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Notes/Taylor Frey/Aug 28, 2026, 5:30 PM
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Note · Taylor Frey

completedEVV pendingunsigned·Aug 28, 2026, 5:30 PM · 120 min
Service record
Taylor Frey · Independent living skills, individual
PDF
Aug 28, 20265:30 PM – 7:30 PM · 120 min · 8 unitsTobi Okaforcompletedacceptedunsigned
Clock in
Aug 28, 2026, 5:30 PM
44.9870, -93.2630
Clock out
Aug 28, 2026, 7:30 PM
44.9861, -93.2612
Level of interaction
Skills worked on
Daily activitiesPick each activity you did with Taylor
  • Assisted Taylor with setting up reminders and systems for appointments and scheduled events
  • Modeled and practiced communication skills with Taylor in a natural setting
Support plan goals
Live in my own apartment
Did Taylor cook or plan a meal today?
Did Taylor complete a chore from the checklist without a prompt?
Progress review
signed by staff
Signatures
  • Caregiversigned Aug 28, 2026, 7:32 PM
  • Clientnot signed: Asleep at end of shift. Hand the phone to the person:
  • Reviewaccepted on submission
Authorization SA-2026-00131PMI 45678901UMPI A100000004POS 12
Accepted Aug 28, 2026, 7:32 PM

Aggregator record

Exactly what the EVV aggregator and the 837P claim line receive

Provider tax ID
41-0000000
PMI #
45678901
Service code
H2032 TG
Units
8 × 15 min
Place of service
12 · Home
Rendering staff
Tobi Okafor · UMPI A100000004
Authorization
SA-2026-00131
Clock in
Aug 28, 2026, 5:30 PM
Clock out
Aug 28, 2026, 7:30 PM
GPS at clock in
44.98701, -93.26297 · ±8 m
GPS at clock out
44.98612, -93.26117 · ±10 m
Manual entry
No
Client signature
not signed Asleep at end of shift

Tasks

2 of 2 completed

  • Personal care / ADLs
  • Skill building per support plan

Shift note

Laundry at the shared laundry room: Taylor loaded, paid with the card, and set a timer. While waiting, practiced reading a bus schedule for the Monday day-support trip.

Edit history

Kept with the note and exported as EVV evidence

No edits since creation.

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