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This version of the form is not currently in use and is provided for reference only. Download this version of
Form ODM03622
for the current year.
Form ODM03622 Preadmission Screening / Resident Review (Pas / Rr) Identification Screen - Ohio
What Is Form ODM03622?
This is a legal form that was released by the Ohio Department of Medicaid - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the purpose of Form ODM03622?
A: Form ODM03622 is used for preadmission screening/resident review (PAS/RR) in Ohio.
Q: What does PAS/RR stand for?
A: PAS/RR stands for preadmission screening/resident review.
Q: What is the purpose of the Identification Screen?
A: The purpose of the Identification Screen is to gather information about an individual for the PAS/RR process.
Q: Who is required to complete the Identification Screen?
A: The Identification Screen must be completed by the individual seeking admission to a long-term care facility.
Q: What information is collected in the Identification Screen?
A: The Identification Screen collects information about the individual's medical, mental health, and functional status.
Form Details:
- Released on August 1, 2014;
- The latest edition provided by the Ohio Department of Medicaid;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form ODM03622 by clicking the link below or browse more documents and templates provided by the Ohio Department of Medicaid.
Download Form ODM03622 Preadmission Screening / Resident Review (Pas / Rr) Identification Screen - Ohio
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