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Notes/Jordan Abelard/Jul 28, 2026, 9:00 AM
JA

Note · Jordan Abelard

completedEVV pendingclient signed·Jul 28, 2026, 9:00 AM · 210 min
Service record
Jordan Abelard · Individualized home supports with training, 1:1
PDF
Jul 28, 20269:00 AM – 12:30 PM · 210 min · 14 unitsSam Nguyencompletedacceptedclient signed
Clock in
Jul 28, 2026, 9:00 AM
44.9783, -93.2575
Clock out
Jul 28, 2026, 12:30 PM
44.9810, -93.2623
Medications on 2026-07-28
  • 09:15Omeprazole20 mg
Level of interaction
Skills worked on
Daily activitiesPick each activity you did with Jordan
  • Modeled and practiced communication skills with Jordan in a natural setting
  • Supported Jordan in contacting family, friends, or providers to stay connected
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 Jul 28, 2026, 12:32 PM
  • Clientsigned with code Jul 28, 2026, 12:31 PM
  • Reviewaccepted on submission
Authorization SA-2026-00101PMI 12345678UMPI A100000003POS 12
Accepted Jul 28, 2026, 12:32 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
14 × 15 min
Place of service
12 · Home
Rendering staff
Sam Nguyen · UMPI A100000003
Authorization
SA-2026-00101
Clock in
Jul 28, 2026, 9:00 AM
Clock out
Jul 28, 2026, 12:30 PM
GPS at clock in
44.97827, -93.25747 · ±8 m
GPS at clock out
44.98101, -93.26230 · ±10 m
Manual entry
No
Client signature
Signed with code Jul 28, 2026, 12:31 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.

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Kept with the note and exported as EVV evidence

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