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Notes/Jordan Abelard/Aug 5, 2026, 9:00 AM
JA

Note · Jordan Abelard

completedEVV pendingclient signed·Aug 5, 2026, 9:00 AM · 195 min
Service record
Jordan Abelard · Individualized home supports with training, 1:1
PDF
Aug 5, 20269:00 AM – 12:15 PM · 195 min · 13 unitsSam Nguyencompletedreturnedclient signed
Clock in
Aug 5, 2026, 9:00 AM
44.9819, -93.2599
Clock out
Aug 5, 2026, 12:15 PM
44.9847, -93.2579
Medications on 2026-08-05
  • 09:15Omeprazole20 mggiven
Level of interaction
Skills worked on
Daily activitiesPick each activity you did with Jordan
  • Assisted Jordan with coordinating transportation to events, appointments, and social outings
  • Supported Jordan with medication reminders and monitoring for side effects
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 5, 2026, 12:17 PM
  • Clientsigned with code Aug 5, 2026, 12:16 PM
  • Reviewreturned Aug 5, 2026, 2:15 PM by Mustafa Ali: Add what prompting you gave during the community outing.
Authorization SA-2026-00101PMI 12345678UMPI A100000003POS 12
Returned for correction Aug 5, 2026, 2:15 PM: Add what prompting you gave during the community outing.

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
13 × 15 min
Place of service
12 · Home
Rendering staff
Sam Nguyen · UMPI A100000003
Authorization
SA-2026-00101
Clock in
Aug 5, 2026, 9:00 AM
Clock out
Aug 5, 2026, 12:15 PM
GPS at clock in
44.98194, -93.25989 · ±8 m
GPS at clock out
44.98474, -93.25790 · ±10 m
Manual entry
No
Client signature
Signed with code Aug 5, 2026, 12:16 PM

Tasks

2 of 2 completed

  • Personal care / ADLs
  • Skill building per support plan

Shift note

Worked on laundry sequence from the support plan: sorted, loaded, and started the machine with verbal prompts only. Reviewed the bus schedule for Thursday's outing. Jordan asked to call a friend and did so independently.

Edit history

Kept with the note and exported as EVV evidence

No edits since creation.

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