Time Card
Documents
Instructions For PCA Time and Activity Documentation
The time card has two sides: Week 1 on one side and Week 2 on the back. Be certain you put the dates on the correct side and fill in both sides correctly.
Make certain you have the following information listed below correct on your timecard for faster processing.
- Current phone number on top
- Eligible name (employee name, dates, signatures)
- SS number
- Dates of hospitilization, jail, and institutionalizations
- Correct pay period dates
- Daily dates, and client/responsible party daily initials
- Lines through non-working days
- Time in and out
- Circling of a.m./p.m.
- Correct daily hours
- Incident reports (if applicable)
- Correct work hours
- Initial daily activities (employee)
- Correct pay period hours
- Client signature/date/date of birth
- Employee #/signature/date
- Total hours of all time sheets
- No overlapping of time between clients (if working with more than one recipient)
- Follow care plan
The time card documents time and activity between one PCA, Homemaker, Chore or Respite Provider, and one recipient.
Document up to three regular PCA visits per day.
NOTE: The time card is NOT to be used for shared care.
Description of Sections
Dates of Service
In order for the time card to be valid, you must enter the date in mm/dd/yy format for each date you provide service. The recipient must draw a line through any dates and times the services were not provided.
Dressing
Appropriate clothing for the day: includes laying-out of clothing, actual applying and changing clothing, orthotics, prosthetics, transfers, mobility, and positioning to complete this task
Grooming
Personal hygiene, includes hair care, oral care, nail care, shaving, applying cosmetics and deodorant, care of eyeglasses, contact lens, hearing aids, and applying orthotics
Bathing
Starting and finishing a bath or shower, transfers mobility, positioning, using soap, rinsing, drying, inspecting of skin, applying lotion
Eating
Getting food into the body, transfers, mobility, positioning, hand washing, applying of orthotics needed for eating, feeding, preparing meals, and grocery shopping
Transfers
Moving from one seating/reclining area or position to another
Mobility
Moving from one place to another including using a wheelchair
Positioning
Moving the person’s body for necessary care and comfort or to relieve pressure areas
Toileting
Bowel/bladder elimination and care, transfers, mobility, positioning, feminine hygiene, using the toileting equipment or supplies, cleansing the perineal areas, and inspecting skin and adjusting clothing
Light Housekeeping
Light housekeeping may include washing dishes, putting dishes in dishwasher, clearing tables, taking out garbage, making bed and cleaning bathroom. This may also include vacuuming, sweeping, and mopping of floors. This is used for Homemaker services.
Laundry
Laundry integral to personal care; includes sorting clothes, putting clothes in washer and dryer, adding soap and/or dryer sheet, folding and putting away clothes
Health-Related Functions
Hands on assistance, supervision, and cueing for health-related tasks under the direction of a Qualified Professional or the person’s physician
Behavior
Redirecting, intervening, observing, monitoring, and documentation of behavior
Respite
This is a service in which the client must be pre-approved for before doing this activity.
Other
Other activities performed in the care plan or other services on a service agreement by DHS that are not listed in the activity list
Visit One
Put your 1st visit of the day with your client.
Time In
Enter time in hours and minutes (rounding to the nearest quarter hour), and circle a.m. or p.m.
Time Out
Enter time in hours and minutes (rounding to the nearest quarter hour) that you stopped providing care, and circle a.m. or p.m.
Visit Two
If you return to your client for a second visit that day, put your time in and time out here.
Visit Three
If you return to your client for a third visit that day, put your time in and time out here.
Visit 4th Late PCA
This section is never to be used.
Chore
Note: You must never put anything here unless Social Services has screened your client for Chore service an approved them.
Respite
Note: You must never put anything here unless Social Services has screened your client for Respite services and approved them.
Clients Initial Daily
The client must initial here every day, or the PCA will not be paid. By initialing this the client is verifying that the PCA has completed the task marked for that day.
Total Daily Time
Add the total time in hours and minutes (rounding to the nearest quarter hour) that you spent with your client for the care documented in one column.
Total Week 1
Add all daily hours and minutes (round off to the nearest quarter hour), and write in Week 1.
Total Week 2
Add all daily hours and minutes (round off to the nearest quarter hour), and write in Week 2.
Total Time Both Sides
Add both week 1 and week 2 totals together, and put the total in the Total Time Both Sides box.