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Notes/Casey Dahl/Jul 23, 2026, 1:00 PM
CD

Note · Casey Dahl

completedEVV pendingclient signed·Jul 23, 2026, 1:00 PM · 120 min
Service record
Casey Dahl · Individualized home supports without training, 1:1
PDF
Jul 23, 20261:00 PM – 3:00 PM · 120 min · 8 unitsTobi Okaforcompletedacceptedclient signed
Clock in
Jul 23, 2026, 1:00 PM
44.9853, -93.2614
Clock out
Jul 23, 2026, 3:00 PM
44.9826, -93.2612
Medications on 2026-07-23
  • 20:00Lamotrigine100 mg
  • 08:00Metformin500 mg
  • 20:00Metformin500 mg
Level of interaction
Skills worked on
Daily activitiesPick each activity you did with Casey
  • Assisted Casey with setting boundaries and navigating social interactions
  • Assisted Casey with setting up reminders and systems for appointments and scheduled events
  • Assisted Casey with organizing personal belongings and daily tasks
Support plan goals
Take medications on schedule
Did Casey take scheduled medications with a reminder only?
Progress review
signed by staff
Signatures
  • Caregiversigned Jul 23, 2026, 3:02 PM
  • Clientsigned with code Jul 23, 2026, 3:01 PM
  • Reviewaccepted on submission
Authorization SA-2026-00088PMI 34567890UMPI A100000004POS 12
Accepted Jul 23, 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
Jul 23, 2026, 1:00 PM
Clock out
Jul 23, 2026, 3:00 PM
GPS at clock in
44.98528, -93.26142 · ±8 m
GPS at clock out
44.98264, -93.26120 · ±10 m
Manual entry
No
Client signature
Signed with code Jul 23, 2026, 3:01 PM

Tasks

2 of 2 completed

  • Personal care / ADLs
  • Skill building per support plan

Shift note

Supported grocery put-away and meal prep for tomorrow. Practiced using the microwave safely. Riley chose to call grandmother afterward. Calm evening.

Edit history

Kept with the note and exported as EVV evidence

No edits since creation.

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