ADW PAS

State of West Virginia Medicaid

Aged and Disabled Waiver
Pre-Admission Screening (PAS)

PAS ID:
PAS Type:
PAS Status:
In Use By:
Offline Checkout:
Offline Checkout:

Create By:
Create Date:
Submit By:
Submit Date:

Vacate Ability

25. In the event of an emergency, the Member can vacate the building (select one):

Home Functional Ability

26. Indicate the Member's functional ability in the home for each item with the level number 1, 2, 3, or 4. Nursing care plan must reflect functional abilities of the client in the home.

a. Eating (not a meal Prep)

b. Bathing

c. Dressing

d. Grooming

e. Continent/Bladder

f. Continent/Bowel

g. Orientation

h. Transferring

i. Walking

j. Wheeling

k. Vision

l. Hearing

m. Communication

n. Describe Functional Ability in the Home

ADW PAS 1.2.0.1