FOR EMPLOYEES: FORMS & RESOURCES

CCS-TVV Progress Note-Exception Form

Telephonic Visit Verification (Progress) Note

CCS-TVV Progress Note-Exception Form


PROGRESS NOTE: Describe/explain “how/what you did” to assist/support Individual toward achieving their outcome goal(s) as is indicated in the ISP. I actively assisted and supported Individual towards achieving their goals in acquiring, maintaining or improving skills(s) and/or ensuring their health and safety by:

SUNDAY

Time In
Time Out

MONDAY

Time In
Time Out

TUESDAY

Time In
Time Out

WEDNESDAY

Time In
Time Out

THURSDAY

Time In
Time Out

FRIDAY

Time In
Time Out

SATURDAY

Time In
Time Out



TELEPHONIC VISIT EXCEPTION REASON CODE:


[1: No Clock-In] [2: No Clock-Out] [3: Out of Scheduled Time] [4: No Plan of Care Completed] [5: Telephone/Landline Issues]

START TIME
END TIME

START TIME
END TIME

START TIME
END TIME

START TIME
END TIME

START TIME
END TIME

START TIME
END TIME

START TIME
END TIME






I am completing this documentation due to my own error. I also understand that no more than three (3) exceptions are permitted within any pay period or my pay date may be affected and I will need to arrange to visit Casmir’s Administrative Office to receive a paper paycheck.

CONTRACTED WITH:

 

 

LICENSED AND ACCREDITED BY:


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4950 Parkside Ave, Suite 400,
Philadelphia, Pa 19131
Phone: 267-292-3116
Fax: 267-292-4879
support@casmircares.com

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