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Notes/Jordan Abelard/Jul 15, 2026, 1:00 PM
JA

Note · Jordan Abelard

completedEVV pendingclient signed·Jul 15, 2026, 1:00 PM · 120 min
Service record
Jordan Abelard · Employment exploration
PDF
Jul 15, 20261:00 PM – 3:00 PM · 120 min · 8 unitsMaria Peterscompletedreturnedclient signed
Clock in
Jul 15, 2026, 1:00 PM
44.9853, -93.2647
Clock out
Jul 15, 2026, 3:00 PM
44.9864, -93.2578
Medications on 2026-07-15
  • 09:15Omeprazole20 mg
Level of interaction
Skills worked on
Daily activitiesPick each activity you did with Jordan
  • Assisted Jordan with hygiene routines to promote consistency
  • Assisted Jordan with household tasks such as laundry, dishes, and tidying living areas
  • Supported Jordan with medication reminders and monitoring for side effects
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 Jul 15, 2026, 3:02 PM
  • Clientsigned with code Jul 15, 2026, 3:01 PM
  • Reviewreturned Jul 15, 2026, 5:00 PM by Mustafa Ali: Add what prompting you gave during the community outing.
Authorization SA-2026-00103PMI 12345678NPI 1234567893POS 12
Returned for correction Jul 15, 2026, 5:00 PM: Add what prompting you gave during the community outing.

Aggregator record

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

Provider tax ID
41-0000000
PMI #
12345678
Service code
T2019 U2
Units
8 × 15 min
Place of service
12 · Home
Rendering staff
Maria Peters · NPI 1234567893
Authorization
SA-2026-00103
Clock in
Jul 15, 2026, 1:00 PM
Clock out
Jul 15, 2026, 3:00 PM
GPS at clock in
44.98526, -93.26465 · ±8 m
GPS at clock out
44.98637, -93.25782 · ±10 m
Manual entry
No
Client signature
Signed with code Jul 15, 2026, 3:01 PM

Tasks

2 of 2 completed

  • Personal care / ADLs
  • Skill building per support plan

Shift note

Employment exploration. Visited Goodwill and spoke with the floor lead about stocking and donation intake. Jordan asked two questions about hours. Afterwards listed what was liked (moving, sorting) and disliked (noise at the register).

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Kept with the note and exported as EVV evidence

No edits since creation.

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