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South Carolina Level I PASRR Screening (Form 234)

South Carolina requires this Level I PASRR screen for everyone applying to a Medicaid-certified nursing facility, whatever the payment source or known diagnosis. The screener records diagnoses and indicators of serious mental illness, intellectual disability or related disability, plus dementia, and decides whether a Level II evaluation is needed. CLTC reviewers use it to apply categorical determinations such as the 30-day hospital discharge exemption.

Who completes it

A screener at the referring hospital, physician office or facility completes the screen and signs with credentials and place of employment. Section V is for SCDHHS/CLTC use, and the hospital discharge exemption rests on the attending physician's certification.

Submitting and payment

How to submit it
Send the completed screen with its accompanying documentation for review before nursing facility admission; incomplete forms are not accepted.

Good to know

  • List medical diagnoses in words; the form specifically says not to include ICD codes.
  • A suicide attempt within the last two years, danger to self or others, or any intellectual disability means the applicant must be referred for a Level II PASRR evaluation.
  • The hospital discharge exemption covers admission straight from acute inpatient care for up to 30 days for the same, non-psychiatric condition; Level II must be done by day 40 if the stay runs longer.
  • A dementia diagnosis can end a Level II evaluation in some cases, but the PASRR process cannot be halted when the person has an intellectual disability. Current revision: February 1, 2026.

Get the official form

Download the current version from the source each time; forms change without notice.

Preadmission Screening and Resident Review (PASRR) Level I PASRR Screening Tool

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Who needs a South Carolina Level I PASRR screen?

Everyone applying for admission to a Title XIX-certified nursing facility, meaning one that accepts Medicaid, regardless of how the stay will be paid and regardless of the person's known diagnosis. PASRR is a federal requirement under 42 CFR Part 483, Subpart C.

What does the attending physician certify on the SC PASRR Level I?

For the exempted hospital discharge, the attending physician certifies that the person is being admitted directly from acute inpatient care for no more than 30 calendar days, for the same condition treated in the hospital and not a psychiatric condition. Longer stays need Level II completed by the fortieth day.

Can ICD-10 codes be used on the SC Level I PASRR?

No. The diagnosis section asks for all medical diagnoses and says not to include ICD codes, so write each diagnosis out. Incomplete forms are not accepted, and accompanying documentation should be sent with the completed screen.