PASRR Request for Reconsideration
Back to PASRR
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
P.O. Box 997419 MS 4507
Sacramento, CA 95899-7419
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