Printable invoice for a homecare service provided 2013 form-2026

1. Click ‘Get Form’ to open the printable invoice for a homecare service provided 2013 form in the editor.
2. Begin by entering the insured’s claim ID and their full name, followed by the informal caregiver’s name. This ensures proper identification of all parties involved.
3. For each date of service, input the time in and time out, making sure to specify a.m. or p.m. Round the time to the nearest quarter hour for accuracy.
4. Fill in the total hours worked, approved hourly charge as per your plan of care, and calculate the daily total for each entry.
5. Summarize the total reimbursement amount requested at the bottom of the form.
6. Indicate which activities of daily living were provided by marking an 'X' in the appropriate boxes next to each service listed.
7. Enter any check or transaction numbers that correspond with each date of service and attach proof of payment as specified in the instructions.
8. Ensure both the informal caregiver and insured (or their legal representative) sign and date the invoice after services are rendered. Remember that photocopied signatures are not accepted.

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