Therapist's Name: Title: Week Starting: Client's Name: Physical, Occupational, and Speech Therapists and their Assistants will use this timesheet to document: Travel time to and from the client's home for in-home therapy visits. Travel miles to and from the client's home. Please utilize the "TRIP" meter to record mileage. Start and end time of the therapy visit provided at the client's home. Note: dates and times MUST NOT overlap with other client's timesheets. A copy of this timesheet will be filed in the Client's chart. This form will be used in addition to the other required forms which may include the Physical Therapy Plan of Care, Therapy Progress Note, Home Health Evaluation Plan of Care, or any other required documents. Travel to Client' Home Client Visit Travel from Client's Home Total Total Total Date Time Time Time Time Time Time Travel Travel Visit (mm/dd/yyyy) Start End Miles Start End Start End Miles Time Tours Hours
Therapist's Name: Title: Week Starting: Client's Name: Physical, Occupational, and Speech Therapists and their Assistants will use this timesheet to document: Travel time to and from the client's home for in-home therapy visits. Travel miles to and from the client's home. Please utilize the "TRIP" meter to record mileage. Start and end time of the therapy visit provided at the client's home. Note: dates and times MUST NOT overlap with other client's timesheets. A copy of this timesheet will be filed in the Client's chart. This form will be used in addition to the other required forms which may include the Physical Therapy Plan of Care, Therapy Progress Note, Home Health Evaluation Plan of Care, or any other required documents. Date (mm/dd/yyyy) Travel to Client' Home Client Visit Travel from Client's Home Total Travel Time Total Travel Tours Total Visit Hours Time Start Time End Miles Time Start Time End Time Start Time End Miles
Skilled%20Services%20Timesheet%20Combined%28OFFICE%29.docx