1. Submitter Information
  2. Person Being Referred
  3. Medical Information
  4. ADL's
  5. Admitting Nursing Facility
  6. Submit
  7. Results

Hospital, clinic, hospice or nursing facility referral for admission to a Medical Assistance (MA)-certified nursing facility, boarding care facility or hospital swing bed.

Only staff at a hospital, clinic, hospice or nursing facility may submit the preadmission screening. The preferred submitter is the agency of the physician writing the nursing facility admission orders. Please complete all fields as accurately as possible. Once the data has been submitted, you will have the option to save or print the data fields for your records. See Minnesota PAS Policy for more information about preadmission screening.

Submitter Information