Week 1

Week 2

After the PCA has documented his/her time and activity, the recipient must draw a line through any dates and times he/she didnot receive services from the PCA. Review the completed time sheet for accuracy before signing. It is a federal crime to provide false information on PCA billings for Medical Assistance payment. Your signature verifies the time and services entered above are accurate and that the services were performed as specified in the PCA Care Plan.