DSHS Form 14-538 "Pre-admission Screening and Resident Review (Pasrr) Addendum" - Washington

What Is DSHS Form 14-538?

This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2015;
  • The latest edition provided by the Washington State Department of Social and Health Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of DSHS Form 14-538 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.

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Download DSHS Form 14-538 "Pre-admission Screening and Resident Review (Pasrr) Addendum" - Washington

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DEVELOPMENTAL DISABILITIES ADMINISTRATION (DDA)
PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR)
PASRR Addendum
NAME
GUARDIAN’S / NSA NAME
DATE OF PASRR LEVEL II
DATE OF ADDENDUM
FACILITY NAME (IF APPLICABLE)
REASON FOR ADDENDUM
SOURCE OF ADDITIONAL INFORMATION
DESCRIBE ANY CHANGES TO RECOMMENDATIONS FOR PROFESSIONAL ASSESSMENTS BELOW.
Physical therapy
Speech therapy
Occupational therapy
Mental Health / Behavior Support
Other (specify):
Comments
DESCRIBE ANY CHANGES TO RECOMMENDATIONS FOR SPECIALIZED SERVICES BELOW.
Community Access
Transportation
Vocational Training
Staff / Family Consultation and Training
Specialized Medical Equipment and Supplies
Assistive Technology
(based on professional recommendation)
Therapeutic Equipment and Supplies
Community Guide
(based on professional recommendation)
Other (specify):
Comments
SIGNATURE OF PERSON COMPLETING ADDENDUM
DATE OF COMPLETION
PRINTED NAME OF PERSON COMPLETING ADDENDUM
PHONE NUMBER (INCLUDE AREA CODE)
EMAIL
ADDRESS
CITY / STATE / ZIP
cc: Nursing facility applicant or resident
Guardian or NSA
Client file (if DDA client)
Admitting or retaining NF
Attending physician or ARNP
Discharging hospital (if person is discharging from a hospital)
Page 1 of 1
PASRR ADDENDUM
DSHS 14-538 (05/2015)
DEVELOPMENTAL DISABILITIES ADMINISTRATION (DDA)
PREADMISSION SCREENING AND RESIDENT REVIEW (PASRR)
PASRR Addendum
NAME
GUARDIAN’S / NSA NAME
DATE OF PASRR LEVEL II
DATE OF ADDENDUM
FACILITY NAME (IF APPLICABLE)
REASON FOR ADDENDUM
SOURCE OF ADDITIONAL INFORMATION
DESCRIBE ANY CHANGES TO RECOMMENDATIONS FOR PROFESSIONAL ASSESSMENTS BELOW.
Physical therapy
Speech therapy
Occupational therapy
Mental Health / Behavior Support
Other (specify):
Comments
DESCRIBE ANY CHANGES TO RECOMMENDATIONS FOR SPECIALIZED SERVICES BELOW.
Community Access
Transportation
Vocational Training
Staff / Family Consultation and Training
Specialized Medical Equipment and Supplies
Assistive Technology
(based on professional recommendation)
Therapeutic Equipment and Supplies
Community Guide
(based on professional recommendation)
Other (specify):
Comments
SIGNATURE OF PERSON COMPLETING ADDENDUM
DATE OF COMPLETION
PRINTED NAME OF PERSON COMPLETING ADDENDUM
PHONE NUMBER (INCLUDE AREA CODE)
EMAIL
ADDRESS
CITY / STATE / ZIP
cc: Nursing facility applicant or resident
Guardian or NSA
Client file (if DDA client)
Admitting or retaining NF
Attending physician or ARNP
Discharging hospital (if person is discharging from a hospital)
Page 1 of 1
PASRR ADDENDUM
DSHS 14-538 (05/2015)