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Notes/Jordan Abelard/Aug 20, 2026, 9:00 AM
JA

Note · Jordan Abelard

completedEVV pendingclient signed·Aug 20, 2026, 9:00 AM · 180 min
Service record
Jordan Abelard · Individualized home supports with training, 1:1
PDF
Aug 20, 20269:00 AM – 12:00 PM · 180 min · 12 unitsSam Nguyencompletedacceptedclient signed
Clock in
Aug 20, 2026, 9:00 AM
44.9856, -93.2613
Clock out
Aug 20, 2026, 12:00 PM
44.9828, -93.2590
Medications on 2026-08-20
  • 09:15Omeprazole20 mggiven
Level of interaction
Skills worked on
Daily activitiesPick each activity you did with Jordan
  • Assisted Jordan with hygiene routines to promote consistency
  • Assisted Jordan with household tasks such as laundry, dishes, and tidying living areas
  • 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 20, 2026, 12:02 PM
  • Clientsigned with code Aug 20, 2026, 12:01 PM
  • Reviewaccepted on submission
Authorization SA-2026-00101PMI 12345678UMPI A100000003POS 12
Accepted Aug 20, 2026, 12:02 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
12 × 15 min
Place of service
12 · Home
Rendering staff
Sam Nguyen · UMPI A100000003
Authorization
SA-2026-00101
Clock in
Aug 20, 2026, 9:00 AM
Clock out
Aug 20, 2026, 12:00 PM
GPS at clock in
44.98563, -93.26131 · ±8 m
GPS at clock out
44.98282, -93.25903 · ±10 m
Manual entry
No
Client signature
Signed with code Aug 20, 2026, 12:01 PM

Tasks

2 of 2 completed

  • Personal care / ADLs
  • Skill building per support plan

Shift note

Quiet morning. Jordan was tired and needed extra time to start; staff used the visual schedule and Jordan completed all three tasks. Practiced texting the case manager to confirm an appointment. No incidents.

Edit history

Kept with the note and exported as EVV evidence

No edits since creation.

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