When entering the time in entry, follow the format Hours : Minutes AM/PM.
Tasks assigned: for family care and primary home care only.
Employees: if more than one employee serves the individual, list employee name(s).
Record of time: day of month, time in, time out and total daily time, with a monthly total of hours.
| Question | Answer |
|---|---|
| Form Name | Form 3054 |
| Form Length | 1 page |
| Fillable? | Yes |
| Fillable fields | 104 |
| Avg. time to fill out | 18 min |
| Edition | July 2015 |
| Other names | Form 3054, 3054, Texas Form 3054, Primary Home Care Service Delivery Record |
| Official source | Form 3054 July 2015, Primary Home Care Service Delivery Record |
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