Follow the steps to accurately complete your form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the provider agency name in the designated field.
3. Input the direct service worker's name clearly in the respective section.
4. Fill in the recipient's name as it appears on their records.
5. Enter the recipient's date of birth to ensure accurate identification.
6. Specify the week of service by entering the starting date and the ending date in the provided fields.
7. Document the day of the week and enter the specific dates for service each day.
8. Record the arrival and departure times for each service session, including signed initials for verification.
9. Indicate the tasks completed each day by placing initials in the appropriate columns for the type of service provided.
10. At the end of each day, enter the total number of hours worked in the daily total hours field.
11. Calculate the weekly total hours for services provided and fill in this information accordingly.
12. Ensure that the required signatures are collected at the end of the week from the recipient or their representative and from the direct service worker.
13. If applicable, the supervisor's review signature can be recorded in the optional section.
14. Complete any additional descriptions, comments, or notes about services provided on the second page of the form.
15. Once all information is correctly filled out, save changes, download, print, or share the completed form as needed.

Start filling out your LA OAAS-PF-11-015 form online today to ensure accurate record-keeping for Community Choices Waiver services.