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Notes/Taylor Frey/Aug 5, 2026, 5:30 PM
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Note · Taylor Frey

completedEVV pendingclient signed·Aug 5, 2026, 5:30 PM · 120 min
Service record
Taylor Frey · Independent living skills, individual
PDF
Aug 5, 20265:30 PM – 7:30 PM · 120 min · 8 unitsTobi Okaforcompletedacceptedclient signed
Clock in
Aug 5, 2026, 5:30 PM
44.9830, -93.2588
Clock out
Aug 5, 2026, 7:30 PM
44.9849, -93.2586
Level of interaction
Skills worked on
Daily activitiesPick each activity you did with Taylor
  • Assisted Taylor with organizing personal belongings and daily tasks
  • Assisted Taylor with physical activity or exercise as tolerated
Support plan goals
Live in my own apartment
Did Taylor cook or plan a meal today?
Did Taylor complete a chore from the checklist without a prompt?
Progress review
signed by staff
Signatures
  • Caregiversigned Aug 5, 2026, 7:32 PM
  • Clientsigned with code Aug 5, 2026, 7:31 PM
  • Reviewaccepted on submission
Authorization SA-2026-00131PMI 45678901UMPI A100000004POS 12
Accepted Aug 5, 2026, 7:32 PM

Aggregator record

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

Provider tax ID
41-0000000
PMI #
45678901
Service code
H2032 TG
Units
8 × 15 min
Place of service
12 · Home
Rendering staff
Tobi Okafor · UMPI A100000004
Authorization
SA-2026-00131
Clock in
Aug 5, 2026, 5:30 PM
Clock out
Aug 5, 2026, 7:30 PM
GPS at clock in
44.98298, -93.25883 · ±8 m
GPS at clock out
44.98494, -93.25857 · ±10 m
Manual entry
No
Client signature
Signed with code Aug 5, 2026, 7:31 PM

Tasks

2 of 2 completed

  • Personal care / ADLs
  • Skill building per support plan

Shift note

Independent living skills. Taylor planned and cooked stir fry, using a knife safely with staff nearby. Cleaned up without prompting. Reviewed the apartment inspection checklist for next week.

Edit history

Kept with the note and exported as EVV evidence

No edits since creation.

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