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Notes/Jordan Abelard/Sep 1, 2026, 9:00 AM
JA

Note · Jordan Abelard

completedEVV pendingclient signed·Sep 1, 2026, 9:00 AM · 210 min
Service record
Jordan Abelard · Individualized home supports with training, 1:1
PDF
Sep 1, 20269:00 AM – 12:30 PM · 210 min · 14 unitsSam Nguyencompletedacceptedclient signed
Clock in
Sep 1, 2026, 9:00 AM
44.9804, -93.2630
Clock out
Sep 1, 2026, 12:30 PM
44.9821, -93.2635
Medications on 2026-09-01
  • 09:15Omeprazole20 mggiven
Level of interaction
Skills worked on
Daily activitiesPick each activity you did with Jordan
  • Assisted Jordan with physical activity or exercise as tolerated
  • 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 1, 2026, 12:32 PM
  • Clientsigned with code Sep 1, 2026, 12:31 PM
  • Reviewaccepted on submission
Authorization SA-2026-00101PMI 12345678UMPI A100000003POS 12
Accepted Sep 1, 2026, 12:32 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
14 × 15 min
Place of service
12 · Home
Rendering staff
Sam Nguyen · UMPI A100000003
Authorization
SA-2026-00101
Clock in
Sep 1, 2026, 9:00 AM
Clock out
Sep 1, 2026, 12:30 PM
Manual entry
No
Client signature
Signed with code Sep 1, 2026, 12:31 PM

Tasks

2 of 2 completed

  • Personal care / ADLs
  • Skill building per support plan

Shift note

Staff provided community support and transportation for Winifred to attend a women's support group, "Circle of Healing." Staff assisted Winifred with safe transportation, arrival, and navigating the environment due to mobility limitations. Upon arrival, staff remained available for support and supervision throughout the duration of the group. During the group session, Winifred was attentive and engaged. She participated by listening to group discussions and shared limited personal reflections when prompted. Topics during the group included emotional wellness, coping strategies, self-reflection, and setting intentions for the new year. Winifred demonstrated appropriate social behavior, maintained a calm demeanor, and interacted respectfully with group members. Staff provided encouragement, reassurance, and verbal prompting as needed to support participation and comfort in the group setting. Winifred's mood throughout the group was stable and cooperative. She appeared relaxed and expressed appreciation for attending the session. No behavioral concerns were observed. Staff remained present to ensure safety, provide emotional support, and assist with transitions as needed. Following the group outing, Staff transported Winifred to a relative's home to attend a New Year family gathering. Staff assisted with transportation, arrival, and ensured Winifred's safety during the transition. At the family gathering, Winifred engaged appropriately with relatives, participated in conversation, and appeared comfortable in the social setting. Staff provided supervision, redirection as needed, and ensured Winifred's needs were met throughout the visit. Throughout the session, staff monitored Winifred for fatigue and mobility concerns, provided reminders to rest as needed, and ensured a safe and supportive environment. No major challenges were noted during this session.

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