CD
Note · Casey Dahl
completedEVV pendingclient signed·Aug 3, 2026, 3:30 PM · 120 min
Service record
Casey Dahl · Individual community living support (ICLS)
Medications on 2026-08-03
- 20:00Lamotrigine100 mggiven
- 08:00Metformin500 mggiven
- 20:00Metformin500 mggiven
Authorization SA-2026-00090PMI 34567890NPI 1234567893POS 12
Accepted Aug 3, 2026, 5:32 PM
Aggregator record
Exactly what the EVV aggregator and the 837P claim line receive
- Provider tax ID
- 41-0000000
- PMI #
- 34567890
- Service code
- H2015 U3
- Units
- 8 × 15 min
- Place of service
- 12 · Home
- Rendering staff
- Maria Peters · NPI 1234567893
- Authorization
- SA-2026-00090
- Clock in
- Aug 3, 2026, 3:30 PM
- Clock out
- Aug 3, 2026, 5:30 PM
- GPS at clock in
- 44.98753, -93.26167 · ±8 m
- GPS at clock out
- 44.98002, -93.25840 · ±10 m
- Manual entry
- No
- Client signature
- Signed with code Aug 3, 2026, 5:31 PM
Tasks
2 of 2 completed
- Personal care / ADLs
- Skill building per support plan
Shift note
Worked on scheduling: Casey booked a dentist appointment by phone with a script and staff prompting only at the end. Added it to the paper calendar and phone reminder.
Edit history
Kept with the note and exported as EVV evidence
No edits since creation.
Edit this note
A reason is required. The change is kept as history and the note is marked manually adjusted for EVV.