HHA/PCA VISIT RECORD FORM SeniorCare HHA, INC. HHA/PCA VISIT RECORD PATIENT’S NAME: PATIENT’S ADDRESS: PHONE #: CAREGIVER’S NAME: CAREGIVER’S #: THE REASON WHY EVV IS MISSING: 6161 Woodhaven Blvd, Ste. 1P, Rego Park, NY 11374 • Tel: (718) 2850705, Fax: (718) 4500755 Email: ygoldman@seniorcarehha.com, jborchak@seniorcarehha.com.