRR Level II Request Form, fax the completed document to the OBH ProviderLink Fax Number at (877) 652-4995. You may also email the form to OBHPASRR@LA.GOV for electronic submissions. Ensure all required documentation accompanies the form and is sent at least 15 calendar days before the expiration of authorization.
What are the important dates for this form in 2024 and 2025?
For 2024 and 2025, ensure that any Resident Reviews that are needed are submitted at least 15 calendar days before the expiration of any authorizations. Keep track of changes in residency and medical assessments which may require updates to submissions, allowing for seamless processing and compliance. It's essential to remain aware of any changes in the guidelines issued by the Office of Behavioral Health.
What is the purpose of this form?
The primary purpose of the OBH PASRR Level II Request Form is to gather essential information regarding residents who may require a Level II evaluation. This evaluation is crucial for determining the appropriateness of placement in nursing facilities and ensuring that residents receive necessary mental health services. By providing a standardized format for submission, the form facilitates compliance with health regulations and enhances care coordination for individuals requiring spec...
Tell me about this form and its components and fields line-by-line.
- 1. Resident Name: The full name of the resident needing a review.
- 2. SS#: The social security number of the resident.
- 3. DOB: The date of birth of the resident.
- 4. Level II Evaluation Received: A checkbox indicating if the resident has received a Level II evaluation.
- 5. Diagnosis Information: Fields for checking appropriate diagnoses and symptoms.
- 6. Signature of Staff: Validates the completion and correctness of the form.
What happens if I fail to submit this form?
If this form is not submitted correctly, your facility may face citations for non-compliance from Health Standards. It's vital to ensure all fields are filled appropriately and the form is signed as required. Failure to comply may lead to delays in resident evaluations, affecting their care and placement.
- Non-compliance Citations: Facilities may be cited for failing to adhere to Preadmission Screening requirements.
- Delays in Processing: Inaccurate or incomplete submissions can delay necessary evaluations for residents.
- Impact on Resident Care: Incorrect submissions may hinder timely access to required mental health services.
How do I know when to use this form?
- 1. Change in Health Status: Use this form if there is a significant change in a resident's mental or physical health.
- 2. New Diagnosis: Complete this form for residents who have received a new mental health diagnosis.
- 3. Request for Evaluation Extension: Submit this form to request an extension of authorization for continued stay reviews.
Frequently Asked Questions
What is the purpose of the OBH PASRR Level II Request Form?
This form is used to request a Level II evaluation for residents in nursing facilities, ensuring compliance with health standards.
Who needs to fill out this form?
This form should be filled out by healthcare professionals such as LPNs, RNs, and social workers involved in resident care.
How can I edit the PDF?
You can edit the PDF using the PrintFriendly platform's built-in editing tools, allowing you to modify sections as necessary.
Is there a specific format I need to follow?
Yes, follow the guidelines provided in the form to ensure all required information is accurately filled out.
What should I do if I have questions while filling out the form?
You can contact the OBH PASRR Level II Office for assistance with any questions regarding the form.
How do I submit the completed form?
You can submit the completed form via fax or email as indicated in the submission instructions on the document.
Can I save my edits on PrintFriendly?
You can download your edited file directly after making changes, ensuring you have the most recent version.
How do I sign the PDF?
Use the electronic signature feature within PrintFriendly to sign the document digitally.
What happens if I do not fill out the form correctly?
If the form is not completed correctly, it may be rejected and returned for resubmission.
When is this form required?
This form is required when a resident meets specific criteria for a Level II evaluation as outlined in the guidelines.
Related Documents - PASRR Level II Request Form
Preparticipation Physical Evaluation Form
The Preparticipation Physical Evaluation Form is used to assess the physical health and fitness of individuals before they participate in sports activities. It covers medical history, heart health, bone and joint health, and other relevant medical questions.
Health Insurance Tax Credits Guide 2015
This document provides a comprehensive guide on health insurance and premium tax credits for the 2015 tax year. It explains the tax filing rules, eligibility criteria, and detailed instructions for claiming and reporting premium tax credits. Essential for individuals who bought health insurance through the ACA Marketplaces.
TSP-77 Partial Withdrawal Request for Separated Employees
The TSP-77 form is used by separated employees to request a partial withdrawal from their Thrift Savings Plan account. It includes instructions for completing the form, certification, and notarization requirements. The form must be filled out completely and submitted along with necessary supporting documents.
Ray's Food Place Donation Request Form Details
This file contains the donation request form for Ray's Food Place. Complete the general information section and follow the guidelines to submit your donation request at least 30 days in advance. The form includes fields for organization details and donation specifics.
Pastoral Ministry Evaluation Form for Board of Elders
This evaluation form is designed for the Board of Elders to assess and provide feedback on a pastor's ministry. It aims to offer affirmation and identify areas for improvement. The form covers preaching, worship leading, pastoral care, administration, and more.
Health Provider Screening Form for PEEHIP Healthcare
This file contains the Health Provider Screening Form for PEEHIP public education employees and spouses. It includes instructions on how to fill out the form for wellness program participation. The form collects personal, medical, and screening details to assess wellness.
Common Law Marriage Declaration Form for FEHB Program
This form is used to declare a common law marriage for the purpose of enrolling a spouse under the Federal Employees Health Benefits (FEHB) Program. It requires personal details, marriage information, and additional documentation. Submission instructions and legal implications are included.
MyPRALUENT™ Enrollment Form Instructions and Details
This document provides comprehensive instructions and details for enrolling in the MyPRALUENT™ program, including benefits, patient assistance, and clinical support. It outlines the required patient, insurance, and prescriber information, as well as the steps for treatment verification and household income documentation.
Application for Certified Copy of Birth Certificate
This form is used to request a certified copy of a birth certificate from the Clerk of Court Office. It includes details about the applicant, the person named on the certificate, and requires a photo ID and the correct fee. This form is only for walk-in services.
Torrance Memorial Physician Network Forms for Patients 18+
This file contains important forms for patients 18 years and older registered with Torrance Memorial Physician Network. It includes patient registration, acknowledgment of receipt of privacy practices, and financial & assignment of benefits policy forms. Complete these forms to ensure your medical records are up-to-date and to understand your financial responsibilities.
Vodafone Phone Unlocking Guide: Steps to Unlock Your Phone
This guide from Vodafone provides a step-by-step process to unlock your phone. Learn how to obtain your unlock code by filling out an online form. Follow the instructions to complete the unlocking process.
Texas Automobile Club Agent Application Form
This file is the Texas Automobile Club Agent Application or Renewal form, which must be submitted within 30 days after hiring an agent. The form includes fields for agent identification, moral character information, and requires signature from both the agent and an authorized representative of the automobile club. Filing fees and submission instructions are also provided.
