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Notes/Jordan Abelard/Jul 29, 2026, 1:00 PM
JA

Note · Jordan Abelard

completedEVV pendingclient signed·Jul 29, 2026, 1:00 PM · 120 min
Service record
Jordan Abelard · Employment exploration
PDF
Jul 29, 20261:00 PM – 3:00 PM · 120 min · 8 unitsMaria Peterscompletedacceptedclient signed
Clock in
Jul 29, 2026, 1:00 PM
44.9846, -93.2555
Clock out
Jul 29, 2026, 3:00 PM
44.9824, -93.2634
Medications on 2026-07-29
  • 09:15Omeprazole20 mg
Level of interaction
Skills worked on
Daily activitiesPick each activity you did with Jordan
  • Assisted Jordan with coordinating transportation to events, appointments, and social outings
  • Supported Jordan with medication reminders and monitoring for side effects
  • Accompanied Jordan on community outings, providing support as needed to promote comfort and participation
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 29, 2026, 3:02 PM
  • Clientsigned with code Jul 29, 2026, 3:01 PM
  • Reviewaccepted on submission
Authorization SA-2026-00103PMI 12345678NPI 1234567893POS 12
Accepted Jul 29, 2026, 3:02 PM

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 29, 2026, 1:00 PM
Clock out
Jul 29, 2026, 3:00 PM
GPS at clock in
44.98464, -93.25555 · ±8 m
GPS at clock out
44.98241, -93.26335 · ±10 m
Manual entry
No
Client signature
Signed with code Jul 29, 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

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