Time Sheet - Achieve Behavioral Associates, L.l.c.
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1
2Achieve Behavioral Associates, L.L.C.
Service Code:
048
Time Sheet
UCI#:
Staff Name:
Non-Billable
Supervision
Training
Month of:
Year:
Total Hours of Services Provided:
Pay Period:
1
or
2
Date
Start Time End Time
Total
Per Session Signature
An authorized signature myst be obtained at the end of every session. Forging signatures is against the company's policy and the law.
The information reported above is an acutal representation of the service provided to the indicated consumer.
My signature indicates that the information contained on this timesheet is true and accurate to the best of my knowledge.
Staff Signature
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