Invoice  Detail: # 20908

Invoice  Date
10/31/2021
Customer Name
Sylvia Smilen Trust
Statement Note
Invoice # 1073 (Old Invoice # system). Customer Sylvia Smilen Trust: Rate = 15.00/hr. Mrs. Sherman: Submitted to John Hancock: Claim #: R12 004 977 via fax @800.638.4040 on Nov 5, 2021@3:46PM. Successful fax confirmation Nov 5, 2021@4:07PM  
Date Task Description Units Total
10/01/2021 Standing Unit of Care for Sylvia Smilen/hr. 10/01/2021 Care: 3:00PM-9:00PM 6.00 90.00
10/06/2021 Standing Unit of Care for Sylvia Smilen/hr. 10/06/2021 Care: 3:00PM-9:00PM 6.00 90.00
10/08/2021 Standing Unit of Care for Sylvia Smilen/hr. 10/08/2021 Care: 3:00PM-9:00PM 6.00 90.00
10/13/2021 Standing Unit of Care for Sylvia Smilen/hr. 10/13/2021 Care: 3:00PM-9:00PM 6.00 90.00
10/15/2021 Standing Unit of Care for Sylvia Smilen/hr. 10/15/2021 Care: 8:00AM-6:00PM 10.00 150.00
10/16/2021 Standing Unit of Care for Sylvia Smilen/hr. 10/16/2021 Care: 6:00PM-9:00PM 3.00 45.00
10/18/2021 Standing Unit of Care for Sylvia Smilen/hr. 10/18/2021 Care: 3:00PM-9:00PM 6.00 90.00
10/20/2021 Standing Unit of Care for Sylvia Smilen/hr. 10/20/2021 Care: 3:00PM-9:00PM 6.00 90.00
10/22/2021 Standing Unit of Care for Sylvia Smilen/hr. 10/22/2021 Care: 3:00PM-9:00PM 6.00 90.00
10/26/2021 Standing Unit of Care for Sylvia Smilen/hr. 10/26/2021 Care: 2:00PM-6:00PM 4.00 60.00
10/29/2021 Standing Unit of Care for Sylvia Smilen/hr. 10/29/2021 Care: 1:00PM-9:00PM 8.00 120.00
    Invoice Totals: 67.00 $1,005.00
Invoice #20908 was created on Sunday, October 31, 2021
This Invoice was paid on Thursday, November 18, 2021

Source Document: Local Storage: Source Docs\John Hancock\Confirmation_JHLTC_DocScan_20211105_Fax.pdf;Local Storage: Source Docs\John Hancock\JHLTC_DocScan_20211105.pdf