Transcription of TEMPUS UNLIMITED, INC., Toll-free Phone #: 1-877 …
1 To://Consumer Name (Print):PCA Name (Print):PCA Telephone #:PCA Last 4 Digits of SSNWEEK#1 Time OutTot. Night signing below, I certify under pain and penalty of perjury that I have received MassHealth PCA services from the PCA during the times described on this activity form; and I am not enrolled in Adult Foster Care and/or Group Adult Foster Period From://Consumer Number: TEMPUS UNLIMITED, INC., 600 Technology Center Drive, Stoughton, MA 02072 Toll-free Phone #: 1-877 -479-7577 Toll-free Fax #: 1-800-359-2884:AMPM:::::AMPMAMPMAMPM:::A MPMAMPMAMPM:::AMPMAMPMAMPM::::AMPMAMPMAM PM:::AMPMAMPMAMPM::AMPMAMPMAMPM:AMPM::AM PMAMPM:::AMPMAMPMAMPM:::AMPMAMPMAMPM:::A MPMAMPMAMPM::::AMPMAMPMAMPM:::AMPMAMPMAM PM::AMPMAMPMAMPM.
2 Total Week 1By signing below, I certify under pain and penalty of perjury that I have providedMassHealth PCA services to the consumer during the times described on this activity form.: Hours6AM to #2 Time OutTot. Night :AMPM::AMPMAMPM::AMPMAMPMAMPM:::AMPMAMPM AMPM:::AMPMAMPMAMPM::::AMPMAMPMAMPM:::AM PMAMPMAMPM::AMPMAMPMAMPM:AMPM::AMPMAMPM: ::AMPMAMPMAMPM:::AMPMAMPMAMPM:::AMPMAMPM AMPM::::AMPMAMPMAMPM:::AMPMAMPMAMPM::AMP MAMPMAMPM:::::::::::::::::::::Total Week 2 Hours6AM to :Telephone #:AMPMAMPMP lease note that TEMPUS pays the PCAbased on daily, not weekly, note that TEMPUS pays the PCAbased on daily, not weekly, up for electronic timesheetsFAST, EASY, ACCURATE!
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