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Notes/Taylor Frey/Aug 24, 2026, 5:30 PM
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Note · Taylor Frey

completedEVV pendingclient signed·Aug 24, 2026, 5:30 PM · 120 min
Service record
Taylor Frey · Independent living skills, individual
PDF
Aug 24, 20265:30 PM – 7:30 PM · 120 min · 8 unitsTobi Okaforcompletedacceptedclient signed
Clock in
Aug 24, 2026, 5:30 PM
44.9796, -93.2551
Clock out
Aug 24, 2026, 7:30 PM
44.9831, -93.2562
Level of interaction
Skills worked on
Daily activitiesPick each activity you did with Taylor
  • Assisted Taylor with hygiene routines to promote consistency
  • Assisted Taylor with household tasks such as laundry, dishes, and tidying living areas
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 24, 2026, 7:32 PM
  • Clientsigned with code Aug 24, 2026, 7:31 PM
  • Reviewaccepted on submission
Authorization SA-2026-00131PMI 45678901UMPI A100000004POS 12
Accepted Aug 24, 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 24, 2026, 5:30 PM
Clock out
Aug 24, 2026, 7:30 PM
GPS at clock in
44.97960, -93.25508 · ±8 m
GPS at clock out
44.98306, -93.25621 · ±10 m
Manual entry
No
Client signature
Signed with code Aug 24, 2026, 7:31 PM

Tasks

2 of 2 completed

  • Personal care / ADLs
  • Skill building per support plan

Shift note

Reviewed medication refill process at the pharmacy. Taylor picked up the prescription and asked the pharmacist one question. Grocery shopping with a list; stayed within budget.

Edit history

Kept with the note and exported as EVV evidence

No edits since creation.

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