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Notes/Jordan Abelard/Aug 12, 2026, 1:00 PM
JA

Note · Jordan Abelard

completedEVV pendingclient signed·Aug 12, 2026, 1:00 PM · 120 min
Service record
Jordan Abelard · Employment exploration
PDF
Aug 12, 20261:00 PM – 3:00 PM · 120 min · 8 unitsMaria Peterscompletedacceptedclient signed
Clock in
Aug 12, 2026, 1:00 PM
44.9856, -93.2611
Clock out
Aug 12, 2026, 3:00 PM
44.9816, -93.2617
Medications on 2026-08-12
  • 09:15Omeprazole20 mggiven
Level of interaction
Skills worked on
Daily activitiesPick each activity you did with Jordan
  • Assisted Jordan with meal planning, grocery shopping, and preparing a meal
  • Assisted Jordan with organizing personal belongings and daily tasks
Support plan goals
Improve social skills
Did Jordan participate in a community outing?
Did Jordan start a conversation with a peer or staff member today?
Cook two meals a week
Did Jordan help plan or cook a meal today?
Progress review
signed by staff
Signatures
  • Caregiversigned Aug 12, 2026, 3:02 PM
  • Clientsigned with code Aug 12, 2026, 3:01 PM
  • Reviewaccepted on submission
Authorization SA-2026-00103PMI 12345678NPI 1234567893POS 12
Accepted Aug 12, 2026, 3:02 PM

Aggregator record

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

Provider tax ID
41-0000000
PMI #
12345678
Service code
T2019 U2
Units
8 × 15 min
Place of service
12 · Home
Rendering staff
Maria Peters · NPI 1234567893
Authorization
SA-2026-00103
Clock in
Aug 12, 2026, 1:00 PM
Clock out
Aug 12, 2026, 3:00 PM
GPS at clock in
44.98555, -93.26113 · ±8 m
GPS at clock out
44.98159, -93.26170 · ±10 m
Manual entry
No
Client signature
Signed with code Aug 12, 2026, 3:01 PM

Tasks

2 of 2 completed

  • Personal care / ADLs
  • Skill building per support plan

Shift note

Toured the Roseville library back office. Jordan shelved returns for 20 minutes with the volunteer coordinator and stayed on task throughout. Discussed transportation options for a possible volunteer slot.

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Kept with the note and exported as EVV evidence

No edits since creation.

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