JA
Note · Jordan Abelard
completedEVV pendingclient signed·Aug 21, 2026, 9:00 AM · 210 min
Service record
Jordan Abelard · Individualized home supports with training, 1:1
Medications on 2026-08-21
- 09:15Omeprazole20 mggiven
Authorization SA-2026-00101PMI 12345678UMPI A100000003POS 12
Accepted Aug 21, 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
- Aug 21, 2026, 9:00 AM
- Clock out
- Aug 21, 2026, 12:30 PM
- GPS at clock in
- 44.98030, -93.26332 · ±8 m
- GPS at clock out
- 44.98751, -93.25932 · ±10 m
- Manual entry
- No
- Client signature
- Signed with code Aug 21, 2026, 12:31 PM
Tasks
2 of 2 completed
- Personal care / ADLs
- Skill building per support plan
Shift note
Jordan planned breakfast, wrote the grocery list, and paid at the register with staff nearby. Practiced counting change; needed one prompt. Walked to the library and checked out two books. Mood bright, no concerns.
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.