TX HHS Form 1012. Mental Illness and Dementia Resident Review

The TX HHS Form 1012, Mental Illness and Dementia Resident Review, is a crucial document for nursing facilities to determine whether further evaluation is needed for residents with a current Negative PASRR Level 1 (PL1) Screening for Mental Illness. This form helps solve the problem of identifying residents who may require additional assessment or treatment for mental health conditions.

This form is typically completed by nursing facility staff, and it requires specific information to be filled out, including resident and nursing facility identifying details, dementia review information, and physician attestation. The form also defines dementia as a neurologically driven disease that interferes with independence and daily life, and distinguishes it from other mental health conditions.

The TX HHS Form 1012 is used to determine whether to submit a new positive PL1 screening form on the Long Term Care Portal. Key features of this form include the required information for resident identification, dementia review, and physician attestation. By completing this form, nursing facilities can ensure that residents receive the necessary evaluation and treatment for their mental health needs.

• This form is used to determine whether further evaluation is needed for residents with a current Negative PASRR Level 1 (PL1) Screening for Mental Illness.
• The form requires specific information, including resident and nursing facility identifying details, dementia review information, and physician attestation.
• This form helps solve the problem of identifying residents who may require additional assessment or treatment for mental health conditions.