| | text only| | OBRA Level II Evaluative Report (DHS-4248-ENG)
for people with developmental disabilities or related conditions |
| | IMPORTANT: We recommend using Google Chrome to complete this form. |
| | The lead agency (county, tribal nation, or in some cases, the managed care organization) completes this form for all referrals for an OBRA II. This form must be completed and submitted before the person’s admission to a nursing facility.
PURPOSE
Lead agencies use this form to:
1. Record the results of the face to face evaluation
2. Document that the person is known to them and does not have a developmental disability or related condition, or
3. Document the QDDP’s decision that the evidence of the person having a developmental disability or related condition diagnosis reviewed from the OBRA I process is not indicative of diagnosis.
The OBRA II evaluative report is required for people who have or might have developmental disabilities or related conditions. The OBRA Level II evaluative report helps lead agencies determine if the person meets the level of care provided in a nursing facility and if specialized services are needed during the person’s stay. |
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