Dear Hospital CEO Letter: Accurate Completion of the SCREEN form, and the Hospital and Community Patient Review Instrument (H/C PRI), August 4, 2011

August 4, 2011

Dear Hospital CEO:

The purpose of this letter is to remind hospitals of the importance of accurate completion of the SCREEN form, and the Hospital and Community Patient Review Instrument (H/C PRI), when considering residential health care facility placement in discharge planning. These documents are used to determine appropriate placement and care needs for all persons being considered for residential health care facility placement. Additionally, these forms must be completed when generating a referral for a Preadmission Screen Resident Review (PASRR). A complete set of instructions and guidelines must be followed by qualified individuals when completing these forms. The instructions and guidelines are available at >

All applicable items on the SCREEN and H/C PRI must be completed in accordance with the appropriate instruction manual. Exploring all potential community placements based on the individual's desire and needs to ensure placement in the least restrictive and most integrated setting is critical to the appropriate completion of these instruments. The hospital is responsible for conducting a thorough review of community options which >must be completed in order to accurately complete the SCREEN. The discharge planner must review all community placement options, including, but not limited to: home care; assisted living; home and community based services waiver programs; Supportive Housing, including Community Residence Single Room Occupancy ("CR/SRO"), Supported Single Room Occupancy ("SP/SRO"), Apartment Treatment, and Family Care; Supported Housing, including Scattered Site Apartment and Single Site Apartments; independent housing with the person's family or friends; independent housing not owned or operated by a social service entity; and Senior Housing. >

SCREENS are considered incomplete if any required patient signatures are missing. The individual (and/or legal representative and/or health care agent) must have the opportunity to participate in his/her health care decisions and be provided information on community services. The acknowledgement (item 37 on the SCREEN) cannot be left blank if the person is unwilling/unable to sign and has no legal representative or health care agent to act on their behalf. If the person is unwilling or unable to sign, the person qualified to complete the SCREEN must enter the reason in the space provided for the patient's signature and have a witness co-sign the reason.

The Department of Health will continue to review compliance with the SCREEN and H/C PRI requirements to ensure accurate completion results in appropriate placement and care decisions. Facilities that are non-compliant with these requirements will be cited for violating applicable regulations. Questions regarding training and completion of the SCREEN or H/C PRI may be directed to the Island Peer Review Organization (IPRO), the Department's contractor for SCREEN training, at (866) 333-4702.


Richard Cook
Deputy Commissioner
Office of Health Systems Management