CD
Note · Casey Dahl
completedEVV pendingclient signed·Jul 20, 2026, 1:00 PM · 120 min
Service record
Casey Dahl · Individualized home supports without training, 1:1
Medications on 2026-07-20
- 20:00Lamotrigine100 mg
- 08:00Metformin500 mg
- 20:00Metformin500 mg
Authorization SA-2026-00088PMI 34567890UMPI A100000004POS 12
Accepted Jul 20, 2026, 3:02 PM
Aggregator record
Exactly what the EVV aggregator and the 837P claim line receive
- Provider tax ID
- 41-0000000
- PMI #
- 34567890
- Service code
- S5135 UC
- Units
- 8 × 15 min
- Place of service
- 12 · Home
- Rendering staff
- Tobi Okafor · UMPI A100000004
- Authorization
- SA-2026-00088
- Clock in
- Jul 20, 2026, 1:00 PM
- Clock out
- Jul 20, 2026, 3:00 PM
- GPS at clock in
- 44.97869, -93.26467 · ±8 m
- GPS at clock out
- 44.98680, -93.25550 · ±10 m
- Manual entry
- No
- Client signature
- Signed with code Jul 20, 2026, 3:01 PM
Tasks
2 of 2 completed
- Personal care / ADLs
- Skill building per support plan
Shift note
Household tasks and medication reminder. Riley wiped counters and took out recycling with one prompt each. Evening medications taken with reminder only. No concerns.
Edit history
Kept with the note and exported as EVV evidence
No edits since creation.
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