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Provide the physical address for where services were provided, not a post office box number.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How should caregivers record dates of service?",{"text":68,"@type":64},"Dates of service must be entered in consecutive order using mm/dd/yy format. The recipient must draw a line through any dates and times services were not provided.",{"name":70,"@type":61,"acceptedAnswer":71},"When and how must the completed timesheet be submitted?",{"text":72,"@type":64},"Submit by email, fax, mail, or in person within thirty (30) days after the first original date of service. Timesheets received after 30 days are held for payment confirmation before the paycheck is issued.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},348644,1791637446,{"code":4,"msg":82,"data":83},"success",[84,89,94,99,104,109,113,118,123],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":95,"doc_module":22,"doc_module_name":25,"category_name":96,"show_sort_weight":97,"slug":98},14,"Invoices",70,"invoices",{"id":100,"doc_module":22,"doc_module_name":25,"category_name":101,"show_sort_weight":102,"slug":103},15,"Posters",60,"posters",{"id":105,"doc_module":22,"doc_module_name":25,"category_name":106,"show_sort_weight":107,"slug":108},16,"Social 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OF RECIPIENT STAY IN HOSPITAL/CARE FACILITY/INCARCERATION |  |  | CURRENT PHONE NUMBERS CHECK □ IF NEW |\n| ADDRESS OF THE LOCATION WHERE SERVICES WERE PROVIDED (DO NOT USE POST OFFICE BOX NUMBERS) RECIPIENT\u003Cbr>CAREGIVER |  |  | ( ) ‐ |\n|  |  |  | ( ) ‐ |\n\nDates of Service  \n(in consecutive order)  \nActivities  \n\n| MM/DD/YY | MM/DD/YY | MM/DD/YY | MM/DD/YY | MM/DD/YY | MM/DD/YY | MM/DD/YY |\n| --- | --- | --- | --- | --- | --- | --- |\n\nSunday Monday Tuesday Wednesday Thursday Friday Saturday  \n\n| Dressing |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| Grooming |  |  |  |  |  |  |  |\n| Bathing |  |  |  |  |  |  |  |\n| Eating |  |  |  |  |  |  |  |\n| Transfers |  |  |  |  |  |  |  |\n| Mobility |  |  |  |  |  |  |  |\n| Positioning |  |  |  |  |  |  |  |\n| Toileting |  |  |  |  |  |  |  |\n| Health Related |  |  |  |  |  |  |  |\n| Behavior |  |  |  |  |  |  |  |\n\nIADL's (only recipients age 18+)  \n\n| Light Housekeeping |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| Laundry |  |  |  |  |  |  |  |\n| Other |  |  |  |  |  |  |  |\n\nVisit One  \n\n| Ratio Staff to Recipient 1:1 1:2 1:3 1:1 1:2 1:3 1:1 1:2 1:3 1:1 1:2 1:3 1:1 1:2 1:3 1:1 1:2 1:3 1:1 1:2 1:3 |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| Shared Care Location |  |  |  |  |  |  |  |\n| Time in\u003Cbr>(circle AM/PM) | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM |\n| Time out\u003Cbr>(circle AM/PM) | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM |\n\nVisit Two  \n\n| Ratio Staff to Recipient 1:1 1:2 1:3 1:1 1:2 1:3 1:1 1:2 1:3 1:1 1:2 1:3 1:1 1:2 1:3 1:1 1:2 1:3 1:1 1:2 1:3 |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| Shared Care Location |  |  |  |  |  |  |  |\n| Time in\u003Cbr>(circle AM/PM) | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM |\n| Time out\u003Cbr>(circle AM/PM) | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM | AM\u003Cbr>PM |\n\nDaily Totals  \nWeekly Total  \n\n|  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- |\n\n\n| Total 1:1 | Total 1:2 | Total 1:3 | Hours worked for other agency |\n| --- | --- | --- | --- |\n|  |  |  |  |\n\nAcknowledgement and Required Signatures If NO hours worked for another agency, mark the circle → ⃝  \nAfter the caregiver has documented his/her time and activity, the recipient must draw a line through any dates and times he/she did not receive services from the caregiver. Review the completed time sheet for accuracy before signing. It is a federal crime to provide false information on billings for Medical Assistance payments. Your signature verifies the time and services entered above are accurate and that the services were performed as specified in the Care Plan.  \n\n| RECIPIENT NAME (FIRST, MI, LAST) | DATE OF BIRTH |  | CAREGIVER NAME (FIRST, MI, LAST) | CAREGIVER UMPI |  |\n| --- | --- | --- | --- | --- | --- |\n| RECIPIENT/RESPONSIBLE PARTY SIGNATURE |  | DATE | CAREGIVER SIGNATURE |  | DATE |\n\nTime sheets must be submitted by email, fax, mail or in person within thirty (30) days after the first original date of service to which the time sheet relates. Time Sheets received after 30 days will be held for confirmation of payment to Home at Heart Care before paycheck is issued.  \nInstructions for Caregiver Time and Activity Documentation  \nThis form documents time and activity between one caregiver and one recipient, up to two visits per day. For more than two visits per day, use a separate form. For shared care, you must use a separate form for each person for whom you are providing care. Home at Heart Care classifies PCAs, Floats, Homemakers, and Housekeepers as caregivers.  \nRecipient Stays  \nEnter dates and location of recipient sta","cbCaif6q6oWoh4te","https://ap.wps.com/l/cbCaif6q6oWoh4te","pdf",118550,"English","# Recipient Stays\n## Service Location Address\n## Service Location Phone Number\n## Dates of Service\n# Activities\n## Activities of Daily Living\n## IADL (age 18+)\n# Visits\n## Visit One\n## Visit Two\n# Totals and Signatures\n## Daily Totals and Weekly Total\n## Acknowledgement and Required Signatures\n# Submission and Compliance","[{\"question\":\"What information must be entered for recipient stays?\",\"answer\":\"Enter the dates and the location where the recipient stayed in a hospital, care facility, or incarceration. Provide the physical address for where services were provided, not a post office box number.\"},{\"question\":\"How should caregivers record dates of service?\",\"answer\":\"Dates of service must be entered in consecutive order using mm/dd/yy format. The recipient must draw a line through any dates and times services were not provided.\"},{\"question\":\"When and how must the completed timesheet be submitted?\",\"answer\":\"Submit by email, fax, mail, or in person within thirty (30) days after the first original date of service. Timesheets received after 30 days are held for payment confirmation before the paycheck is issued.\"}]","Time and Activity Documentation - 2017 Caregiver Timesheet | PDF",1790076383]