Timesheet and EVV (Review)

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Timesheet 2024-2025

Here is a copy of the HHA Timesheet to be completed:

EVV (Electronic Visit Verification) REMINDER

1. Write your First Name, Last Name, Employee Phone
   

2. Write the Full Patient Name, Dates, Time IN, Time OUT, and Total Hours, for each work day.
   

3. Write EVV Reason Code (if needed) (Explanation below)
   

4. Write name of Staff Notified (if needed) (Explanation below)
   

5. For EVV by phone : Use the following steps when calling in and out: - Use Patients Phone - Use your Sandata ID #
   

   EVV PHONE NUMBERS 844-926-3925 833-548-1201 *IF you don't have your Sandata ID# or the Patient's Phone is not available, Please call management 24/7 for next step: 202-882-9310 *IF you CAN'T USE EVV by Phone or EVV in Sandata App: You must explain why and do the following steps to get paid for all days & hours not found in EVV : 1. Complete Section "EVV REASON CODE" Number # See Below 2. Complete section "STAFF NOTIFIED" Name (Call 202-822-9310) *Otherwise you will only be paid based on your hours found in EVV

   
   

   EVV REASON CODES / DESCRIPTION

   1 : No Wi-Fi

   2 : Phone Not Working

   3 : Sandata App Offline

   4 : Other/Emergency (Please Explain)

   5 : Technical Issues (Please Explain)

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HHA TIMESHEET - PRINTABLE VERSION :

*Same image as previous image but without underlined sections.

To be included in payroll, timesheet must be returned by monday.

On tuesday, it is considered late.

(CLICK IMAGE TO DOWNLOAD)

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PATIENT ("pt") Daily Condition Sheet :

Instructions :

1. Document any observed changes to patient's physical condition, behaviour, appearance, etc.
   

2. If you need additional space, attach a page to this note.

   
   

3. Notify supervisory staff of any changes or incidents.
   

***In case of emergency, Call 911, and then the office

Here is a copy of Daily Condition sheet to be completed:

(CLICK IMAGE TO DOWNLOAD)

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PCA WEEKLY VISIT RECORD :

(CLICK IMAGE TO DOWNLOAD)

Reminder :

Acknowledgements and Required Signatures

After the PCA had documented their time & activities, the recipient must draw a line through any dates/times they did not receive service.

It is a federal crime for either the beneficiary or PCA to provide false information for medical assistance payments.

Your signature verify the time and services entered above are accurate and that the services were performed as specified in the Care Plan.

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Prepared by PSHC In-Service Exams 2025