* Required Information
HHA Exchange Incomplete Call ins/Call Outs Verification Form
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Please document the reason for your missed Clock in/Clock out on HHA Exchange EVV. Call the office within 24 hrs. of missed clocks so appropriate action can be taken to adjust the calendar. After hours messages can be left on voice messaging and retrieved the next business day. This form MUST be received in the office on Monday by 12pm to confirm change in order to bill for that day.

Note: Only 10% correction allowed