Real IRF-PAI Form Completion Walkthrough
Step-by-step guide to completing an IRF-PAI assessment using a sample patient case
Patient Demographics
- Name: Margaret Thompson
- DOB: 03/15/1952 (Age: 72)
- Gender: Female
- Medicare ID: 123-45-6789A
- Admission Date: 11/15/2025
- Admission Time: 14:30
Clinical Summary
- Primary Diagnosis: Ischemic stroke, left MCA (I63.512)
- Onset Date: 11/10/2025
- Transferred From: Memorial Acute Hospital
- Presenting Symptoms: Right hemiparesis, aphasia
- Rehab Potential: Good
Active Comorbidities
- • Hypertension (I10) - on metoprolol
- • Type 2 Diabetes (E11.9) - on insulin
- • Atrial fibrillation (I48.91) - on warfarin
- • Dyslipidemia (E78.5) - on atorvastatin
Functional Status on Admission
- • Requires moderate assist for transfers
- • Maximal assist for ADLs
- • Unable to ambulate independently
- • Expressive aphasia present
- • Alert and oriented x3
Step-by-Step IRF-PAI Completion
All demographic information matches Medicare card and acute hospital records
FIM scores match PT, OT, SLP, and nursing documentation
Primary diagnosis matches acute hospital discharge diagnosis with medical evidence
All comorbidities have active treatment with physician orders and documentation
Comorbidity tier assignment is accurate based on CMS guidelines
60% Rule qualification verified (stroke = qualifying condition)
Assessment completed within 3-day window (by 11/18/2025)
Interdisciplinary team reviewed and approved all scores
No discrepancies between IRF-PAI and medical record
IRF-PAI Coordinator final review completed before submission
✓ IRF-PAI Ready for Submission
This assessment demonstrates best practices for zero-fault accuracy and MAC audit prevention.