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Clear Form*DHS4691ENG* DHS4691ENG816PCA Time and Activity Documentation PCA AGENCY NAMEDates of ServiceDATES/LOCATION OF RECIPIENT STAY IN HOSPITAL/CARE FACILITY/INCARCERATIONMM/DD/YYMM/DD/YYMM/DD/YYMM/DD/YYMM/DD/YYPHONE.

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How to use or fill out the Fillable Online Outlook Is A Spreadsheet Application Fax online

Filling out the Fillable Online Outlook Is A Spreadsheet Application Fax form is a straightforward process designed to ensure clarity and accuracy in documentation. This guide will walk you through each step necessary to complete the form online effectively.

Follow the steps to complete the form accurately.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Enter the PCA agency name along with the agency's phone number in the designated fields. This information is essential for identifying the service provider.
  3. Record the dates of service in consecutive order using the mm/dd/yy format for each visit. Ensure all entries are accurate and that any dates without service are crossed out.
  4. In the activities section, for each date of care, write your initials beside all activities you provided. Only initial once per activity per day, even if it was performed multiple times.
  5. Document the ratio of PCA to recipient for each visit. Circle the correct option (1:1, 1:2, or 1:3) according to the number of recipients you assisted.
  6. Fill in the time in and time out for each visit by entering the hour and minutes and circling AM or PM.
  7. Calculate the total minutes spent on each visit and enter this total in the appropriate section, ensuring it accurately reflects the services provided.
  8. Complete the Acknowledgement and Required Signatures section by having both the recipient and PCA sign and date the form. Ensure that all names are printed clearly, along with identifying information.
  9. Once all the fields are populated, review the completed form for any inaccuracies. After ensuring everything is correct, save your changes, download, or print the form as needed.

Start filling out your PCA Time and Activity Documentation form online to ensure a smooth and accurate submission.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232