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DDES Memo Series 2004-19

February 9, 2005

Department of Health and Family Services
Division of Disability and Elder Services

Area Administrators/ Human Services Area Coordinators
Bureau Directors
County Departments of Community Programs Directors
County Departments of Developmental Disabilities
Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Facilities Serving People with Developmental Disabilities
Licensing Chiefs/Section Chiefs
Nursing Homes
Tribal Chairpersons/Human Services Facilitators

Sinikka Santala

The attached revision of the PASARR Level I Screen form, DDE-2191, is to be used immediately. Please do not use prior versions of the PASARR Level I form. The content of the form has changed in many areas to clarify the intent of the federal PASARR regulations and Wisconsin's PASARR policies and procedures, although no changes in policy are made.

The Bureau of Quality Assurance will not provide copies of this form because it may be downloaded from, an Adobe Acrobat fillable format, or, a Microsoft Word fillable format.

If you have questions about the form, contact:

Dan Zimmerman
PASARR Contract Administrator
Bureau of Mental Health and Substance Abuse Services
1 West Wilson Street, room 850
P. O. Box 7851
Madison, WI 53707-7851
(608) 266-7072
(608) 267-7793 - fax (E-mail address)



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