​PASRR Facility Approver Enrollment

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Directions for Facility Administrators to fill out the Facility Approver Certification Appointment Form

To ensure the confidentiality of facilities PASRR data, DHCS requests the facility administrator to designate two contacts for approving staff requests for access in the PASRR system. The Approvers will also be responsible for adding users, removing users, and electronic PASRR File Exchanges. The facility administrator needs to complete and sign the online form and attach it to an email and send to the PASRR@dhcs.ca.gov.


Please do not fill out the form in the browser window, as it will not save your information correctly and can delay the processing of your request. We highly recommend to right click the form link and select the “Save Target As” or “Save Link As” option. The form must be saved to a computer first, then opened with Adobe Acrobat/Reader, for the form to work properly.

The PASRR Facility Approver Certification Appointment form is available: PASRR Facility Approver Certification Appointment.

Instructions:

  1. Download the PASRR Facility Approver Certification Appointment Form by right clicking the “Facility Approver Certification Appointment ” link and selecting one of the “Save as" options to save to your computer first and then open with Adobe Acrobat/Reader. A separate form must be completed for each facility.
  2. Facility Information: Enter the facility name, address, and phone number on file with the California Department of Public Health (CDPH) by using their Cal Health Find.
  3. Facility Type: Select Skilled Nursing Facility (SNF) or General Acute Care Hospital (GACH).
  4. Add or Remove Approvers: Please verify that each approver’s last name, first name, job title, cell phone number, and email address are entered correctly. A facility cannot request enrollment for more than two Approvers.
  5. Authorize: Check box authorizing the facility individuals to have independent authority to approve access requests and file exchanges in the PASRR system. DHCS may rely on approvals, denials, and changes made by the individuals listed on the Facility Approver Certification Appointment Form.
  6. Print name and digitally sign in Adobe: Facility Administrator to digitally sign, print name, add date, and facility email address. If you need assistance with creating a digital signature, please follow the instructions in the Adobe Digital Signature Guide
  7. Submitting the Form: The email must be sent from the signer’s (Facility Administrator) email account. Hand written and scanned forms will not be accepted. The facility administrator must submit the completed form to IT Service Desk by saving the form and emailing as an attachment to PASRR@dhcs.ca.gov with the subject: “Name of your facility" PASRR Request. Please include your first name, last name, and phone number in the body of the email. IT Service Desk will need this information to create a work order ticket for your request.
  8. Create Account: Each approver will receive an email from: Microsoft invitation on behalf of Department of Health Care Service invites@microsoft.com requesting them to accept the invitation with a link to setup their account.

 

Having Issues with the Facility Approver Certification Appointment Form

Please ensure that you are downloading the form from a Windows PC Computer and selecting the “Save as" option before opening and using the form. Please do not fill out the form in the browser window, as it will not save your information correctly and can delay the processing of your request. If you are using Google Chrome, right click the link and select “Save target as" to save to your computer. If you need assistance with creating a digital signature, please follow the instructions in the Adobe Digital Signature Guide. If you are still having issues, please contact ITServiceDesk@dhcs.ca.gov for further assistance.

Last modified date: 3/24/2021 12:29 PM