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Contact Sheets

You will fill out one Contact Sheet for each consumer for every two week period. This two week period will correspond to each pay period.


To access and download PCA Contact Sheets, please use the link below:

PCA Contact Sheet

To see an example of a completed Contact Sheet, please use the link below:

PCA Contact Sheet (Sample)

To access and download Homemaker/Respite Contact Sheets, please use the link below:

Homemake/Respite Contact Sheet

To see an example of a completed Homemaker/Respite Contact Sheet, please use the link below:

Homemaker/Respite Contact Sheet (Sample)


IMPORTANT things to remember . . .

In order to ensure that consumers will be able to continue
to benefit from PCA Choice services, it is IMPORTANT
that both PCAs and consumers remember the following:


  • It is a federal crime to provide false information on PCA billings for medical assistance payment.

    Your signature, (or telephone input when using the Dial-n-Documents), verifies the time and services are accurate and that the services were performed as specified in the PCA Care Plan.

  • All parties are responsible for complying with all rules and regulations
    related to the PCA program.


    This includes, but is not limited to:
    1. MN State Vulnerable Adults Act
    2. Data Privacy regulations
    3. PCA regulations, including medication administration
    4. Department of Labor laws governing overtime

  • If you are a consumer or a PCA for Access North, you are responsible to know and follow the PCA Handbook, as well as the PCA Agreements.