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How to use or fill out 701 N Cass St Jefferson Texas 75657 HHA 903-742-4139 Fax with our platform
- Click ‘Get Form’ to open it in the editor.
- Begin by entering the CLIENT NAME in the designated field at the top of the form. Ensure you include the first name, middle initial, and last name for accurate identification.
- Fill in your HOME HEALTH AIDE NAME similarly, providing your first name, middle initial, and last name.
- Indicate the week of service by filling in the dates for Sunday through Saturday. Use the MM/DD format for clarity.
- For each day of service, record TIME IN and TIME OUT. Be sure to circle AM or PM as appropriate.
- Document daily total hours worked and calculate TOTAL HOURS FOR WEEK at the end of this section.
- In the CARES PERFORMED section, ensure staff initials are documented next to each service provided. Note any refusals as required.
- Complete CLIENT SIGNATURE and HOME HEALTH AIDE SIGNATURE sections with dates before submission.
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See more 701 N Cass St Jefferson Texas 75657 HHA 903-742-4139 Fax versions
| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2014 | 4.8 Satisfied (85 Votes) |
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