HorizonCare

0.0

Hours This Period

0

Shifts Submitted

📋 Alerts & Reminders

👤 My Assignment

📝 New Timesheet

Employee

Initials/Title

Patient

Pay Period

🕐 Weekly Hours

✱ Your initials are required for every day you work. Client initials fill in automatically.

Day	Date	Time In	Time Out	Hours	HHA Init.	Client Init.

Total Hours Worked

0.0

✅ Tasks / Services Rendered

Tasks load automatically from your patient's care plan.

✍️ Signatures

Employee Signature

Sign here

Client / Guardian Signature

I confirm that I am the patient or authorized guardian and that the services marked above were received during this visit.

🔒 Check the box above to unlock signature

BY SIGNING THIS FORM, YOU ACKNOWLEDGE THAT ALL MARKED SERVICES HAVE BEEN RENDERED

• Notify office at 216-291-7094 for hospitalization, falls, hours changes, or cancellations.

• Timesheets due by 12pm every Monday. Fax: 216-666-2402

• You will not be paid for unauthorized hours. Contact the office with any concerns.

📋 My Submitted Timesheets

📋 Recent Submissions

Welcome back