CD
Note · Casey Dahl
completedEVV pendingclient signed·Aug 7, 2026, 1:00 PM · 120 min
Service record
Casey Dahl · Individualized home supports without training, 1:1
Medications on 2026-08-07
- 20:00Lamotrigine100 mggiven
- 08:00Metformin500 mggiven
- 20:00Metformin500 mggiven
Authorization SA-2026-00088PMI 34567890UMPI A100000004POS 12
Accepted Aug 7, 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
- Aug 7, 2026, 1:00 PM
- Clock out
- Aug 7, 2026, 3:00 PM
- GPS at clock in
- 44.98249, -93.26092 · ±8 m
- GPS at clock out
- 44.98708, -93.25733 · ±10 m
- Manual entry
- No
- Client signature
- Signed with code Aug 7, 2026, 3:01 PM
Tasks
2 of 2 completed
- Personal care / ADLs
- Skill building per support plan
Shift note
Assisted with room cleanup and laundry. Riley needed hand-over-hand help folding towels, then did the rest alone. Reviewed the week's calendar together.
Edit history
Kept with the note and exported as EVV evidence
No edits since creation.
Edit this note
A reason is required. The change is kept as history and the note is marked manually adjusted for EVV.