JA
Note · Jordan Abelard
completedEVV pendingclient signed·Aug 4, 2026, 9:00 AM · 180 min
Service record
Jordan Abelard · Individualized home supports with training, 1:1
Medications on 2026-08-04
- 09:15Omeprazole20 mggiven
Authorization SA-2026-00101PMI 12345678UMPI A100000003POS 12
Accepted Aug 4, 2026, 12:02 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
- 12 × 15 min
- Place of service
- 12 · Home
- Rendering staff
- Sam Nguyen · UMPI A100000003
- Authorization
- SA-2026-00101
- Clock in
- Aug 4, 2026, 9:00 AM
- Clock out
- Aug 4, 2026, 12:00 PM
- GPS at clock in
- 44.98751, -93.26002 · ±8 m
- GPS at clock out
- 44.98325, -93.26497 · ±10 m
- Manual entry
- No
- Client signature
- Signed with code Aug 4, 2026, 12:01 PM
Tasks
2 of 2 completed
- Personal care / ADLs
- Skill building per support plan
Shift note
Worked on laundry sequence from the support plan: sorted, loaded, and started the machine with verbal prompts only. Reviewed the bus schedule for Thursday's outing. Jordan asked to call a friend and did so independently.
Edit history
Kept with the note and exported as EVV evidence
No edits since creation.
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