CD
Note · Casey Dahl
completedEVV pendingclient signed·Jun 19, 2026, 1:00 PM · 120 min
Service record
Casey Dahl · Individualized home supports without training, 1:1
Medications on 2026-06-19
- 20:00Lamotrigine100 mg
- 08:00Metformin500 mg
- 20:00Metformin500 mg
Authorization SA-2026-00088PMI 34567890UMPI A100000004POS 12
Accepted Jun 19, 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
- Jun 19, 2026, 1:00 PM
- Clock out
- Jun 19, 2026, 3:00 PM
- GPS at clock in
- 44.98537, -93.26010 · ±8 m
- GPS at clock out
- 44.97865, -93.25948 · ±10 m
- Manual entry
- No
- Client signature
- Signed with code Jun 19, 2026, 3:01 PM
Tasks
2 of 2 completed
- Personal care / ADLs
- Skill building per support plan
Shift note
Casey completed the kitchen routine (dishes, wipe-down, trash) with a checklist and no prompts. Medications taken on time. Watched a show together and talked about weekend plans.
Edit history
Kept with the note and exported as EVV evidence
No edits since creation.
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