• All datasheet documentation should be filled out within 24 hours of completed services.
  • Medicaid will only accept a datasheet filled out in black ink. No other colors are acceptable.
  • All datasheets must be signed and initialed in order to be processed.
  • Documentation must be filled out completely and accurately for each service completed.
  • The full date (Month/Day/Year) must be completed for each day service is delivered.
  • Medicaid will not accept any billing turned in 90 days past the date of delivery. Timesheets turned in later than 60 days of the date of service cannot be processed for payment as USS must have time to process the forms. Therefore, please submit all completed paperwork prior to 60 days of the date of service.

Printable Sheets:

Please insert the client's name and the date legibly on each sheet after printing.