TF
Note · Taylor Frey
completedEVV pendingclient signed·Aug 22, 2026, 4:00 PM · 360 min
Service record
Taylor Frey · Respite care, out of home
Authorization SA-2026-00133PMI 45678901NPI 1234567893POS 99
Accepted Aug 22, 2026, 10:02 PM
Aggregator record
Exactly what the EVV aggregator and the 837P claim line receive
- Provider tax ID
- 41-0000000
- PMI #
- 45678901
- Service code
- S5150 UB
- Units
- 24 × 15 min
- Place of service
- 99 · Other / community
- Rendering staff
- Maria Peters · NPI 1234567893
- Authorization
- SA-2026-00133
- Clock in
- Aug 22, 2026, 4:00 PM
- Clock out
- Aug 22, 2026, 10:00 PM
- GPS at clock in
- 44.98140, -93.26407 · ±8 m
- GPS at clock out
- 44.97902, -93.26094 · ±10 m
- Manual entry
- No
- Client signature
- Signed with code Aug 22, 2026, 10:01 PM
Tasks
2 of 2 completed
- Personal care / ADLs
- Skill building per support plan
Shift note
Out-of-home respite at the Elm Street residence. Taylor settled in with a movie, ate dinner with residents, and completed the bedtime routine independently. Slept through the night.
Edit history
Kept with the note and exported as EVV evidence
No edits since creation.
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