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Wheels on the Bus, Inc

Month/year _____ Client Name_____ Provider Name _____ POS = Place of Service. Indicate H for home to verify that is where service was conducted. These services can only take place in the client home. Payments will not be issued for services provided in unapproved sites, and disciplinary actions will be taken. Wheels ON THE BUS, INC TIMESHEET Responsible Person Name _____ Responsible Person Signature_____ Provider Signature _____ *My signature attests that the service dates and times, as well as Place of Service codes are accurate: Attendant Care Attendant Care Date In Out Total *Ratio POS Date In Out Total *Ratio POS Total Hours Total Hours *In no

WHEELS ON THE BUS, INC TIMESHEET Responsible Person Name _____ Responsible Person Signature_____ Provider Signature _____ *My signature attests that the service dates and times, as well as Place of Service codes are accurate: Attendant Care Attendant Care ...

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