Intercommunity

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  • 612-435-0461
Facebook-f Twitter Instagram
  • 612-435-0461

ILS Time & Activity Form

1First Week
2Second Week

  • Intercommunity Home Health Care– 27 E Franklin Ave – Minneapolis, MN 55404.Ph: 612-435-0283
    Fax: 612-338-1493

    ILS Time and Activity

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    • Thursday

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    • Friday

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    • Saturday

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    • Sunday

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    • Monday

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    • Tuesday

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    • Wednesday

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    • Client/Responsible Party and Staff MUST review the complete time sheet for accuracy before signing. Your signature verifies the time and services entered above are accurate and that the Client was not admitted to another facility during the times provided (i.e. hospital, ICF-MR or Respite facility).

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