Creative Home Care - Missed Visit Timesheet

CLOCK-IN/CLOCK-OUT TIME*

:ClockInAM/PM Option
Until
until :ClockOutAM/PM Option
TOTAL HOURS WORKED*
REASON FOR MISSING VISIT*

Forgot to Call In/Call OutPhone not working or Technical issuesChange in Schedule/Schedule not updatedHHA App ProblemClient received services outside of home

Employee Signature*

Clear
Employee Notice: By your signature above, you certify that the hours posted in this timesheet are accurate and that you worked according to the service plan within authorized units. You also agree to reimburse the amount if you have been overpaid due to technical error or you have provided a false record on this timesheet and also bear the possible legal consequences thereafter.
Consumer Signature*

Clear
Consumer Notice: By your signature above, you certify that the hours are accurate and that care was provided on the date/shifts mentioned above.
Should be Empty:

717-558-4300