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Notes/Jordan Abelard/Sep 4, 2026, 5:51 PM
JA

Note · Jordan Abelard

completedEVV pendingclient signed·Sep 4, 2026, 5:51 PM · 0 min
Service record
Jordan Abelard · Individualized home supports with training, 1:1
PDF
Sep 4, 20265:51 PM – 5:51 PM · 0 min · 0 unitsMustafa Alicompletedacceptedclient signed
Clock in
Sep 4, 2026, 5:51 PM
44.8966, -93.4149
Clock out
Sep 4, 2026, 5:51 PM
44.8966, -93.4149
Medications on 2026-09-04
  • 09:15Omeprazole20 mg
Level of interaction
Skills worked on
Daily activitiesPick each activity you did with Jordan
  • Assisted Jordan with budgeting, paying bills, and tracking spending
  • Supported Jordan in practicing coping strategies during moments of stress or frustration
  • Provided supervision and safety monitoring throughout the service
Support plan goals
Improve social skills
Did Jordan participate in a community outing?
Did Jordan start a conversation with a peer or staff member today?
Cook two meals a week
Did Jordan help plan or cook a meal today?
Progress review
signed by staff
Signatures
  • Caregiversigned Sep 4, 2026, 5:52 PM
  • Clientsigned with code Sep 4, 2026, 5:53 PM
  • Reviewaccepted on submission
Authorization SA-2026-00101PMI 12345678UMPI A100000001POS 12
Accepted Sep 4, 2026, 5:52 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
0 × 15 min
Place of service
12 · Home
Rendering staff
Mustafa Ali · UMPI A100000001
Authorization
SA-2026-00101
Clock in
Sep 4, 2026, 5:51 PM
Clock out
Sep 4, 2026, 5:51 PM
GPS at clock in
44.89664, -93.41489 · ±35 m
GPS at clock out
44.89664, -93.41489 · ±35 m
Manual entry
No
Client signature
Signed with code Sep 4, 2026, 5:53 PM

Tasks

1 of 2 completed

  • Meal preparation
  • Community integration

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