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Notes/Jordan Abelard/Jul 21, 2026, 9:00 AM
JA

Note · Jordan Abelard

completedEVV pendingclient signed·Jul 21, 2026, 9:00 AM · 210 min
Service record
Jordan Abelard · Individualized home supports with training, 1:1
PDF
Jul 21, 20269:00 AM – 12:30 PM · 210 min · 14 unitsSam Nguyencompletedacceptedclient signed
Clock in
Jul 21, 2026, 9:00 AM
44.9787, -93.2634
Clock out
Jul 21, 2026, 12:30 PM
44.9779, -93.2592
Medications on 2026-07-21
  • 09:15Omeprazole20 mg
Level of interaction
Skills worked on
Daily activitiesPick each activity you did with Jordan
  • Supported Jordan in contacting family, friends, or providers to stay connected
  • Assisted Jordan with setting boundaries and navigating social interactions
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 Jul 21, 2026, 12:32 PM
  • Clientsigned with code Jul 21, 2026, 12:31 PM
  • Reviewaccepted on submission
Authorization SA-2026-00101PMI 12345678UMPI A100000003POS 12
Accepted Jul 21, 2026, 12:32 PM

Aggregator record

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

Provider tax ID
41-0000000
PMI #
12345678
Service code
H2014 UC U3
Units
14 × 15 min
Place of service
12 · Home
Rendering staff
Sam Nguyen · UMPI A100000003
Authorization
SA-2026-00101
Clock in
Jul 21, 2026, 9:00 AM
Clock out
Jul 21, 2026, 12:30 PM
GPS at clock in
44.97870, -93.26344 · ±8 m
GPS at clock out
44.97793, -93.25922 · ±10 m
Manual entry
No
Client signature
Signed with code Jul 21, 2026, 12:31 PM

Tasks

2 of 2 completed

  • Personal care / ADLs
  • Skill building per support plan

Shift note

Community outing to Cub Foods. Jordan compared prices on two items and chose the cheaper one without prompting. Cooked pasta for lunch with staff supervising the stove. Reviewed tomorrow's plan on the whiteboard.

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Kept with the note and exported as EVV evidence

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