DISCIPLINE(circle one):
In signing, I am certifying that I have personally completed this timesheet and the hours are accurate.Fax 1-888-681-9011 or deliver to office. DEADLINES: end of day on the 1st and 16th. Note: your paycheck will be delayed if your time sheet is not received by the above dates.
01-reg. visit(60+miles from/to office or pt. approved02-initial eval/DC eval/&DC Oasis03-RE-eval04-other07-Attempted visit(does not answer door)10-Inservices11-meetings(in office or per request by phone)