CD
Note · Casey Dahl
completedEVV pendingclient signed·Jul 16, 2026, 3:30 PM · 90 min
Service record
Casey Dahl · Homemaker, home management
Medications on 2026-07-16
- 20:00Lamotrigine100 mg
- 08:00Metformin500 mg
- 20:00Metformin500 mg
Authorization SA-2026-00089PMI 34567890UMPI A100000004POS 12
Accepted Jul 16, 2026, 5:02 PM
Aggregator record
Exactly what the EVV aggregator and the 837P claim line receive
- Provider tax ID
- 41-0000000
- PMI #
- 34567890
- Service code
- S5130 TF
- Units
- 6 × 15 min
- Place of service
- 12 · Home
- Rendering staff
- Tobi Okafor · UMPI A100000004
- Authorization
- SA-2026-00089
- Clock in
- Jul 16, 2026, 3:30 PM
- Clock out
- Jul 16, 2026, 5:00 PM
- GPS at clock in
- 44.98694, -93.26408 · ±8 m
- GPS at clock out
- 44.97837, -93.25586 · ±10 m
- Manual entry
- No
- Client signature
- Signed with code Jul 16, 2026, 5:01 PM
Tasks
2 of 2 completed
- Personal care / ADLs
- Skill building per support plan
Shift note
Deep-cleaned the bathroom and changed bed linens. Organized the medication cabinet and discarded an expired bottle with Casey's agreement. Set out clothes for the week.
Edit history
Kept with the note and exported as EVV evidence
No edits since creation.
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