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Phone: 913-599-2221
     Fax: 913-599-5660
 

Missed Visit

  All visits are to be recorded through the state's AuthentiCare phone system. Occasionally a phone may not be available at the time of check-in/out. Use this form to notifying Another Day if your Direct Support Worker was unable to use the phone system and missed a check-in or check-out.

Worker Name  
Service Date  
Check-In :    
Check-Out :    
Activity Codes  
Reason    
Verification 1 + 3 =