JA
Note · Jordan Abelard
completedEVV pendingclient signed·Jul 8, 2026, 9:00 AM · 210 min
Service record
Jordan Abelard · Individualized home supports with training, 1:1
Medications on 2026-07-08
- 09:15Omeprazole20 mg
Authorization SA-2026-00101PMI 12345678UMPI A100000003POS 12
Accepted Jul 8, 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 8, 2026, 9:00 AM
- Clock out
- Jul 8, 2026, 12:30 PM
- GPS at clock in
- 44.98667, -93.25726 · ±8 m
- GPS at clock out
- 44.98111, -93.25660 · ±10 m
- Manual entry
- No
- Client signature
- Signed with code Jul 8, 2026, 12:31 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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