Documents
Effective Date:
7/2018
- 1015.pdf (105.51 KB)
Instructions
Updated: 7/2018
Purpose
The Local Mental Health Authority (LMHA) service coordinator uses Form 1015 to identify the needs of a nursing facility resident with an intellectual or developmental disability (IDD) for Pre-admission Screening and Resident Review (PASRR) specialized services.
When to Prepare
The LMHA staff member responsible for the completion of a PASRR Evaluation (PE) for a dually diagnosed person, must complete this checklist following the completion of the PE and provide a copy to the LIDDA Service Coordinator.
Form Retention
Retention according to 1.7.4 HHSC Records Retention Schedule. Retain the form in the resident’s record until notified otherwise by HHSC Legal Services.