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Notes/Jordan Abelard/Jul 1, 2026, 9:00 AM
JA

Note · Jordan Abelard

completedEVV pendingclient signed·Jul 1, 2026, 9:00 AM · 210 min
Service record
Jordan Abelard · Individualized home supports with training, 1:1
PDF
Jul 1, 20269:00 AM – 12:30 PM · 210 min · 14 unitsSam Nguyencompletedacceptedclient signed
Clock in
Jul 1, 2026, 9:00 AM
44.9779, -93.2578
Clock out
Jul 1, 2026, 12:30 PM
44.9869, -93.2552
Medications on 2026-07-01
  • 09:15Omeprazole20 mg
Level of interaction
Skills worked on
Daily activitiesPick each activity you did with Jordan
  • Assisted Jordan with organizing personal belongings and daily tasks
  • Assisted Jordan with physical activity or exercise as tolerated
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 1, 2026, 12:32 PM
  • Clientsigned with code Jul 1, 2026, 12:31 PM
  • Reviewaccepted on submission
Authorization SA-2026-00101PMI 12345678UMPI A100000003POS 12
Accepted Jul 1, 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 1, 2026, 9:00 AM
Clock out
Jul 1, 2026, 12:30 PM
GPS at clock in
44.97790, -93.25780 · ±8 m
GPS at clock out
44.98691, -93.25515 · ±10 m
Manual entry
No
Client signature
Signed with code Jul 1, 2026, 12:31 PM

Tasks

2 of 2 completed

  • Personal care / ADLs
  • Skill building per support plan

Shift note

Jordan planned breakfast, wrote the grocery list, and paid at the register with staff nearby. Practiced counting change; needed one prompt. Walked to the library and checked out two books. Mood bright, no concerns.

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Kept with the note and exported as EVV evidence

No edits since creation.

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