PASRR Level I and Level II Documentation

This template captures the core documentation needed for PASRR Level I and, when indicated, Level II review before skilled nursing admission. It includes submission details, resident screening identifiers, Level I findings, Level II referral status, admission disposition, and attestation. Use it to create a consistent record of what was screened, what triggered referral, and what happened next.

Use it before a resident is admitted to a skilled nursing facility, especially when Medicaid-covered admission may require PASRR documentation. It is also useful when a Level I screen identifies possible mental illness or intellectual disability and a Level II review must be tracked. Do not use it as a general intake form for unrelated admissions that do not require PASRR review.

The Level I section is typically completed by the facility or intake staff responsible for pre-admission screening. The person completing it should be able to identify suspected mental illness or intellectual disability and document the basis for that determination. The form should also show who completed the screen and on what date, so the record supports an audit trail.

Document whether a referral was made, the referral date, the reviewing entity, the current status, and a short outcome summary. If the review is pending, the form should make that clear so admission decisions are not based on incomplete information. Keep the summary factual and limited to what is needed for the admission decision and follow-up.

The template is structured to support minimum-necessary collection by using initials, a date of birth field, and the last four digits of the Medicaid ID instead of broader identifiers. It also includes an anonymous submission option where appropriate and an attestation section to support accountability. If your workflow collects any PII, add disclosure language and limit access to staff with a legitimate need.

Common mistakes include leaving the Level I basis blank, failing to record the referral date after a positive screen, and using free-text fields for data that should be structured. Another issue is treating the form as complete before the Level II outcome is known, which can create gaps in the admission record. The template works best when required fields are clearly marked and conditional logic hides Level II fields until a referral is needed.

Yes. Facilities can adjust the admission disposition options, add state-specific review fields, or rename the reviewing entity field to match local PASRR workflows. You can also add conditional logic for different admission types or payer sources. Keep the structure aligned with your internal policy so the form stays usable and does not collect unnecessary data.

A dedicated template creates a single record with validation, required fields, and an audit trail instead of scattered notes across email threads. It is easier to review, easier to hand off, and less likely to miss the Level II referral or disposition step. Spreadsheets can work for tracking, but they usually do a worse job of enforcing completion and preserving context.

After submission, the record should route to the responsible admissions or compliance reviewer for confirmation and any needed follow-up. If Level II is required, the workflow should assign the referral task and set a next review date. If admission is delayed or denied, the disposition and follow-up actions should be visible to the team managing placement.