{"id":5082,"date":"2025-04-19T07:00:56","date_gmt":"2025-04-19T06:00:56","guid":{"rendered":"https:\/\/www.wellcaresupportservices.com\/?page_id=5082"},"modified":"2025-04-19T07:25:24","modified_gmt":"2025-04-19T06:25:24","slug":"activity-report","status":"publish","type":"page","link":"https:\/\/www.wellcaresupportservices.com\/index.php\/activity-report\/","title":{"rendered":"Activity Report"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"5082\" class=\"elementor elementor-5082\">\n\t\t\t\t        <section class=\"elementor-section elementor-top-section elementor-element elementor-element-32e4207 elementor-section-boxed elementor-section-height-default elementor-section-height-default ct-header-fixed-none ct-row-max-none\" data-id=\"32e4207\" data-element_type=\"section\">\n            \n                        <div class=\"elementor-container elementor-column-gap-narrow \">\n                    <div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-8a14dce\" data-id=\"8a14dce\" data-element_type=\"column\">\n        <div class=\"elementor-widget-wrap elementor-element-populated\">\n                    \n                <section class=\"elementor-section elementor-inner-section elementor-element elementor-element-eae5cd1 elementor-hidden-desktop elementor-hidden-tablet elementor-hidden-mobile elementor-section-boxed elementor-section-height-default elementor-section-height-default ct-header-fixed-none ct-row-max-none\" data-id=\"eae5cd1\" data-element_type=\"section\">\n            \n                        <div class=\"elementor-container elementor-column-gap-default \">\n                    <div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-c19903c elementor-hidden-desktop elementor-hidden-tablet elementor-hidden-mobile\" data-id=\"c19903c\" data-element_type=\"column\">\n        <div class=\"elementor-widget-wrap elementor-element-populated\">\n                    \n        \t\t<div class=\"elementor-element elementor-element-e340a8e elementor-widget elementor-widget-image\" data-id=\"e340a8e\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.20.0 - 26-03-2024 *\/\n.elementor-widget-image{text-align:center}.elementor-widget-image a{display:inline-block}.elementor-widget-image a img[src$=\".svg\"]{width:48px}.elementor-widget-image img{vertical-align:middle;display:inline-block}<\/style>\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"156\" height=\"115\" src=\"https:\/\/www.wellcaresupportservices.com\/wp-content\/uploads\/2025\/04\/Capture.png\" class=\"attachment-large size-large wp-image-5094\" alt=\"\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t            <\/div>\n        <\/div>\n                <div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-10e82c5\" data-id=\"10e82c5\" data-element_type=\"column\">\n        <div class=\"elementor-widget-wrap elementor-element-populated\">\n                    \n        \t\t<div class=\"elementor-element elementor-element-59b6aa6 elementor-widget elementor-widget-text-editor\" data-id=\"59b6aa6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.20.0 - 26-03-2024 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p>New Jersey Department of Human Services. Division of Developmental Disabilities <a href=\"http:\/\/www.nj.gov\/humanservices\/ddd\"><u>www.nj.gov\/humanservices\/ddd<\/u><\/a><a href=\"http:\/\/www.nj.gov\/humanservices\/ddd\">\u00a0<\/a><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t            <\/div>\n        <\/div>\n                <div class=\"elementor-column elementor-col-33 elementor-inner-column elementor-element elementor-element-9788e54\" data-id=\"9788e54\" data-element_type=\"column\">\n        <div class=\"elementor-widget-wrap elementor-element-populated\">\n                    \n        \t\t<div class=\"elementor-element elementor-element-40aefff elementor-widget elementor-widget-text-editor\" data-id=\"40aefff\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>Community Based \/ Individual Supports<\/p><p><em>(Not applicable when delivering daily rate version of Individual Supports. \u00a0Only used for 15 minute unit version) <\/em><\/p><p><strong>\u00a0<\/strong><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t            <\/div>\n        <\/div>\n                    <\/div>\n        <\/section>\n        \t\t<div class=\"elementor-element elementor-element-0759e14 elementor-widget elementor-widget-shortcode\" data-id=\"0759e14\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-5086 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-5086\" data-uid=\"6a6be4138f48b\"><br\/><\/div><form\r\n\t\t\t\tid=\"forminator-module-5086\"\r\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-5086 forminator-design--default  forminator_ajax\"\r\n\t\t\t\tmethod=\"post\"\r\n\t\t\t\tdata-forminator-render=\"0\"\r\n\t\t\t\tdata-form-id=\"5086\"\r\n\t\t\t\t\r\n\t\t\t\tdata-design=\"default\"\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\tdata-grid=\"open\"\r\n\t\t\t\t\r\n\t\t\t\t\r\n\t\t\t\tstyle=\"display: none;\"\r\n\t\t\t\t\r\n\t\t\t\tdata-uid=\"6a6be4138f48b\"\r\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a6be4138f48b\" id=\"forminator-field-name-1_6a6be4138f48b-label\" class=\"forminator-label\">Employee&#039;s Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_6a6be4138f48b\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_6a6be4138f48b\" id=\"forminator-field-name-2_6a6be4138f48b-label\" class=\"forminator-label\">Individual&#039;s Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"\" id=\"forminator-field-name-2_6a6be4138f48b\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_6a6be4138f48b\" id=\"forminator-field-text-1_6a6be4138f48b-label\" class=\"forminator-label\">Service Plan Year <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_6a6be4138f48b\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_6a6be4138f48b\" id=\"forminator-field-text-2_6a6be4138f48b-label\" class=\"forminator-label\">ISP Outcome <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"\" id=\"forminator-field-text-2_6a6be4138f48b\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-6a6be4138f48b-label\"><span id=\"forminator-checkbox-group-6a6be4138f48b-label\" class=\"forminator-label\">Service Strategies (Check all that apply) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-checkbox-1-1-6a6be4138f48b-label\" for=\"forminator-field-checkbox-1-1-6a6be4138f48b\" class=\"forminator-checkbox\" title=\"Assistance with Activities of Daily Living (such as getting dressed, eating, personal hygiene, etc.)\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-6a6be4138f48b\" aria-labelledby=\"forminator-field-checkbox-1-1-6a6be4138f48b-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assistance with Activities of Daily Living (such as getting dressed, eating, personal hygiene, etc.)<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6a6be4138f48b-label\" for=\"forminator-field-checkbox-1-2-6a6be4138f48b\" class=\"forminator-checkbox\" title=\"Assistance with Increasing Community Participation (such as daily errands, attending events, restaurant, purchasing items, travel training, etc.)\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-2-6a6be4138f48b\" aria-labelledby=\"forminator-field-checkbox-1-2-6a6be4138f48b-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assistance with Increasing Community Participation (such as daily errands, attending events, restaurant, purchasing items, travel training, etc.)<\/span><\/label><label id=\"forminator-field-checkbox-1-3-6a6be4138f48b-label\" for=\"forminator-field-checkbox-1-3-6a6be4138f48b\" class=\"forminator-checkbox\" title=\"Assistance with Increasing Independence (such as helping the individual learn to do laundry, cook, clean, dress, grocery shop, pay for items, etc.)\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Assistance-with-Increasing-Independence-(such-as-helping-the-individual-learn-to-do-laundry,-cook,-clean,-dress,-grocery-shop,-pay-for-items,-etc.)\" id=\"forminator-field-checkbox-1-3-6a6be4138f48b\" aria-labelledby=\"forminator-field-checkbox-1-3-6a6be4138f48b-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assistance with Increasing Independence (such as helping the individual learn to do laundry, cook, clean, dress, grocery shop, pay for items, etc.)<\/span><\/label><label id=\"forminator-field-checkbox-1-4-6a6be4138f48b-label\" for=\"forminator-field-checkbox-1-4-6a6be4138f48b\" class=\"forminator-checkbox\" title=\"Assistance with On-The-Job Support (such as safety awareness, using the restroom, attending to task, lunch\/breaks, etc.)\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Assistance-with-On-The-Job-Support-(such-as-safety-awareness,-using-the-restroom,-attending-to-task,-lunch-breaks,-etc.)\" id=\"forminator-field-checkbox-1-4-6a6be4138f48b\" aria-labelledby=\"forminator-field-checkbox-1-4-6a6be4138f48b-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assistance with On-The-Job Support (such as safety awareness, using the restroom, attending to task, lunch\/breaks, etc.)<\/span><\/label><label id=\"forminator-field-checkbox-1-5-6a6be4138f48b-label\" for=\"forminator-field-checkbox-1-5-6a6be4138f48b\" class=\"forminator-checkbox\" title=\"Assistance with Learning Activities (such as basic tutoring \u2013 math, reading, writing; support in attending a class; etc.)\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Assistance-with-Learning-Activities-(such-as-basic-tutoring-\u2013-math,-reading,-writing;-support-in-attending-a-class;-etc.)\" id=\"forminator-field-checkbox-1-5-6a6be4138f48b\" aria-labelledby=\"forminator-field-checkbox-1-5-6a6be4138f48b-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Assistance with Learning Activities (such as basic tutoring \u2013 math, reading, writing; support in attending a class; etc.)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_6a6be4138f48b\" id=\"forminator-field-text-3_6a6be4138f48b-label\" class=\"forminator-label\">Date <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_6a6be4138f48b\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_6a6be4138f48b\" id=\"forminator-field-text-4_6a6be4138f48b-label\" class=\"forminator-label\">Start Time <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"\" id=\"forminator-field-text-4_6a6be4138f48b\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_6a6be4138f48b\" id=\"forminator-field-text-5_6a6be4138f48b-label\" class=\"forminator-label\">End Time <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_6a6be4138f48b\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_6a6be4138f48b\" id=\"forminator-field-textarea-1_6a6be4138f48b-label\" class=\"forminator-label\">Individualized Activity <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-1\" placeholder=\"Individualized Activity\" id=\"forminator-field-textarea-1_6a6be4138f48b\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_6a6be4138f48b\" id=\"forminator-field-textarea-2_6a6be4138f48b-label\" class=\"forminator-label\">Tell us about the day, and how the activities will help the individual reach the above outcome <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-2\" placeholder=\"Tell us about the day, and how the activities will help the individual reach the above outcome\" id=\"forminator-field-textarea-2_6a6be4138f48b\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_6a6be4138f48b\" id=\"forminator-field-text-6_6a6be4138f48b-label\" class=\"forminator-label\">Total Hours Worked <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_6a6be4138f48b\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-7\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-7_6a6be4138f48b\" id=\"forminator-field-text-7_6a6be4138f48b-label\" class=\"forminator-label\">Completed By <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-7\" value=\"\" placeholder=\"\" id=\"forminator-field-text-7_6a6be4138f48b\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"signature-1\" class=\"forminator-field-signature forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-field-signature\"><label for=\"forminator-field-ctlSignature6a6be413908b4\" id=\"forminator-field-ctlSignature6a6be413908b4-label\" class=\"forminator-label\">Signature <span class=\"forminator-required\">*<\/span><\/label><div class=\"forminator-signature\" data-elementheight=\"112\"><span id=\"ctlSignature6a6be413908b4_placeholder\" class=\"forminator-signature--placeholder\" aria-hidden=\"true\">Start signing your signature here<\/span><div id=\"ctlSignature6a6be413908b4_Container\" class=\"forminator-signature--container\"><canvas id=\"ctlSignature6a6be413908b4\" class=\"forminator-signature-canvas\" height=\"112\" tabindex=\"-1\"><p>Your browser does not support e-Signature field.<\/p><\/canvas><\/div><\/div><input type=\"hidden\" name=\"field-signature-1\" value=\"6a6be413908b4\" class=\"signature-prefix\"><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Submit<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"2e67376304\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/5082\" \/><input type=\"hidden\" name=\"form_id\" value=\"5086\"><input type=\"hidden\" name=\"page_id\" value=\"5082\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.wellcaresupportservices.com\/index.php\/activity-report\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t            <\/div>\n        <\/div>\n                    <\/div>\n        <\/section>\n        \t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>New Jersey Department of Human Services. Division of Developmental Disabilities www.nj.gov\/humanservices\/ddd\u00a0 Community Based \/ Individual Supports (Not applicable when delivering daily rate version of Individual Supports. \u00a0Only used for 15 minute unit version) \u00a0<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5082","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.wellcaresupportservices.com\/index.php\/wp-json\/wp\/v2\/pages\/5082","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.wellcaresupportservices.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.wellcaresupportservices.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.wellcaresupportservices.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wellcaresupportservices.com\/index.php\/wp-json\/wp\/v2\/comments?post=5082"}],"version-history":[{"count":10,"href":"https:\/\/www.wellcaresupportservices.com\/index.php\/wp-json\/wp\/v2\/pages\/5082\/revisions"}],"predecessor-version":[{"id":5112,"href":"https:\/\/www.wellcaresupportservices.com\/index.php\/wp-json\/wp\/v2\/pages\/5082\/revisions\/5112"}],"wp:attachment":[{"href":"https:\/\/www.wellcaresupportservices.com\/index.php\/wp-json\/wp\/v2\/media?parent=5082"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}