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Notes/Jordan Abelard/Jul 27, 2026, 9:00 AM
JA

Note · Jordan Abelard

completedEVV pendingclient signed·Jul 27, 2026, 9:00 AM · 210 min
Service record
Jordan Abelard · Individualized home supports with training, 1:1
PDF
Jul 27, 20269:00 AM – 12:30 PM · 210 min · 14 unitsSam Nguyencompletedreturnedclient signed
Clock in
Jul 27, 2026, 9:00 AM
44.9788, -93.2552
Clock out
Jul 27, 2026, 12:30 PM
44.9799, -93.2592
Medications on 2026-07-27
  • 09:15Omeprazole20 mg
Level of interaction
Skills worked on
Daily activitiesPick each activity you did with Jordan
  • Supported Jordan with medication reminders and monitoring for side effects
  • Assisted Jordan with budgeting, paying bills, and tracking spending
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 27, 2026, 12:32 PM
  • Clientsigned with code Jul 27, 2026, 12:31 PM
  • Reviewreturned Jul 27, 2026, 2:30 PM by Mustafa Ali: Add what prompting you gave during the community outing.
Authorization SA-2026-00101PMI 12345678UMPI A100000003POS 12
Returned for correction Jul 27, 2026, 2:30 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
H2014 UC U3
Units
14 × 15 min
Place of service
12 · Home
Rendering staff
Sam Nguyen · UMPI A100000003
Authorization
SA-2026-00101
Clock in
Jul 27, 2026, 9:00 AM
Clock out
Jul 27, 2026, 12:30 PM
GPS at clock in
44.97879, -93.25525 · ±8 m
GPS at clock out
44.97992, -93.25922 · ±10 m
Manual entry
No
Client signature
Signed with code Jul 27, 2026, 12:31 PM

Tasks

2 of 2 completed

  • Personal care / ADLs
  • Skill building per support plan

Shift note

Community outing to Cub Foods. Jordan compared prices on two items and chose the cheaper one without prompting. Cooked pasta for lunch with staff supervising the stove. Reviewed tomorrow's plan on the whiteboard.

Edit history

Kept with the note and exported as EVV evidence

No edits since creation.

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