Sample
Monthly care record
Eleanor A. · Prepared October 1, 2026 for Maria A., agent under power of attorney · Plan: Record plus follow-up
11
1 missed shift, 5 late starts, 3 early departures, 1 unfamiliar caregiver and 1 unreturned call. All 11 resolved.
3
Sept 12: skipped dinner. Sept 18: slipped getting up, no injury noted. Sept 23: more confused after lunch. Each was raised with the agency the same day.
Hospice nurse 8 · aide 9 · social worker 2
From caregivers' check-out notes, not verified by check-in.
Caregiver shifts, first 6 of 60
| Date | Shift | Caregiver | Scheduled | Checked in–out | Verified h | Billed h | Note |
|---|---|---|---|---|---|---|---|
| Tue Sep 1 | Day | Rosa | 7:00–3:00 | 7:02–3:05 | 8.0 | 8.0 | — |
| Tue Sep 1 | Evening | Daniel | 3:00–9:00 | 2:58–9:01 | 6.0 | 6.0 | — |
| Wed Sep 2 | Day | Rosa | 7:00–3:00 | 7:18–3:00 | 7.7 | 8.0 | Late 18 min |
| Wed Sep 2 | Evening | Daniel | 3:00–9:00 | 3:00–9:02 | 6.0 | 6.0 | — |
| Thu Sep 3 | Day | Relief aide | 7:00–3:00 | No check-in | 0.0 | 8.0 | Missed, but billed |
| Thu Sep 3 | Evening | Daniel | 3:00–9:00 | 3:00–8:40 | 5.7 | 6.0 | Left 20 min early |
54 more shifts, with every caregiver note, are in the attached log.
Billing reconciliation · Sample Home Care
Invoice: 420.0 hours at $40.00. Verified: 409.7 hours. The 10.3-hour difference is one missed day shift on September 3 (8.0 h), five late starts (1.6 h) and three early departures (0.7 h).
Credit request for $412.00 ready for approval
Follow-up log, 3 of 11
- Sept 3The relief aide didn't check in for the day shift, and the agency billed 8.0 hours. We asked the agency the same morning; the credit request above covers it.
- Sept 22The evening shift hadn't started at 3:21 PM. We called Sample Home Care at 3:22 PM; Daniel arrived at 3:41 PM. The 41 minutes are in the credit request above.
- Sept 23Maria couldn't reach anyone about a change to Eleanor's evening medication. We reached Sample Home Care's nurse at 4:40 PM; the nurse called Maria at 5:20 PM, and the new schedule was added to this record.
Included each month
This record
PDF and CSV: every shift, note, problem and resolution.
Accounting exhibit
Care paid for against care verified, by month, for trustees and fiduciaries.
Caregiver roster
Everyone who worked in the home, their agency and Home Care Aide Registry number.
How we count: a shift is verified when the caregiver checks in and out from their check-in link with the phone at the home. Hours count inside the scheduled window and round to the nearest 0.1 hour. All names, agencies and amounts on this page are sample data.