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Notes/Taylor Frey/Aug 19, 2026, 5:30 PM
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Note · Taylor Frey

completedEVV pendingclient signed·Aug 19, 2026, 5:30 PM · 120 min
Service record
Taylor Frey · Independent living skills, individual
PDF
Aug 19, 20265:30 PM – 7:30 PM · 120 min · 8 unitsTobi Okaforcompletedacceptedclient signed
Clock in
Aug 19, 2026, 5:30 PM
44.9841, -93.2620
Clock out
Aug 19, 2026, 7:30 PM
44.9799, -93.2569
Level of interaction
Skills worked on
Daily activitiesPick each activity you did with Taylor
  • Assisted Taylor with developing and following a weekly activity schedule to reduce idle time and promote active daily routines
  • Assisted Taylor with coordinating transportation to events, appointments, and social outings
Support plan goals
Live in my own apartment
Did Taylor cook or plan a meal today?
Did Taylor complete a chore from the checklist without a prompt?
Progress review
signed by staff
Signatures
  • Caregiversigned Aug 19, 2026, 7:32 PM
  • Clientsigned with code Aug 19, 2026, 7:31 PM
  • Reviewaccepted on submission
Authorization SA-2026-00131PMI 45678901UMPI A100000004POS 12
Accepted Aug 19, 2026, 7:32 PM

Aggregator record

Exactly what the EVV aggregator and the 837P claim line receive

Provider tax ID
41-0000000
PMI #
45678901
Service code
H2032 TG
Units
8 × 15 min
Place of service
12 · Home
Rendering staff
Tobi Okafor · UMPI A100000004
Authorization
SA-2026-00131
Clock in
Aug 19, 2026, 5:30 PM
Clock out
Aug 19, 2026, 7:30 PM
GPS at clock in
44.98415, -93.26196 · ±8 m
GPS at clock out
44.97986, -93.25695 · ±10 m
Manual entry
No
Client signature
Signed with code Aug 19, 2026, 7:31 PM

Tasks

2 of 2 completed

  • Personal care / ADLs
  • Skill building per support plan

Shift note

Laundry at the shared laundry room: Taylor loaded, paid with the card, and set a timer. While waiting, practiced reading a bus schedule for the Monday day-support trip.

Edit history

Kept with the note and exported as EVV evidence

No edits since creation.

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