John Doe
Community Living Support · 08:00–10:00 · Maple Street Home
Support level
Extensive
Allergies
Penicillin
Risk flags
Fall risk
Authorization
AUTH-2026-44118
- Start
- EVV
- Note
- Outcome
- Complete
- Signed
1 · Electronic visit verification
2 · Goals for this service
From the current ISP
Community Integration
on trackJohn will independently order and pay for a meal in a community setting.
Method: Verbal prompt fading · 3x weekly
Daily Living
at riskJohn will complete morning hygiene routine with no more than one prompt.
Method: Task analysis checklist · Daily
Health & Safety
on trackJohn will use a mobility aid on uneven terrain when prompted.
Method: Observation · Each community outing
3 · Medication task
4 · Service note
Documentation attaches to this service event
5 · Goal outcome
Completion checks
Evaluated live by the rules engine
Documentation
Service note complete with goal outcome
EVV
GPS check-in/out within site geofence
Goal outcome
2 goal outcome(s) recorded
Staff qualification
All required credentials current
Supervisor signature
Supervisor e-signature applied
Authorization
AUTH-2026-44118 — units available