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Required Documents and Forms

According to 59G-1.040, F.A.C., the following documents are required for a PASRR Level II evaluation and determination.

Referral Packet

  • Completed PASRR Level I Screen or Resident Review for Serious Mental Illness (SMI) and/or Intellectual Disability or Related Conditions (ID) (Completed online via the provider portal.)
  • Informed consent, as documented on the Level I PASRR Screen (Completed online via the provider portal, printed, and signed.)
  • AHCA-5000-3008
  • Other current and relevant medical documentation including:
    • History and physical
    • Relevant case notes or records of treatment
    • Medication administration records
  • Psychiatric or psychological evaluation, if available
  • Minimum Data Set (MDS), if available