[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-348641-105":53,"doc-detail-348641-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","hmi-home-health-pcahha-time-activity-sheet","HMI Home Health - PCA/HHA Time & Activity Sheet","","PCA/HHA Time & Activity Sheet for HMI Home Health documents daily care activities and time tracking for a beneficiary. The form requires verification that all tasks are performed per the care plan, with caregiver and beneficiary signatures and dates for recorded activities. It includes sections for Activities of Daily Living, mobility, special maintenance, and accompanying or medication reminders. Additional pages capture client condition checks and required acknowledgments, emphasizing accuracy before submission.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/hmi-home-health-pcahha-time-activity-sheet/348641/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/hmi-home-health-pcahha-time-activity-sheet/348641.png","ImageObject",442,249,{"name":88,"@type":89},"Nguyễn Văn Học","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-09-22",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",10,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What does the PCA/HHA Time & Activity Sheet require for each day?","Question",{"text":109,"@type":110},"It requires documenting daily services and hours, with signatures and dates from both the beneficiary and the caregiver for all activities performed.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How are Activities of Daily Living tasks recorded on the form?",{"text":114,"@type":110},"The form lists specific ADL functions (such as bathing, toileting, and meal preparation) with cueing or hands-on assistance options and total time fields, followed by required daily signatures.",{"name":116,"@type":107,"acceptedAnswer":117},"What happens if the time sheet is incomplete or inaccurate?",{"text":118,"@type":110},"Incomplete documents will not be processed. The sheet also states it is a federal crime to provide false billing information, and signatures confirm the entered services were performed as specified in the care plan.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},348641,1791161565,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":76,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":9},1374402739827,"https://ap-avatar.wpscdn.com/avatar/14000c97e7351f1a627?x-image-process=image/resize,m_fixed,w_180,h_180&k=1787885694763230660","HMI HOME HEALTH  \n1707 L St, NW, Suite 900, Washington, DC 20036 PCA/HHA TIME & ACTIVITY SHEET  \nBeneficiary Name:   Beneficiary ID\\#  Place of Service  HHA/ PCA Name:   HHA/PCA NPI\\#   \n\n| Week of  / /  Through  / /  |  |  |  |  |  |  |  | Is Care Plan in Home:  Yes/  No If no, contact the office to get a copy. |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| ALL TASKS MUST BE PREFORMED PER THE CARE PLAN FOR BENEFICIARY/CLIENT |  |  |  |  |  |  |  | HHA’s must observe, document, and report beneficiary's physical condition, behavior, and appearance and report all services provided on a daily basis:\u003Cbr>Beneficiary and aide must sign and date daily for all activities performed. |\n| Date: (mm/dd/yr)\u003Cbr>Day of week\u003Cbr>Time In:(also show:A=am, P=pm)\u003Cbr>Time Out:(also show:A=am, P=pm) Daily Total Hours: | Sun\u003Cbr>_____\u003Cbr>_____ | Mon\u003Cbr>_____\u003Cbr>_____ | Tues\u003Cbr>_____\u003Cbr>_____ | Wed\u003Cbr>_____\u003Cbr>_____ | Thu\u003Cbr>_____\u003Cbr>_____ | Fri\u003Cbr>_____\u003Cbr>_____ | Sat |  |\n| Activities of Daily Living -Cueing or Hands-on Assistance with the following functions |  |  |  |  |  |  |  | MON:\u003Cbr>Beneficiary Signature Date\u003Cbr>HHA Signature Date |\n| Bathing:\u003Cbr>(T)Tub/(SH)Shower/(SP)Sponge/(PC)Perineal Care |  |  |  |  |  |  |  |  |\n| Hair-(SC)Shampoo/Condition/(CB)Comb/Brush |  |  |  |  |  |  |  |  |\n| Oral/dental care (D) clean dentures (S) Shave |  |  |  |  |  |  |  |  |\n| (D) Dressing (L) Layout Clothing |  |  |  |  |  |  |  |  |\n| (S) SkinCare/(F)FootCare/(N)NailCare-Clean & file |  |  |  |  |  |  |  |  |\n| Bathing Total Time: |  |  |  |  |  |  |  | TUE:\u003Cbr>Beneficiary Signature Date\u003Cbr>HHA Signature Date |\n| Toileting-Cueing or Hands-on Assistance with the following functions |  |  |  |  |  |  |  |  |\n| Toileting:(B) Bathroom/Commode Incontinence |  |  |  |  |  |  |  |  |\n| Assisting with Bowel and Bladder Elimination |  |  |  |  |  |  |  |  |\n| Assist with incontinence- Empty urinary drainage bag Y (yes) N ( No) or NA (no catheter) |  |  |  |  |  |  |  |  |\n| Monitoring urine in/output according to POCY (yes) N ( No) or NA |  |  |  |  |  |  |  | WED:\u003Cbr>Beneficiary Signature Date\u003Cbr>HHA Signature Date |\n| Toileting Total Time: |  |  |  |  |  |  |  |  |\n| Eating/Meal Preparation-Cueing or Hands-on Assistance with the following functions |  |  |  |  |  |  |  |  |\n| Meal/Snack preparation (per the dietary guideline) |  |  |  |  |  |  |  |  |\n| Assist with Feeding Cueing-setting up |  |  |  |  |  |  |  |  |\n| Eating/ Meal PreparationTotal Time: |  |  |  |  |  |  |  |  |\n| Mobility |  |  |  |  |  |  |  | THU:\u003Cbr>Beneficiary Signature Date\u003Cbr>HHA Signature Date |\n| Range of Motion Exercise per PT/OT Care Plan |  |  |  |  |  |  |  |  |\n| Assist/Supervise Ambulating:(S)Self/(C) Crutch (AWC)Assist Walker/Cane (WC) Wheelchair |  |  |  |  |  |  |  |  |\n| Transfer-Bed/chair,wheelchair/commode/HoyerLift |  |  |  |  |  |  |  |  |\n| Position Change every 2 hours.\u003Cbr>Indicate which side L, R, back or sitting |  |  |  |  |  |  |  |  |\n| Mobility Total Time: |  |  |  |  |  |  |  | FRI:\u003Cbr>Beneficiary Signature Date\u003Cbr>HHA Signature Date |\n| Special Maintenance-Promoting Safe, Living Environment/Universal Precautions/Infection Control of areas occupied by and or used in the delivery of care to the beneficiary. |  |  |  |  |  |  |  |  |\n| Free of Clutter, trip hazards, rugs (BA) Bathroom (K) Kitchen (BD) Bedroom (LA) Living Area |  |  |  |  |  |  |  |  |\n| Practice Infection Control (Sanitize and Disinfect)(BA) Bathroom/(K) Kitchen/(BD) Bedroom (soiled linen/clothing)/(LA)Living Areas/(DME) Durable Medical Equipment (cane, walker, wheelchair etc.) |  |  |  |  |  |  |  | SAT:\u003Cbr>Beneficiary Signature Date\u003Cbr>HHA Signature Date |\n| Accompany to Medical/Dental appt. recreational/community activities according to POC. N (no) Y( yes) None (NA) |  |  |  |  |  |  |  |  |\n| Medication Reminder-Y(yes)/N( No) or R( refused) |  |  |  |  |  |  |  |  |\n| Assistance with telephone use |  |  |  |  |  |  |  | SUN:\u003Cbr>Beneficiary Signature Date\u003Cbr>HHA Signature Date |\n| Shop","cbCaipcYvGMmrfQt","https://ap.wps.com/l/cbCaipcYvGMmrfQt","pdf",427696,"English","# PCA/HHA Time & Activity Sheet\n## Daily time tracking and signatures\n## Activities of Daily Living and care tasks\n## Special maintenance and infection control\n## Client daily condition checklist and comments\n## Acknowledgments and required signatures","[{\"question\":\"What does the PCA/HHA Time \\u0026 Activity Sheet require for each day?\",\"answer\":\"It requires documenting daily services and hours, with signatures and dates from both the beneficiary and the caregiver for all activities performed.\"},{\"question\":\"How are Activities of Daily Living tasks recorded on the form?\",\"answer\":\"The form lists specific ADL functions (such as bathing, toileting, and meal preparation) with cueing or hands-on assistance options and total time fields, followed by required daily signatures.\"},{\"question\":\"What happens if the time sheet is incomplete or inaccurate?\",\"answer\":\"Incomplete documents will not be processed. The sheet also states it is a federal crime to provide false billing information, and signatures confirm the entered services were performed as specified in the care plan.\"}]","HMI Home Health - PCA/HHA Time & Activity Sheet | PDF",1790076376]