The provider agency must maintain service delivery documentation that contains:     
       (1) the name of the person delivering the services;      
       (2) the client's name;      
       (3) the client's Medicaid number;      
       (4) the specific coverage period, including month, day, and year, as applicable;      
       (5) the tasks assigned;      
       (6) the units of service delivered;      
       (7) the dates of service delivery; and      
       (8) certification that the documented services were delivered.      
     Source Note:        The provisions of this §58.133 adopted to be effective April 1, 2004, 29 TexReg 2381