Ivey Jack DOS Start Time:HH : MM AMPMAM/PM End Time:HH : MM AMPMAM/PM Place of ServiceHomeDay CareOther Note:TERMS OF ACCEPTANCE and SIGNATUREI, Katherine Stanton for this treatment note, warrant the truthfulness of the information provided in this application. Electronic Signature: Confirm:I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.SubmitReset Share this:Facebook