​PASRR Request for Reconsideration

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Request for Reconsideration

​If a resident, facility, and/or conservator disagrees with the DHCS Level II Determination, a PASRR Request for Reconsideration can be requested.
The PASRR Request for Reconsideration form is available here: Request for Reconsideration


1. Download the Request for Reconsideration form by clicking the link above and selecting “Save as” to save to your computer.
2. Send the completed form to DHCS by mail or fax.



Department of Health Care Services
Clinical Assurance and Administrative Support Division
PASRR Section
P.O. Box 997419 MS 4507
Sacramento, CA 95899-7419



(916) 319-0980

When DHCS receives the Reconsideration Request, clinical staff will review the case, resulting in a letter with modified recommendation(s) or no changes to the original Determination.

Having Issues with the Reconsideration Form

Please ensure that you are downloading the form by clicking the link above and selecting the “Save as” option before opening and using the form. If you are using Google Chrome, right click the link and select “Save target as” to save to your computer. If you are still having issues, please contact IT Service Desk for further assistance

Phone: (916) 440-7000 and select option 1

E-mail ITServiceDesk@dhcs.ca.gov

Last modified date: 3/24/2021 12:15 AM