JA
Note · Jordan Abelard
completedEVV pendingclient signed·Aug 19, 2026, 1:00 PM · 120 min
Service record
Jordan Abelard · Employment exploration
Medications on 2026-08-19
- 09:15Omeprazole20 mggiven
Authorization SA-2026-00103PMI 12345678NPI 1234567893POS 12
Returned for correction Aug 19, 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
- Aug 19, 2026, 1:00 PM
- Clock out
- Aug 19, 2026, 3:00 PM
- GPS at clock in
- 44.97915, -93.26449 · ±8 m
- GPS at clock out
- 44.98602, -93.25998 · ±10 m
- Manual entry
- No
- Client signature
- Signed with code Aug 19, 2026, 3:01 PM
Tasks
2 of 2 completed
- Personal care / ADLs
- Skill building per support plan
Shift note
Toured the Roseville library back office. Jordan shelved returns for 20 minutes with the volunteer coordinator and stayed on task throughout. Discussed transportation options for a possible volunteer slot.
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Kept with the note and exported as EVV evidence
No edits since creation.
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