Form 1015, LMHA PASRR Specialized Services Discussion Checklist

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Effective Date: 7/2018


Updated: 7/2018


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.