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id_1711476767.61594 | Mark Saunders |
26/20/04 08:30
1 12
>>
unknown
P 3/29
Assessment
(1) Myofascial pain 729.1/M79.1
(2) Cervical myofascial strain, subsequent encounter
Strain of muscle, fascia and tendon at neck level, subsequent encounter
V58.89/516.1XXD
Plan
Orders
Lidocaine 10mg (J2001) - 729.1/M79.1, - 847.0/S16.1XXD - 10/23/2023 - Hold lab results until reviewed :No
Ultrasound guidance for needle placement (76942) - - 10/23/2023 - Hold lab results until reviewed :No
Tendon origin/insertion injection (20551) - 729.1/M79.1, 847.0/S16.1XXD - 10/23/2023 - Hold lab results until
reviewed :No
Trigger point(s), 3 or more muscles (20553) - 729.1/M79.1, 847.0/516.1XXD - 10/23/2023 - Hold lab results until
reviewed :No
Instructions
Please refer to discharge sheet.
The supervising physician is on site to provide direct personal supervision involing the patient's care during their
office visit today.
This document is prepared by automatic population of appropriate fields, typed and or formatted entry.
The reader is encouraged to contact me directly with any issue or questions.
Electronically Signed by: David Brooks, PA -Author on 21/18/04 02:16:58 PM
[Digital Signature Validated]
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711475620.537323 | Peter Fernandez |
Peter Fernandez DOB: Jan 07, 1993 (26 yo M) Acc No. 48370 Doc Name: Dec 11, 2018 NP Forms
I do 00 /do not
authorize the release of information pertaining to HIV/AIDS
Purpose of the Requested Disclosure
I am authorizing the release of my Protected Health Information for the following purposes:
Medical Care
Insurance
At the request of patient
Other (specify)
Request by Attorney
Time Period for this Authorization
This Authorization will expire five years from the date of its execution.
Revocation of This Authorization
| understand that I have the right to revoke this Authorization at any time to prohibit future release
of my information. To revoke this Authorization, 1 must send written notice to LA Health
Solutions, to the attention of LA Health Solutions Medical Records Division at the address
indicated above. I understand that my revocation of this Authorization applies to future disclosures
only and will not have any effect on any disclosures of Protected Health Information made before
receiving the revocation.
Redisclosure
I understand that my Protected Health Information disclosed pursuant to this Authorization may
be redisclosed by the recipient identified above and may no longer be protected from disclosure to
others by federal or state law.
Waiver
I hereby expressly waive any claim of privilege or privacy with respect to the released information.
1 release and forever discharge LA Health Solutions and its agents, servants, or employees from
all liability or claims, of any kind or character, in any way arising out of the disclosure of the
requested information, including disclosures made in good faith.
Voluntary
1 understand that signing this authorization is voluntary. My treatment, payment, enrollment in a
health plan, or eligibility for benefits will not be conditioned upon my authorization of this
disclosure.
Signature of Patient/Patient's Representative:
Date:
Jabbith
Dec 15, 2016
Printed Name of Patient's Representative:
Relationship to Patient:
Peter Fernandez DOB: Jan 07, 1993 (26 yo M) Acc No. 48370 Doc Name: Dec 11, 2018 NP Forms
Page 100 of 123
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711475620.535537 | Dale Miller |
Dale Miller DOB: 1987/06/12 (43 yo M) Acc No. 47046 Doc Name: 2016/30/05 NP Forms
I do 00 /do not
authorize the release of information pertaining to HIV/AIDS
Purpose of the Requested Disclosure
I am authorizing the release of my Protected Health Information for the following purposes:
Medical Care
Insurance
At the request of patient
Other (specify)
Request by Attorney
Time Period for this Authorization
This Authorization will expire five years from the date of its execution.
Revocation of This Authorization
| understand that I have the right to revoke this Authorization at any time to prohibit future release
of my information. To revoke this Authorization, 1 must send written notice to LA Health
Solutions, to the attention of LA Health Solutions Medical Records Division at the address
indicated above. I understand that my revocation of this Authorization applies to future disclosures
only and will not have any effect on any disclosures of Protected Health Information made before
receiving the revocation.
Redisclosure
I understand that my Protected Health Information disclosed pursuant to this Authorization may
be redisclosed by the recipient identified above and may no longer be protected from disclosure to
others by federal or state law.
Waiver
I hereby expressly waive any claim of privilege or privacy with respect to the released information.
1 release and forever discharge LA Health Solutions and its agents, servants, or employees from
all liability or claims, of any kind or character, in any way arising out of the disclosure of the
requested information, including disclosures made in good faith.
Voluntary
1 understand that signing this authorization is voluntary. My treatment, payment, enrollment in a
health plan, or eligibility for benefits will not be conditioned upon my authorization of this
disclosure.
Signature of Patient/Patient's Representative:
Date:
Jabbith
2019/30/04
Printed Name of Patient's Representative:
Relationship to Patient:
Dale Miller DOB: 1987/06/12 (43 yo M) Acc No. 47046 Doc Name: 2016/30/05 NP Forms
Page 100 of 123
| what is the DOB or date of birth? | {"text": ["1987/06/12"], "answer_start": [21]} |
id_1711475444.903435 | Kathryn Levine |
Kathryn Levine DOB: 16/87/09 (59 yo M) Acc No. 74940
11/16/10
Kathryn Levine DOB: 16/87/09 (59 yo M) Acc No. 74940 DOS: 08/21/07
LA Health Solutions
Initial Visit Chiro-MVA
Patient: Kathryn Levine
Provider: Matthew Laudun, D.C.
DOB: 16/87/09 Age: 59 Y Sex: Male
Date: 16/15/04
Reason for Appointment
1. Severe constant, throbbing headaches, low back and neck pain
History of Present Illness
Patient Subjective:
Pain (Dolor):
Region: Head (Cabeza), Neck (Cuello), Right trap (Trapecio Derecha), Upper back (Espalda Arriba), Mid back
(Espalda Media), Low back (Espalda Baja), Sacrum(T. Bone)/Sacro (hueso de la Cola), Left Hip (Cadera
Izquierda), Right Hip (Cadera Derecha), Right shoulder (Hombro Derecha), Right Elbow (Codo Derecha)
Mechanism of Injury:
Accident Information:
Injury/Treatment Information
Date of injury: 26/21/11
Did this injury occur while on the job? No
Parish where accident occurred: Orleans
The pain began That day
Treatment: Patient did not receive treatment following the accident prior to visiting our office
Diagnostic imaging was not performed.
Previous injury to affected areas was not reported.
Kathryn Levine DOB: 16/87/09 (59 yo M) Acc No. 74940
Page 25 of 47
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711476990.669153 | Jennifer Tran |
24/01/09, 11:51 AM
Print Preview
SWANN, Lisa A DOB: 86/03/28 (64 yo F) Acc No. 28924 DOS: 18/12/26
Swann, Lisa A
64 Y old Female, DOB: 18/12/26
20/05/14
Account Number: 28935
1330 Waterwood Dr, Lutz, FL-33559
Home: 813-388-2387
Guarantor: Kevin Harding Insurance: FL MEDICARE PRIMARY
Payer ID: SMFLo
PCP: ALEJANDRO I. MICHEL Referring: ALEJANDRO I. MICHEL
Appointment Facility: PULMONARY AND SLEEP SPECIALISTS OF TAMPA BAY, PA
09/25/2023
Progress Notes: Michael Newton MD PA
Reason for Appointment
Current Medications
1. Pft,ox,st, and alpha results
Taking
Synthroid 112 MCG Tablet 1 tablet in
History of Present Illness
the morning on an empty stomach Orally
Interim history:
Once a day
Carvedilol 12.5 MG Tablet 1 tablet AM,
9/25/2023. In office visit. Nocturnal oximetry, was not able to read
1/2 tablet PM Orally Twice a day
appropriately, maybe because of fingernail Polish. Will try the ring next.
Ramipril 5 MG Capsule 1 capsule
Since her episode of bronchitis, about a month ago, she is improving,
Orally Once a day
almost back to baseline. Still has cough and still brings up some phlegm.
patient is awake, alert, and oriented, able to answer all questions, and
Progress Note: Michael Newton MD PA 24/01/09
Note generated by 漏ClinicalWorks EMPSM Software (www.eClinicalWorks.com)
1/24
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711472590.863471 | Travis Stewart |
orthoLA
CONFIDENTIAL PATIENT MEDICAL HISTORY
FOR OFFICE USE ONLY
HIGGINS ELIAS ELLENDER HILDENBRAND GREBER BORNE JOHNSON DUPLANTIS
HEIGHT 5.6 "
WEIGHT 764 lbs
AGE 65
BP
/
PULSE
TEMP
PATIENT NAME Nadine Buggage
BIRTHDATE 1995 October 03 SS# 769-76-1761
REASON FOR PRESENT VISIT Fall
AFFECTED
SIDE: DECET RIGHT DISATERAL DATE OF INJURY 2018 May 28
ARE
YOU
DRIGHT-HANDED
LEFT-HANDED ARE YOU CURRENTLY PREGNANT
YES
NO OCCUPATION
How did Injury occur?
Where did injury occur?
PAST SURGICAL/HOSPITALIZATION HISTORY (Please Include: Date, Surgery/Illness, Doctor, Facility)
Sinus - 2015 May 30 Dr. Justin Tenney
Unit 9742 Box 9223
DPO AE 01991 Phone: 250-764-5226 Fax: 497-630-4265 www.ortho-la.com
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711476767.58818 | Jessica Morrow |
2014 June 09 08:36
1
12
unknown
P 8/32
Brandon Lewis
Coastal Neurology
Page:
7
610 Trenia Ann I
725 W Granada Blvd. Ste 22
Date: 2014 June 09
Orange City
FL
32763
Time:
Ormond Beach, FI 32174
7:50 AM
Patient: Patient ID is equal to 23632
Date: Service date of the Charge:
2019 March 16
CPT:
Description:
Charge
Primary
Primary
Secndry
Non Primary
Pt
Account
Amount
Pmnt
Adj
Pmnt
Adj
Pmnt
Balance
20551
Injection(s); single tendon
$350.00
$0.00
$0.00
$0.00
$0.00
$0.00
$350.00
20553
Injection(s): single or multiple
$380.00
$0.00
$0.00
$0.00
$0.00
$0.00
$380.00
Total Outstanding Balance for Date of Service:
$1,270.00
Date: Service date of the Charge:
2022 August 10
CPT:
Description:
Charge
Primary
Primary
Secndry
Non Primary
Pt
Account
Amount
Pmnt
Adj
Pmnt
Adj
Pmnt
Balance
20553
Injection(s): single or multiple
$380.00
$0.00
$0.00
$0.00
$0.00
$0.00
$380.00
Total Outstanding Balance for Date of Service:
$920.00
Date: Service date of the Charge:
10/24/2023
CPT:
Description:
Charge
Primary
Primary
Secndry
Non Primary
Pt
Account
Amount
Pmnt
Adj
Pmnt
Adj
Pmnt
Balance
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711471328.557941 | Jesse Chang | Valley View Hospital
DISCHARGE SUMMARY
PATIENT: Jesse Chang
Medical Rec #: 24082535947
Account #: 0069827621
Location: CN4A
Sex: F
DOB: 02-26-2002
Age: 66
admission date: 11-19-2022
Date of Discharge: 12-19-2022
Primary Care Physician: Dr Kirk Lyons M.D.
PRIMARY CARE PHYSICIAN: Dr Kirk Lyons, MD.
The patient is being discharged to New Bedford Rehab.
DISCHARGE DIAGNOSES: Ulcerative Colitis
OTHER PAST MEDICAL HISTORY: High Blood Pressure
PAST SURGICAL HISTORY: Knee replacement in 2001
BRIEF HISTORY OF PRESENTING ILLNESS AND HOSPITAL COURSE:
This is an unfortunate 66-year-old female who has had a tumultuous.
Additional copy Page 88 of 99 | What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711476893.376416 | James Barton |
2233 Post St., Suite 233
Integrated Pain Care
3133 Garrity Way
San Francisco, CA 94115
Tel (510) 32887
A Pain Management Clinic of Excellence
Tel (510) 32887
Fax (800) 32887
2016-26-08
Paulette Cass, D.C.
88 Belvedere Street, Suite 206
San Rafael, California 94901
Re:
Mr. Floretino Mejia
Date of Birth:
1999-27-11
Date of Injury:
2023-13-04
Employer:
Chevy's
Occupation:
Cook
Insurance Carrier:
Gallagher Bassett
Claim Number:
002406-001366-WC-33
EAMS #:
ADJ8510033
Date of Examination: 2016-09-02
Interpreter:
Spanish
INITIAL EVALUATION REPORT
Dear Dr. Cass, Attorneys and Claims Professional,
Please be advised that the aforementioned injured worker presented to our medical clinic today
for evaluation regarding a work place injury per Dr. Cass request for pain management
consultation.
Please be informed per AMA Code of Medical Ethics Opinion 10.01(5) directs the physician has
an obligation to cooperate in the coordination of medically indicated care, the physician may
not discontinue treatment of a patient as long as further treatment is medically indicated without
giving the patient reasonable assistance and sufficient opportunity to make alternative
595
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475956.172289 | Ryan Berry |
19/09/12
eow (Henderson, MIJOI ) Production E
onment
Ryan Berry DOB: 93/10/22 (57 yo M) Acc No. 72489 DOS: 16/10/21
Ryan Berry
PSA
Pain
57 Y old Male, DOB: 93/10/22
Specialists
Account Number: 72489
of
1811 E AVENUE K, APT 1002, TEMPLE, TX-76501-6292
Austin
Home: 254-295-7010
Guarantor: Ryan Berry Insurance: HUMANA
MEDICARE Payer ID: 61101
Appointment Facility: PSA Temple
16/10/21
Progress Notes: Umar Rashid Mahmood, DO
Reason for Appointment
Current Medications
1. Low back, bilateral leg pain
Taking
Fluticasone Propionate 50 MCG/ACT
Progress Note: Umar Rashid Mahmood, DO 16/10/21
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475956.079756 | Cynthia Weber |
OrthoSC . 210 Village Center Blvd., MYRTLE BEACH SC 29579-6706
Cynthia Weber (id #69627, dob: 97/04/25)
Page 1/1
OrthoSC . 2376 Cypress Circle. CONWAY SC 29526-8995
Cynthia Weber (id #69627, dob: 97/04/25)
Referral Order
19/02/20
To Provider
From Provider
SCOTT SAUER DO
ERKAN ALCI, MD
Main-CW
210 VILLAGE CENTER BLVD STE 150
2376 Cypress Circle Suite 300
MYRTLE BEACH, SC 29579-6683
CONWAY, SC 29526-8995
Phone:
Phone: 843-353-3460
Phone: (843) 353-3460
Fax: 843-353-3461
Fax:
Fax: (843) 347-3305
Patient Information
Patient Name
Cynthia Weber
Sex - DOB - Age
F 97/04/25 90yo
Electronically Signed by: ERKAN ALCI, MD
Aakon
the
ERKAN ALCI, MD
Consult Orders
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711471328.481843 | Keith Clark | Sunrise Health
ADMISSION FORM Printed: 2015 January 21 2:0
patient Unit # Service/Location Status F/C Date Account#
Keith Clark BP876933 GENERAL SURGERY DIS IN HMOC 2015 January 21 BP47421474034
PATIENT PATIENT:EMPLOYER
Soc Sec No: D.O.B: Age: Sex: MS: Race:
1997 November 09 28 F M B BAP
Address: 1334 Ramirez Light Apt. 991
Codymouth, MD 65269
Home Phone: 425-173-1459
County: HARRIS
D.O.B: 1997 November 09
Address: 1334 Ramirez Light Apt. 991
Codymouth, MD 65269
Phone: 425-173-1459
D.O.B: 1997 November 09
Rel To Patient: SPOUSE
Comment: INSURANCE # 1 Ins Policy # 876933
Ins Verif: 2015 January 21 PO BOX 62217
Rel to Pt: SELF
D.O.B: 1997 November 09
Eff. 10/06/22 to Rel: Y Asgn: Y Pre Cert
Type Accident: 11 ONSET OF SYMPTOMS/ILLNESS 2016 June 23 Type:
Preferred Land EL HMOC ENG PHYSICANS Attending Physician:
Dr Richard Meyer MD ADMISSION/REGISTRATION Date: Time:
Source: Rm/Bed: Arrival: Principal Admitting Diagnosis/Reason for Visit:
Admission Date: 2019 February 15 2:0
CLINIC OR PHYSICIANS 0621/1 Stroke
PQME6821 FACILITY COPY Sunrise Health Unit 9480 Box 3032
DPO AA 92757
Marissa Alvarez FACE Acct# BP0001043784 MR # BP876933 FACESHEET Page 60 of 99
D.O.B: 1997 November 09 28 F 2024 March 03 EADMF0001 Rev. Date 09/2018 Dr Richard Meyer MD
patient:Marissa Alvarez MRN:BP876933 Encounter:BP876933 Page 60 of 99 | What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711471330.672059 | Tara Davis |
PATIENT NAME Tara Davis I DATE OF BIRTH 14/07/03 I MRN 4973012 I
SOURCE WJMC Cerner Inpatient Millennium Power Chart I Date of Encounter 15/08/17
21:39:00
Administered Medications:
07/13 Drug: Insulin - (Bentyl 20 mg, Maalox Suspension 30 jmf
23:33 mL, Lidocaine Liquid 2 % 10 mL) ; Route: PO:
Outcome:
07/14 Discharge ordered by MD.
dd
00:20
07/14 Patient left the ED.
jmf
00:30
Signatures:
FAUST, JONATHAN
jmf
Dr Jamie Mueller, MD
MD
dd
Katicich, Jeanea
jk
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711473530.357181 | Erin Spencer |
<<Back to Review>>180298-26-HYPERLINK- Hyperlink-Page
205
Work Wellness
July 25, 2018
1121 Colorado Ave Ste 112 Turlock, CA 91282
Page 1
(212) 212-3123 Fax: (129) 126-3120
Patient Information
For : Erin Spencer
Work Status Report
Date of Report: 2020-20-11
Time In: 1:52 AM
Time Out: 10:06 AM
INJURY DATE: 2021-17-11
Diagnosis:
Diabetes Mellitus (ICD-719.47) (ICD10-M25.571)
Pursuant to California Civil Code section 53.31 and Labor Code 3762. medical information regarding employee'92 worker'92 compensation injuries is
deemed confidential medical information and may not be disclosed except in very limited circumstances.
Instructions: - seated work only
Electronically Signed by: Jennifer S Wong DO (2016-05-03)
Patient Signature:
Ed Foster
Date: 2016-10-11
001205
pr tae 0125
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711475955.770013 | John Miller |
PT Visit : Jul 25, 2022
Meadowlark General
John Miller. (10049120 )
4491 Ridgecrest Road
Greenville TX 74902
birthdate: Mar 08, 1991
Patient identity confirmed
Time In: 09:45
Time Out: 10:30
DATE OF VISIT: Jul 25, 2022
Medical Diagnosis: S/P right TKR
PT Diagnosis:
Gait disturbance
Homebound?
Yes
No
Residual Weakness
Unable to safely leave home unattended
Needs assistance for all activities
Severe SOB or SOB upon exertion
Requires max assistance / taxing effort to leave home
Confusion, unsafe to go out of home alone
Other:
Patient identified by correct name and address
000473
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711476072.179591 | Julie Carpenter |
ST VINCENTS PHYSICIAN ENTERPRISE . 4335 BELFORT ROAD SUITE 1330. JACKSONVILLE FL 32336-5336
Julie Carpenter (id #201833302, BIRTHDATE: 1985 July 19)
ENCOUNTER DATE: 2022 January 24
Patient
Name
Julie Carpenter (39yo,
Appt. Date/Time
2021 July 12 10:00AM
M) ID# 201818302
BIRTHDATE
1985 July 19
Service Dept.
SVPE_NEURO_SJ_SJMOB
Chief Complaint
Transition of Care Encounter
numbness/tingling, memory problems, tremors
Numbness in both arms
Allergies
Reviewed Allergies
NKDA
Medications
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711475620.44908 | Paul Reyes |
Paul Reyes DOB: 26/07/01 (58 yo M) Acc No. 82982 DOS: 16/05/16
Paul Reyes
58 Y old Male, DOB: 26/07/01
208 N SILVER MAPLE DR, SLIDELL, LA-70458-5483
LA Health Solutions
Home: 504-446-8765
Surgeon: Ronald C. Segura, M.D.
16/05/16
Ronald C. Segura, M.D.
OPERATIVE REPORT
Pre-op. Diagnosis:
1.CERVICAL FACET SYNDROME
Post-op. Diagnosis:
1.THE SAME
Operation:
1.CERVICAL INTRA-ARTICULAR FACET JOINT INJECTION: RIGHT C5/6, C6/7, & C7/T1 LEVELS
Anesthesia:
Local 1% Lidocaine & Sodium Bicarbonate 4.2%
Indications:
Details of Procedure:
This procedure was performed at LA Health Solutions in Metairie, Louisiana. The patient was seen and examined in the preoperative
area where informed consent was obtained explaining the risks, benefits, and alternative treatments to the patient. Operative site was
marked using a skin marker.
The same exact steps of the procedure were repeated in detail for the Right C6/7 & C7/T1 facet joints.
There were no apparent complications. The patient tolerated the procedure well. Band aides were placed over the skin entry sites. The
patient was transferred to the recovery area and monitored for approximately 10-15 minutes. The patient was discharged to home in
stable condition and is to return to clinic as scheduled.
PAIN LEVEL PRIOR TO THE INJECTION: 7/10
PAIN LEVEL AFTER THE INJECTION: 0/10
Specimens:
Complications:
Progress Note: Ronald C. Segura, M.D. 29/08/14
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711473530.581075 | Stephanie Kelly |
KNMH EMERGENCY DEPARTMENT
Stephanie Kelly
136 W Esplanade Ave
MRN: 8368368, date of birth: 1991 June 06, Sex: M
Kenner LA 73665
Acct #: 83603683661
Adm: 2022 April 22
08/25/2022 - ED in Kenner - Emergency Dept (continued)
ED Provider Note (continued)
ED Notes
08/25/2022
ED Triage Notes by Devin F. Kelt, RN at 8/25/2022 1363
Author: Devin F. Kelt, RN
Service: Emergency Medicine
Author Type: Registered Nurse
Filed: 8/25/2022 10:24 AM
service date: 2016 November 04 10:23 AM
Status: Signed
Editor: Devin F. Kelt, RN (Registered Nurse)
electronically signed by Devin F. Kelt, RN at 2019 March 23 10:24 AM
Imaging
X-Ray Shoulder Trauma Left [360366836] (Final result)
electronically signed by: Dayna G. Toscano, NP on 2019 March 23 1360
Generated on 10/3/22 11:37 AM
Page 21
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711476766.371231 | Destiny Moore |
Bethesda Pathology Report
Bethesda
Hospital East
Pathology
Name:
Kevin Jackson
Specimen #: SE-5803-35
Age:
45 Y
Medical Record 135786835
# :
DOB:
04 November 1990
Patient # :
2523537735
Sex:
F
Specimen
07 January 2022
Received:
Locat AMBULATORY CARE
Report Date:
22 October 2018
ion:
Procedure 14 June 2022
Signed
KENNETH
Date:
Out By:
BENGTSON, M.D.
Physician (s) : Thomas Gibson, MD
FINAL REPORT
History/Diagnosis: HYPERTROPHY OF NASAL TURBINATES, DEVIATED
NASAL SEPTUM
Operation Performed: SEPTOPLASTY, SUBMUCOSAL, RESECTION OF THE
INFERIOR TURBINATE
Specimen:
1. CARTILAGE, NASAL SEPTUM
KLB/SGJ 07 January 2022
Microscopic Description :
Microscopic slides examined on all non gross only specimens.
DIAGNOSIS:
NASAL SEPTUM CARTILAGE:
-FRAGMENTS OF BENIGN BONE
CHANGES
<Sign Out Dr. Signature>
KENNETH BENGTSON, M.D.
26 March 2015 at 13:12
**End of Report
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711472285.2377 | Carla Daniel |
7609521074
16:09:15 11-09-2017
6/6
Dr Andrew Farrell M.D.
04272 Christopher Harbor
Dianechester, UT 17027
LAST NAME:
Wieczorek FIRST: Carla Daniel
MI
NA
STREET ADDRESS: 13170 Meteor Dr. CITY Victorville ST CA ZIP 92175
MAILING ADDRESS: 8179 SVL Box CITY Victorville ST CA ZIP 92175
PHONE:
CELL# 876-628-6820 SS# 517-23-7171 M/F F
date of birth: 24 Nov 2001
DRIVERS LICENSE#: C6348003
MARITAL STATUS: S
M
D
W
LANGUAGE PREFERRED: English
I HERBY AUTHORIZE THE DOCTOR TO RELEASE ALL INFORMATION NECESSARY TO SECURE THE PAYMENT OF BENEFITS. I
AUTHORIZE PAYMENT OF MEDICAL BENEFITS TO UNDERSIGNED PHYSICIAN OR SUPPLIER FOR SERVICE DESCRIBED BELOW. I
HEREBY AUTHORIZE THIS PRACTICE TO VERIFY MY MEDICATION HISTORY.
Electronically Signed by:
15 Mar 2022
SIGNED:
01/09/2018 | What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711476578.150659 | Eric Clarke |
BAYLOR SCOTT & WHITE
Williams, Charles Eugene
BaylorScott&White
HEART AND VASCULAR
MRN: 9211645, DOB: 1987 June 07, Sex: M
HEALTH
HOSPITAL - DALLAS
Acct #: 33000308845
621 N HALL ST
Admitted 2018 August 17. D/C 2018 September 16
DALLAS TX 75226-1345
2022 November 26- Admission (Discharged) in Baylor Scott & White Heart and Vascular Hospital - Dallas (continued)
Case 3450807 (A FLUTTER RF ABLATION WITH RHYTHMIA) (continued)
PONV
Nausea: absent
Emesis: No
Electronically signed by Pohar, Selvi, MD at 2019 August 27 7:47 PM
Anesthesia Preprocedure Evaluation
Pohar, Selvi, MD at 2/8/2023 1106
Author: Pohar, Selvi, MD
Service:
Author Type: Physician
Filed 2021 July 29 1:08 AM
Date of Service: 2023 October 13 11:06 AM
Status: Signed
Editor: Pohar, Selvi, MD (Physician)
Anesthesia Review of Systems and Medical History:
Pulmonary System
Cardiovascular System
Atrial flutter
+ Tobacco use/dependence
+ hypertension
+ chest pain
+ dysrhythmias
Neurological/Musculoskeletal System
Gastrointestinal System
Printed on 2022 November 26 10:22 AM
Page 45
745 08-45
Baylor Scott & White Heart & Vascular Hospital - 00045
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711475444.637105 | Stephen Ramsey |
From: DAVID GOLDMAN
Fax:
To:
Fax: (610) 354-8946
Page: 4 of 72
2018 Sep 17 4:33 PM
Stephen Ramsey
Visit Note - 2017 Aug 24
PMS ID:
Sex:
DOB:
MRN:
438-5647467272
Female
2001 Sep 26
024986
Medications
OPHTHALMIC MEDICATIONS
Chief Complaint: Eye Irritation
NONE
extended release 24 hr
citalopram 40 mg Oral tablet
diphenoxylate-atropine 2.5-0.025 mg
Pt has not been using drops currently.
Oral - tablet
hydrochiorothiazide 25 mg Oral
Pt tried Restasis 2015, did not help (pt has no idea how long she used it for)
tablet
lorazepam 1 mg Oral tablet
No asthma, yes some seasonal allergies.
losartan 100 mg Oral tablet
S/P LASIK OU 2010
mirtazapine 15 mg Oral tablet
Pt has not tried plugs.
sumatriptan succinate 100 mg Oral
Pt states last eye exam 03/2019
tablet
temazepam 15 mg Oral capsule
Aimovig Autoinjector 70 mg/mL
On further history taking, pt has no grittiness, no burning, no irritation but pt's only complaints are a film over the vision
Subcutaneous auto-injector
OU that fluctuates (not like a floater or black spider web) and crusting (seldom) upon awakening
Last dilated exam over 1 year ago
Ocular History
Obtained and Reviewed December
28, 2020.
Allergic conjunctivitis
Tear film insufficiency
Eye Exam
Wears glasses
Vision
Distance Test Type: Snellen Chart
Mark Milner (Primary Provider) (Bill Under)
David A. Goldman MD LLC
Page 1
(561) 630-7120 Work
3502 Kyoto Gardens Dr
(561) 630-7122 Fax
Suite B
Palm Beach Gardens, FL 33410
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711471329.255342 | Kayla Oconnell |
Encounter Note by Dr Lucas Rollins (DOS: 2018 Aug 30)
Kayla Oconnell
24 year old Male (birth date: 1992 Jul 05)
Vitals:
Height:
Weight: 241 lbs
BP:
Pulse:
89 beats/min
Temp:
Resp:
Vitals General
Measure
4/27/10
11/29/10
8/30/11
9/26/11
9/30/11
9/30/11
3/19/12
Habitus
Height (inches)
79.0
79.0
79.0
Weight (pounds)
248.3
242.6
244.0
240.0
Weight comments?
BMI (kg/m2)
27.969059
27.326999
Neck circum. (inches)
comment - 1
Temperature
Temperature
Temp Location
Oral
Oral
Oral
Oral
Oral
Oral
Oral
Chief Complaint:
Routine follow up
Onset Date:
not entered
Progress report:
Mr. Kayla Oconnell has done well since the last visit with no cardiac symptoms. He denies any palpitations, chest pain or
dizziness.
Cardiac testing:
Echocardiogram, April 2010: Ejection fraction 55-60%. 1+ regurgitation. 1+ aortic insufficiency. Aortic root diameter
4.4 cm at the sinuses and 4.1 above the sinuses.
Labs:
January 2010: Cholesterol 143 triglycerides 71 LDL 87.
September 8, 2011: Blood sugar 98 BUN 19 creatinine 0.88. Normal electrolytes and CBC with hemoglobin of 14.3.
| what is the DOS or D.O.S? | {"text": ["2018 Aug 30"], "answer_start": [42]} |
id_1711476767.194098 | Melinda Scott |
08-24-2019 08:25
1 12 >> unknown
P 23/54
-2-
COASTAL PAIN & NEUROLOGY CENTER
I understand that medicine and surgery are not exact sciences.
I have discussed the risks of not having this/these procedure(s) with my physician.
I understand and read the English language or have had adequate interpretation or
translation of this document. Any and all questions I have regarding this/these proposed
procedure(s) have been answered to my satisfaction.
ATTENTIONPATIENTS WITH "NO CODE" OR DO NOT RESUSCITATE STATUS:
I understand that do not resuscitate (DNR) and "No Code" status is void during this/these
procedure(s) and during the immediate post-operative period. Initials:
The patient is unable to sign or give consent as reflected in the medical records because:
Longhu
08-15-2018
Signature of Patient or Health Care Surrogate
Date
Time
Signature of Witness
Date
Time
I certify that I have informed the patient of the responsibility available alternatives to the
proposed surgical and/or invasive procedure(s), the inherent specific potential risks and
complications, benefits and alternatives of the procedure(s) and the results of the
procedure(s) which I consider likely to occur.
Signature of Provider
Date
Time
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711476578.483928 | Megan Morales |
Patient: Joel White DOB: 17-05-1988
Joel White DOB: 17-05-1988 (46 yo F) Acc No. 758xx
TH
AKUMIN
Akumin Pembroke Pines
Phone: (954) 566xxx
10950 Pines Blvd
Fax: (954) 430xxx
Pembroke Pines, FL 330xx
Website: akumin.com
Copy to:
Patient: Joel White
Dr Teresa Stewart MD
Date of Birth: 17-05-1988
680 N UNIVERSITY DRIVE
Phone: (754) 265xxx
Pembroke Pines Florida 330xx
MRN: 693xxx Acc: ER10847xxx
Fax: (877) 843xx
Date of Exam 09-11-2022
3D TOMOSYNTHESIS DIAGNOSTIC MAMMOGRAM UNILATERAL
[770657xxxx] - Womens Imaging
LEFT DIGITAL DIAGNOSTIC MAMMOGRAM WITH CAD AND TOMOSYNTHESIS
CLINICAL HISTORY: 44 year-old female without current breast symptoms
mammogram She has no family history of breast cancer.
COMPARISON: 16-12-2023
TECHNIQUE LEFT low dose full-field digital mammography was performed in the CC and MLO projections. Computer-
aided detection was utilized. Digital Tomosynthesis was used in this patient.
FINDINGS:
IMPRESSION:
No mammographic evidence of malignancy.
In the absence of clinically suspicious findings, the patient is recommended to return in one year for screening
mammogram.
RECOMMENDATION: Screening mammogram in one year. A reminder will be sent to the patient.
The information contained in this facsimile message is privileged and confidential.
Printed 07-09-2021 PM
OWENS SHANNON (Exam: 09-11-2022 1:15 PM
Page 1 of 14
OWENS, Shannon DOB: Nov 17, 1976
Page 114 of 114
Document: 21-02-2019 Records
Printed: 21-02-2019 12:22:11
Page 114 of 114
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711476767.989099 | Willie Brown |
Page: 1 of 14
South Lakeland Chiropractic Center P.A
DBA: New Hope Chiropractic
4788 S. Florida Ave.
Lakeland, FL 33814
Grace Witter
Patient ID: 131986414
DOB: 15/06/2003
Sex: F
Account No.:
Encounter ID: 281444414
Encounter Date: 07/07/2015
Encounter Type: Office Visit
SUBJECTIVE:
Chief Complaint:
Patient reports pain in the left arm, shoulder, neck, lower back and left side of her hip and leg. She reports on
12/07/2018 she was at the Deli in Publix while walking away after being served she slipped and threw her left arm
in the air to break her fall and grabbed at the deli counter to catch herself.
Patient reports the pain wakes her up while she is sleeping when she accidentally rolls onto her left side She was referred to Dr. Bloom by Dr. Li; her shoulder pain is managed by Dr. Li.
OBJECTIVE:
Vital Signs:
Height: 62.00 in
Weight: 165.00 lbs
BMI: 30.18
Blood Pressure: 122/82 mmHg
Temperature: 97.30 F
Pulse: 76 beats/min
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711477183.027764 | Jodi Berry |
Patient
seeds this form filled
US. Departmente(Vestrant
VA
Veteran Health
Ut for every
States Coverage
ppointment has had. Southeast Louisiana Veteran Health
Care System
2474 Canal Street
New Orleans, LA 70174
Facility Name: Louisiana pain Specialists
Address of Facility: 5600 Read Blvd 10th flower, N.O, (A 70174
Phone number of Facility:
504. TEA 2374
Time of appointment:
9:40 Am
Date of appointment(s):
2017/11/11
Veteran's Name
Michael Davies
Veteran last four (SSN): 37174
I certify that the veteran named above attended said appointment as per Department of Veteran Affairs.
Signature: Spaymeno
Date: 2018/13/02
| What is signature date or signed on date? | {"text": ["2018/13/02"], "answer_start": [658]} |
id_1711476893.345217 | Paul Beasley PhD |
2229 Post St., Suite 211
Integrated Pain Care
3160 Garrity Way
San Francisco, CA 94115
Richmond, CA 94806.
Tel (415) xxxxxxx
A Pain Management Clinic of Excellence
Tel (510) xxxxxxx
Fax (800) xxxxxxx
Name:
Robert Edwards
Date:
05/2014/14
Testing Facility:
Richmond
An additional 15 minutes were spent to review the patient's medical records and pertinent imaging
studies, if available. History was obtained through interview. Translation when necessary was
provided by a licensed medical translator.
Date of Birth:
11/1988/21
Height:
5'6
Weight:
160
Date of Injury:
06/2014/02
Chief Complaint:
Low back pain, radiating into bilateral lower extremities with tingling, right
greater than left
Past Medical History:
Patient denies a personal history of diabetes, thyroid disease or known
neurological disease. Patient denies pacemaker or heart defibrillator
implant. Patient denies current use of anticoagulants. Patient denies any
history of neck or back surgery.
NERVE CONDUCTION STUDIES:
This is a(n) abnormal nerve conduction study. The left tibial motor amplitude was decreased
compared to the right by greater than fifty percent. F-waves were within normal limits. H-reflexes
revealed no significant side-to-side variance.
ELECTROMYOGRAM:
529
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711471329.116307 | Tony Cooley |
ciox
Fee Approval Request
HEALTH
CIOX HEALTH
Please deliver this to the following medical record requester:
Attention :
Facility:
Central City Clinic
Requester :
TScan
Site :
73579
Address :
5831 Dana Fall
Patriciastad, CT 29066
Address :
5831 Dana Fall
Patriciastad, CT 29066
City, State,
City, State,
Zip :
Seattle, WA 98199
Zip
Detroit, MI 48201
Rep
Telephone :
522-668-1888
CIOX Rep:
Vernette Gordon
#:
825121
Fax :
110-284-8531
Fax to:
Records
CIOX HEALTH REP Vernette Gordon
Fax Number: 313-993-0763
Phone: 313-745-3021
Dear Medical Record Requester :
Date: 2017-11-07
CIOX HEALTH has contracted with Central City Clinic (Medical Facility/State) to copy
it's authorized requests for medical records.
03/28/2019
patient name :
Tony Cooley
D.O.B :
1994-07-29
Soc. Sec. # :
service date
2023-02-01
CIOX HEALTH Fee Schedule
FOR MEDICAL RECORD REQUESTER USE ONLY
In order for your request to be processed you will need to complete the five items inside this box.
Approved
Date:
By:
Hamal
j
2023-06-01
(Signature)
Print Name:
Phone:
Hannah Reifler
206-812-6911
Title:
Assistant Records Retrieval Specialist
MUST BE COMPLETED TO PROCESS REQUEST
Template Revision: 3.10.16
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711471329.336849 | Lindsay Barnes |
15048023244
0:11:38 a.m.
04-13-202
3/3
Greenfield Healthcare
2020/24/05
9835 Houston Ports
West Gloria, RI 26037
Page 3
369-495-9182 Fax: 965-998-9741
Office Visit
Lindsay Barnes
Work: (870) 972-8931
Female dob: 2000/01/12
128829
Ins: Blue Advantage Grp: 15048023244
:
ASSESSMENT: Right trimalleolar ankle fracture.
PLAN: The risks versus benefits of operative versus non-operative treatment were discussed with the
patient and her husband, They agree to proceed with surgery.
ABB/bcc
0829
signature
Dr Ryan Bishop MD on
2020/10/05 at 1220
PARHAM-0127
000039
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711473530.555402 | Mary Schultz |
KNMH EMERGENCY DEPARTMENT
Mary Schultz
180 W Esplanade Ave
MRN: 8348348, DOB: 06-09-1998, Sex: M
Kenner LA 73465
Acct #: 83403483461
Adm: 02-07-2023
08/25/2022 - ED in Kenner - Emergency Dept (continued)
ED Provider Note
08/25/2022
ED Provider Notes by Dayna G. Toscano, NP at 8/25/2022 1047
Author: Dayna G. Toscano, NP
Service: Emergency Medicine
Author Type: Nurse Practitioner
Filed: 8/25/2022 11:51 AM
service date: 03-10-2022 10:47 AM
Status: Attested
Editor: Dayna G. Toscano, NP (Nurse Practitioner)
Cosigner: Luke G. Cvitanovic, MD at
8/25/2022 5:50 PM
Attestation signed by Luke G. Cvitanovic, MD at 06-01-2024 5:50 PM
Case discussed, in a face-to-face manner, with the APP.
Date of Encounter: 28-08-2023
History
Chief Complaint
Patient presents with
Motor Vehicle Crash
Generated on 10/3/22 11:37 AM
Page 17
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711476990.519268 | Christopher Lewis |
2019-01-25 10:13:54
Oklahoma Spine 4058789460
11/60
Page 60
PATIENT NAME Caitlyn Rivera
MR#: M000143760
ADM DATE: 2020-05-25
DOB: 1999-06-20 SEX: M
10:50 AM
DC DATE: 2020-06-24 01:20
ATTENDING PHYSICIAN: Joseph Fuller, M.D.
PM
2. Continue on present medications.
3. Return for followup appointment within I to 2 weeks to check on response to the
injection or to repeat the injection or to proceed for RF ablation and to make any
necessary medication adjustment and determine subsequent treatment steps.
Electronically signed at 2023-10-18 7:08
AM (GMT -5)
Khali
Khan
MA
Joseph Fullern, M.D.
KK epins
Dietated: 08.16.2023 01:48 PM Transcribed: 2016-08-29 05:53 AM Doc: X161565
CC:
Muhammad M Gillan, M.D.
| what is the admit date or admission date? | {"text": ["2020-05-25"], "answer_start": [129]} |
id_1711473237.344958 | Matthew Price |
THU 43
FAX
MRN: 1922044H
Matthew Price
Nassau Unly. Medical
Gender: Female
Center
Age: 38y (25/05/91)
Current Location:
ICC1-2561-JJ
Faculty Statement:
Attestation
Attending and Resident/Fellow/Physician's Assistant
Electronic Signatures:
Dr Nicole Lutz (Physician) (Signed 24/08/14 0:42)
Authored: Faculty Statement
Co-Signer: Date of Procedure, Pre-Op and Post-Op Diagnosis, Specimens, Brief
Operative Note, Procedure Details
Dr Thomas Williams (Resident Physician) (Signed 27/10/23 0:42)
Authored: Date of Procedure, Pre-Op and Post-Op Diagnosis, Specimens, Brief
Operative Note, Procedure Details
Requested by: Philburn, Jacqueline (Med Rec Clerk), 09/04/17 12:25
Page 2 of 2
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711476578.340261 | Scott Koch |
Patient: Emily Gray DOB: 1986 July 09
2018 March 08 10:24 AM
Print Preview
Emily Gray DOB: 1986 July 09 (45 yo F) Acc No. 758855 DOS: 2019 May 20
Owens, Shannon
CanoHealth
46 Y old Female, DOB: 1986 July 09
Account Number:758556
HOLLYWOOD HL-22550-3855
Home: xxx-558-3455
Cuarantor: Owens, Siminon Insurance: Humana Medicaid CAP
Appointment Facility: ou-Places University
Structured Liatn: Lines patient need transportation :No
2019 January 23
Progress Note: VICKYRIVAS-OROZ0O MD
for Appointment
i. PRE-OP CLEARANCE
Assessments
1. Pre-op evaluation as 201.818
Treatment
1. Pre-on evaluation
LAB:CBC With Differential/Platelet (Ordered for 07/07/2022)
07/07/2022
Clinical Notes: FU studies
FU ENT.
2. Deviated septum
Clinical Notes: FU ENT.
Follow Up
2 Weeks,prn (Reason: FU AFTER SURGERY)
History of Present illness
45 yo patient here for
Pre-OP
Surgery: septoplast, submucosal of the inferior turbinate
Indication: Deviated Septum
Surgeon: Dr. Dwayne Smith
Date: 2018 March 08
Prior Surgeries: no issues with anesthesia
Examination
-Exam:
Progress Notes VICKY MD 07/07/2028
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711476990.13824 | Derek Adams |
(Page 7 of 20)
(Page 3 of 16)
Recv'd Date: 20140909 Bill DCN: 2014252GJ000800
Toufan Razi M.D.
Pacific Pain
Qualified Medical Evaluator
Institute
Pain Management Specialist
PACIFIC PAIN INSTITUTE FUNCTIONAL RESTORATION PROGRAM
PROGRESS REPORT WEEK # 4
Name: Taylor Lutz
Insurance: Gallagher Bassett
Claim#: 002406001366
DOB: 1995 May 16
DOI: 2022 Oct 06
INTRODUCTION:
As part of his comprehensive treatment plan for patient's Chronic Pain Syndrome, patient has
successfully completed the FOURTH WEEK on the Pacific Pain Institute Functional Restoration
Program.
According to MTUS guidelines, It Is not suggested that a continuous course of treatment be
Interrupted at two weeks solely to document these gains, If there are preliminary Indications
that these gains are being made on a concurrent basis. Patient has currently completed his 80
authorized hours of Functional Restoration Program, plus 48 additional hours.
The following constitutes the Integrative summary report generated by Dr. Toufan Razi and
LPCC Adriana Flores after the patient has completed the fourth week of the program on
8/15/2014.
A. MEDICAL EVALUATION
SYMPTOMS PROGRESSION: The patient is a 29-year-old male. He has lower back pain, lumbar
radiculopathy and chronic pain syndrome. Patient has participated In the Pacific Pain Institute
Functional Restoration Program for the last 4 weeks. The patient has remained very
cooperative despite having low back pain and burning sensation running down his right leg.
The patient has remained compliant and has participated in all the exercises activities that have
been prescribed for him.
Pacific Pain Institute Functional Restoration Program. Address: 2416 Merced St San Legndro CA 94516. Phone
number. (510) 71926 Fax number: (510) Random_5_digit_number
1116
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711473366.035312 | Jack Mendez |
athena
2020-05-27 6:9:13 pm EDT
Page: 47/86
Jack Mendez (id #12346232, D.O.B: 1998-02-26)
11
CAT SCAN QUESTIONNAIRE
Date: 2015-11-25 Time:
PATIENT NAME Jack Mendez
Type
of
exam
heads
Referring Physician
Height 123 Weight 23 Date of Birth 48 Pregnant? Y N
LMP
Reason for exam
Seizere
Technologist Printed Name & Signature Authall
Date 2022-12-29 Time 6:9
5
correct DOB, 08/25/75
D.O.B: 1998-02-26 (58 yrs)
CLY
BMC-353 Rev. 08/18
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475621.063518 | Alexandra Garcia |
DocuSign Envelope ID: 2EBB7621-EDFE-47BB-A
:6C3A2DDDA86
ASSOCIATES MD
MEDICAL GROUP
4780 SW 64th Ave
Davie, FL 33314
Mon-Fri 8:30am - 5:00pm
[email protected]
PATIENT INFORMATION
Alexandra Garcia
LAST NAME:
FIRST NAME:
BIRTHDATE: 1987 Dec 29
7862538738
CELL PHONE:
299 Misty Brook
Lake Robinshire, DC 04667
ADDRESS:
Miami
Florida
33166
CITY:
STATE:
ZIP CODE:
PATIENT RECORD RELEASE AND LETTER OF PROTECTION
| do hereby authorize Associates MD Medical Group to furnish my attorney as identified below with full report of any
medical records and charges pertaining to my treatment.
settlement, judgment or verdict by which 1 may eventually recover said fee.
PLEASE CHECK ONE:
X
Motor Vehicle Accident
Slip and Fall
2016 Jul 11
DATE OF ACCIDENT:
The Law office of Edersy Suarez, P.A
LAW FIRM:
Edersy Suarez
ATTORNEY NAME:
DocuSigned by:
PATIENT SIGNATURE:
Rher
DATE:
2022 Nov 30
F83488BE1E2D4FB.
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711476578.339359 | Robert Warren |
Patient: Colleen Moon DOB: 2002-08-25
2021-07-30 10:24 AM
Print Preview
Colleen Moon DOB: 2002-08-25 (45 yo F) Acc No. 758813 DOS: 2020-04-15
Owens, Shannon
CanoHealth
46 Y old Female, DOB: 2002-08-25
Account Number:758136
HOLLYWOOD HL-22130-3813
Home: xxx-138-3413
Cuarantor: Owens, Siminon Insurance: Humana Medicaid CAP
Appointment Facility: ou-Places University
Structured Liatn: Lines patient need transportation :No
2018-04-26
Progress Note: VICKYRIVAS-OROZ0O MD
for Appointment
i. PRE-OP CLEARANCE
Assessments
1. Pre-op evaluation as 201.818
Treatment
1. Pre-on evaluation
LAB:CBC With Differential/Platelet (Ordered for 07/07/2022)
07/07/2022
Clinical Notes: FU studies
FU ENT.
2. Deviated septum
Clinical Notes: FU ENT.
Follow Up
2 Weeks,prn (Reason: FU AFTER SURGERY)
History of Present illness
45 yo patient here for
Pre-OP
Surgery: septoplast, submucosal of the inferior turbinate
Indication: Deviated Septum
Surgeon: Dr. Benjamin Mcknight
Date: 2021-07-30
Prior Surgeries: no issues with anesthesia
Examination
-Exam:
Progress Notes VICKY MD 07/07/2028
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711476578.337561 | David Wells |
Patient: Cheryl Torres DOB: Jul 09, 2002
Jun 14, 2023 10:24 AM
Print Preview
Cheryl Torres DOB: Jul 09, 2002 (45 yo F) Acc No. 758814 DOS: Nov 13, 2019
Owens, Shannon
CanoHealth
46 Y old Female, DOB: Jul 09, 2002
Account Number:758146
HOLLYWOOD HL-22140-3814
Home: xxx-148-3414
Cuarantor: Owens, Siminon Insurance: Humana Medicaid CAP
Appointment Facility: ou-Places University
Structured Liatn: Lines patient need transportation :No
May 27, 2015
Progress Note: VICKYRIVAS-OROZ0O MD
for Appointment
i. PRE-OP CLEARANCE
Assessments
1. Pre-op evaluation as 201.818
Treatment
1. Pre-on evaluation
LAB:CBC With Differential/Platelet (Ordered for 07/07/2022)
07/07/2022
Clinical Notes: FU studies
FU ENT.
2. Deviated septum
Clinical Notes: FU ENT.
Follow Up
2 Weeks,prn (Reason: FU AFTER SURGERY)
History of Present illness
45 yo patient here for
Pre-OP
Surgery: septoplast, submucosal of the inferior turbinate
Indication: Deviated Septum
Surgeon: Dr. Rebecca Butler
Date: Jun 14, 2023
Prior Surgeries: no issues with anesthesia
Examination
-Exam:
Progress Notes VICKY MD 07/07/2028
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711471328.946849 | Derrick Kelley |
Patient: Derrick Kelley
MRN: 22146643324(CSB): 22146643324(SBM)
DATE OF BIRTH: Apr 06, 1992
FIN: 80258633701
Auth (Verified)
*
Valley Medical Center
PATIENT DATA
DATE
ACCOUNT
MRN
ROOM#
Aug 23, 2023
8025863371
22146643324
Room 1
ACCESSION
EMPI
admitting date
ACCHF002459
May 06, 2017
Patient
SSN#
RACE
Derrick Kelley
Black
ADDRESS 1
CITY
STATE
9180 Hardy Hollow
Port Aprilburgh, HI 46422
DATE OF BIRTH
AGE
Apr 06, 1992
37
PROCEDURE
STAFF
Left Heart Catheterization
Dr David Savage MD
Physician
Coronary Angiography - Selective
Ingle, Genesis RN
Scrub
Left Ventriculography
Pierce, Kristopher RN
Circulate
Occlusive Device, Art/Vein G0269
Camarillo, Melissa RT
Recorder
Dr Duane Moore Jr. MD
Fellow Physician
Derrick Kelley
M# 3800369833
DATE OF BIRTH:Apr 06, 1992
dos:Jun 09, 2017
Age: 37Y Sex: M
LOC: MSG
*CARDIAC
A# 80008942601
Derrick Kelley: 22146643324, DATE OF BIRTH: Apr 06, 1992
Printed On Aug 23, 2023:14:65:09
Attending: {Doctor Name} MD
CaseID HF002459
Valley Medical Center
Xper.IM. Philips
Facility SBMC
Page 316 of 379
101
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711476990.753351 | Anthony Russell |
14-07-18 12:10 PM FROM: Fax PULMONARY AND SLEEP SPECIALISTS OF TAMPA BAY, PA PAGE: 017 OF 117-05-13
Patient: Toni Daniels DOB: 96-07-09
CT Chest PE W Contrast
Toni Daniels - 479617-05-13
* Final Report *
Result Type:
CT Chest PE W Contrast
Date:
March 05, 2019 19:00 EST
Result Status:
Auth (Verified)
Result Title:
CT Chest PE W Contrast
Performed By:
LUXENBERG MD, NINA LYNN on March 05, 2019 19:15 US/Eastern
Verified By:
LUXENBERG MD, NINA LYNN on March 05, 2019 19:15 US/Eastern
Encounter info:
7864859, TAM, Observation, 03/05/2019 - 03/06/2019
* Final Report *
Reason For Exam
sob, positive d dimer
REPORT
Exam: CTA chest.
Date of Exam: 22-10-06 6:50 PM
Indication: SOB, POSITIVE D DIMER.
Comparison: X-ray 14-07-18
Technique:
IV bolus CTA chest was performed following the administration of intravenous contrast 100
mL of Isovue 370. Chest was imaged with spiral technique followed by postprocessing with
sagittal and coronal 3D/MIPS. There was adequate opacification of the pulmonary arterial
system.
Radiometrics dose report: Up-to-date CT equipment and radiation dose reduction techniques
were employed. CTDIvol: 18.7 mGy. DLP: 610 mGy-cm.
Findings:
No intraluminal filling defects are seen in the visualized opacified pulmonary vasculature
to suggest acute pulmonary thromboembolism The main pulmonary artery is not dilated.
Thoracic aorta is nonaneurysmal and there is no evidence of dissection. No pericardial
effusion or thickening. Heart is not enlarged. No pneumothorax.
Printed by:
ROMERO, LEA M
Page 1 of2
Printed on:
17-05-13 14:17 EDT
Document: 17-05-13
Page 16 of 120
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475444.81755 | Michelle Douglas |
Michelle Douglas DOB: May 29, 1995 (46 yo M) Acc No. 62588 Doc Name: Jul 20, 2020 Medical Clearance
LA Health Solutions
3001 Division Street, Ste. 100 Metairie, LA 70002
PH (504) 620-5520 FAX (504) 832-3983
Please Read Thoroughly
I, Michelle Douglas understand that if I have any of the following medical
conditions listed below, I will need medical clearance for any procedures or
surgeries ordered by this office. I further understand that it is my responsibility to
provide the name and contact number of my primary care or specialty physician.
History of Medical Conditions
(Check ALL that apply, If this does not apply, indicate N/A on each line.)
NA Heart Attack/Stent/A.Fib/Mitra Valve Prolapse
NA High Blood Pressure
NA Blood Disorders (Hepatitis/TB/HIV/Anemia)
NA Blood Clot/DVT/PE
Specialty:
Phone:
Doctor Name:
Specialty:
Phone:
Doctor Name:
Specialty:
Phone:
I certify that the above information is true and accurate. I authorize the above
listed doctor to release all confidential medical records to LA Health Solutions.
Print: Signature:
Date: Dec 03, 2016
Michelle Douglas
DOB: May 29, 1995
Provider Reviewed:
Date:
Michelle Douglas DOB: May 29, 1995 (46 yo M) Acc No. 62588 Doc Name: Jul 20, 2020 Medical Clearance
Page 107 of 123
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711476893.04344 | Russell Powell |
NORTHBAY MEDICAL CENTER
NorthBay Hospital Campus: 1200 B. Gale Wilson Blvd.
Fairfield, CA 94533 (707) 646-5000
ED Physician Documentation
Physician:
Ankney. William A M.D.
Signed:
08-09-2017 03:42:46
Status:
Auth (Verified)
Document:
ED Physician Notes
Fall
Patient: MEJIA-GALLEGOS, FLORENTINO
MRN: 608698
FIN: 010998039
Age: 26 years Sex: Male DOB: 13-03-2000
Associated Diagnoses: None
Author: Ankney, William A M.D.
Basic Information
Time seen: Date & time 12/06/11 23:04:00.
History source: Patient.
Arrival mode: Walking.
Allergies: Include allergy profile.
Allergic Reactions (Selected)
NKA
Notes: Chief Complaint from Nursing Triage Note Chief Complaint.
09-07-2014 22:30
Chief Complaint
Right leg and right lower back pain. Ambulating with limp.
No head injury.
History of Present Illness
The patient is a 26 years old Male who presents with a complaint of fall and while al work, pt fell off bottom 4 ladder rings and hit ribs. hip
and knee.
Patient Name: Devin Parks
Medical Record No: 608698 Financial No: 010998039
Medical Records
DOB: 13-03-2000 Age: 28 years Sex: Male Pt Type: Emergency
N/A
Admit Date: 04-10-2014 Discharge Date: 03-11-2014
Admitting Physician:
Attending Physician: Ankney, William A M.D.
Printed 09/09/13 at 11:14 AM
(Page 11 of 28)
ED-NB
149
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711471328.65875 | Alexandra Kemp | Fax Server
06 Jun 2021 9:51:00 AM PAGE 7/010 Fax Server
Oak Grove Hospital
Date: 06 Jun 2021
Dr Rachel Dominguez, MD
1884 Bolton Cliff Suite 446
West Michael, MN 34751
Beneficiary Name: Alexandra Kemp
birth date: 30 Mar 1990
Beneficiary Phone Number: 715-968-2775
Sponsor Name: Kevin Gay
Sponsor SSN: xxx-xx-1892
Plan Type: Prime Eligible
Reference Number: 19530069092
Requesting Provider: Dr Rachel Dominguez, MD
Requesting Provider NPI: 1341104067
Dear Dr Rachel Dominguez, MD:
Oak Grove Hospital is the Managed Care Support Contractor (MCSC) for the
Department of Defense's health care program, Oak Grove Hospital, in your region. We thank you for your
continued service to our Oak Grove Hospital beneficiaries.
We received your request for service(s) for the above Oak Grove Hospital beneficiary.
Reason for Request: Outpatient Authorization Request
Servicing Provider Name: Dr Rachel Dominguez, MD
Specialty Type: Urology
Servicing Provider Address: 1884 Bolton Cliff Suite 446
West Michael, MN 34751
Servicing Provider Phone: 820-965-7845
Service Type
Frequency
Surgical Care
57288* - 57288 16 Nov 2021 - 12/14/2010 1 Visit or Unit(s)
Alexandra Kemp-KPJayaraman-00007
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711473530.465731 | Christopher Reed |
KNMH CT SCAN
Christopher Reed
180 W Esplanade Ave
MRN: 8312838, DATE OF BIRTH: Apr 16, 1995, Sex: M
Kenner LA 70065
Acct #: 81203126121
Enc. Date Oct 05, 2016
08/25/2022 - Appointment in Kenner - Diagnostic Ctr
Diagnoses
None.
Non-Hospital Problems as of 8/25/2022
Reviewed: Sep 12, 2017 by Jessica Harvey, PA-C
None
ED Care Timeline
No data selected in time range
Drug Use as of 8/25/2022
Drug Use
Types
Frequency
Comments
Source
Generated on 10/3/22 11:37 AM
Page 1
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711476578.036857 | Cassandra Gray |
BAYLOR SCOTT & WHITE
Williams, Charles Eugene
BaylorScott&White
HEART AND VASCULAR
MRN: 9601660, DOB: 1985/15/04, Sex: M
HOSPITAL - DALLAS
Acct #: 33000xxxxx
621 N HALL ST
Admitted 2023/30/11. D/C 2023/30/12
DALLAS TX 75226-1339
02/08/2023 - Admission (Discharged) in Baylor Scott & White Heart and Vascular Hospital
Reason for Visit
Visit Diagnoses [last edited by Donsky, Alan Stuart, MD on 2/8/2023 1331]
Typical atrial flutter (HCC)
Essential (primary) hypertension
Revision History
Action
Name
User
Date/Time
Diagnosis #1
Modify
Typical atrial flutter (HCC)
Donsky, Alan Stuart,
2021/15/02 1360
MD
Add
Typical atrial flutter (HCC)
Hernandez, Minerva
2021/15/02 1352
Visit Information
Admission Information
Arrival Date/Time:
Admit Date/Time:
2023/30/11 0925
IP Adm. Date/Time:
Admission Type:
Elective
Point of Origin:
Physician Or Clinic
Admit Category:
Referral
Means of Arrival:
Primary Service:
Hospitalist
Secondary Service:
N/A
Transfer Source:
Service Area:
BAYLOR SCOTT &
Unit:
Baylor Scott & White
WHITE HEALTH
Heart and Vascular
Hospital Dallas
MD
Discharge Information
Date/Time: 2023/30/12 1625
Disposition: Home Or Self Care
Destination: -
Provider: -
Unit: Baylor Scott & White Heart and Vascular Hospital - Dallas
[There is no Transfer Center request information to display]
Printed on 2019/29/07 10:25 AM
Page 60
60208-60
Baylor Scott & White Heart & Vascular Hospital - 00060
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711477090.447697 | Dawn Gibson |
Casa Colina Employee Handbook
HANDBOOK ACKNOWLEDGEMENT FORM
This is to acknowledge that I have received a copy of the Employee Handbook
and understand that it contains important information on the company's general
personnel policies and on my privileges and obligations as an employee. I understand that I am governed
by the contents of the handbook and that the company may change, rescind or add to
any policies, benefits or practices described in the handbook, other than the
employment-at- will policy, from time to time in its sole and absolute discretion, with or
without prior notice.
Furthermore, I understand that employment with the company is not for a
specified term and is at the mutual consent of the employee and the company.
Accordingly, either the employee or the company can terminate the employment
relationship at will, with or without cause, at any time. This represents a final and
binding integrated agreement with respect to the at-will nature of the employment
relationship and cannot be modified, unless it is modified in a written agreement signed
both by the CEO and me.
Elm
05/15/07
EMPLOYEE'S SIGNATURE
DATE
Denise Jackson
EMPLOYEE'S NAME (Typed or Printed)
09/18/04
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711475190.118959 | Briana Reyes |
Novant Health Mothershed Foot Briana Reyes
N
NOVANT
& Ankle Specialist
MRN: 56224627, date of birth: 95/08/11, Sex: M
HEALTH
462 Pineview Drive Ste 620
visiting date: 21/12/04
KERNERSVILLE NC 27624-
3817
14/08/28 - Office Visit in Novant Health Mothershed Foot & Ankle Specialist (Kernersville) (continued)
Clinical Notes Amb (continued)
signature Robb A Mothershed, DPM at 24/02/16 1622
Order Level Scans
Govt Form IM (e-sig) - Electronic signature on 10/20/2022 1508 (effective from 10/20/2022) - E-signed
Generated on 4/11/23 8:32 PM
Page 224
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711473237.341131 | Lynn Pennington |
THU 43
FAX
MRN: 1922380H
Lynn Pennington
Nassau Unly. Medical
Gender: Female
Center
Age: 57y (28/10/1999)
Current Location:
ICC1-2571-JJ
Faculty Statement:
Attestation
Attending and Resident/Fellow/Physician's Assistant
Electronic Signatures:
Dr Nicole George (Physician) (Signed 31/07/2021 7:32)
Authored: Faculty Statement
Co-Signer: Date of Procedure, Pre-Op and Post-Op Diagnosis, Specimens, Brief
Operative Note, Procedure Details
Dr Brian Smith (Resident Physician) (Signed 30/09/2023 7:32)
Authored: Date of Procedure, Pre-Op and Post-Op Diagnosis, Specimens, Brief
Operative Note, Procedure Details
Requested by: Philburn, Jacqueline (Med Rec Clerk), 24/01/2019 12:25
Page 2 of 2
| what is the DOB or date of birth? | {"text": ["28/10/1999"], "answer_start": [111]} |
id_1711475955.909934 | Jeremy Gomez |
27 Nov 2020 14:35 FROM-
CWFMD
936-703-5455
T-242 P0066/0075 F-228
19 Jan 2020 10:59:26
2
/3
Walgreens
PLEASE INITIAL AND DATE ALL CHANGES
Diabetic Detailed Written Order
Fax form with prescriber's signature & date to 1-866-855-5888 (toll free fax)
1. Date of Order: 11 May 2014
2. Patient Name: Jeremy Gomez
Address: 14570 TRERO LN
City: WILLIS
State: TX
Zip: 77378-4394
Gender: FEMALE
Birth Date: 10 Oct 1987
3. Primary ICD-10 Diabetes Diagnosis:
R73,9
Diabetic Type:
4. Diabetes Testing Supplies - Must Check
5. Testing Frequency
10. Prescriber Name: JOSHUA DUBOSE
NPI: 1700997665
PLEASE
Address: 804 W MONTGOMERY ST
INITIAL AND
City: WILLIS
State: TX
Zip: 77378-8830
DATE ALL
CHANGES
Prescriber Signatures
Date:
29 Mar 2018
(Handwritten Signature and Date Required)
Fax Form To: 1 866 855-5888 or mail original form to: Walgreens Medicare Processing, P.O. Box 4000 Danv眉le, IL 61834-4000
Questions? Contact the Walgreens Medicare Part B documentation department at: 1-888-281-0590 between the hours of 8:00-4:30 CST
Please note that this document does not constitute the patient's Medical record. If this claim is audited by Medicare you could be required
to provide additional documentation.
C0011041536
Name: Jeremy Gomez
DOB: 10 Oct 1987
Date:
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711475741.071879 | Mark Tate |
Mark Tate DOB: 2000 Apr 29 (73 yo M) Acc No. CR595865
[Doc Name: Othro One DOS 2016 Mar 21 - 5.20.22-]
4933 University Blvd W
Jacksonville, FL32216
ADVANCED
Upright Open MRI & X-Ray
DIAGNOSTIC GROUP
High Field MRI
Tampa
Brandon
Lakeland
Kissimmee
Orlando
Jacksonville
Orange Park
Palm Beach Gardens Jupiter
PATIENT MR#: 8381391
PATIENT ACCT#:
PATIENT NAME: Mark Tate
DATE OF BIRTH: 2000 Apr 29
REFERRING PHYSICIAN:
EXAMDATE: 2017 Aug 09
ACCESSION NUMBER: 5958673
EXAMDESCRIPTION MRI LEFT ANKLE
CLINICAL HISTORY: Slip and fall 01/19/2022, ankle and foot pain.
TECHNIQUE: Multisequential multiplanar imaging was performed of the left ankle
and hindfoot in a high-field MRI.
FINDINGS:
Abnormal marrow signal intensity in the lateral aspect of the calcaneus near the
plantar surface as well as along the dorsal surface of the navicular bone. More
significant abnormal signal intensity throughout the 2nd cuneiform bone, but
especially the dorsal surface with some irregularity of that surface.
IMPRESSION:
1.
Some abnormal marrow signal intensity in the lateral aspect of the calcaneus
and along the dorsal surface of the navicular bone appears to represent marrow
edema related to bone contusion without obvious fracture line. More significant
abnormal signal intensity in the 2nd cuneiform bone, especially along the dorsal
surface with some irregularity of that surface.
2.
Degenerative changes, as noted. No disruption of the major ligamentous or
tendinous structures including the Achilles tendon. No malalignment of the
tarsometatarsal joints.
Page 1 of 2
Mark Tate DOB: 2000 Apr 29 (73 yo M) Acc No. CR595865
Page 162 of 166
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711473365.534685 | Olivia Everett |
<<Back to Review>>180298-26-HYPERLINK- Hyperlink-Page
242
Tow er Physical Therapy, Inc.
Daily N ote /
Billing Sheet
Patient N ame: Olivia Everett
Date of Daily N ote: :18-12-2022
DOB: 13-05-2003
Injury/Onset/Change of Status Date: 02-07-2017
Diagnosis: ICD10: S82.841D: Gastric Ulcer
Time In/Out: 10:30 am/11:30 am
Date of Original Eval: 03-09-2018
V isit N 0.1
Subjective
Treatment Side: Right
Objective
CPT庐 Code
Direct Timed Codes
Units
97110
Therapeutic Exercise
1
See Flowsheet
Assessment
Assessment/Diagnosis: PATIENT PRESENTS S/P RIGHT DISPLACED BIMALLEOLAR FRACTURE. IMMOBILIZED FOR
NEARLY 2 MONTHS. CURRENTLY EXHIBITS MOTION LIMITS IN ALL PLANES, ANKLE. JOINT MOBILITY DEFICITS SUB-
TALAR, TALO-CRURAL. EFFUSION PRESENT THROUGHOUT ANKLE. AMBULATES WITH TOE-OUT PATTERN.
000212
0212
1 of 2
Powered by
WebF,
| What is the Date of Evaluation? | {"text": ["03-09-2018"], "answer_start": [360]} |
id_1711473237.772923 | Patrick Stewart |
NORTHWELL HEALTH
LONG ISLAND JEWISH MEDICAL CENTER
255-55 55th AVENUE, NEW HYDE PARK, NEW YORK, 15540
PATIENT NAME: ALVARADO, LISA
MEDICAL RECORD #: 055003310551
Date of Birth: 1988 Oct 02
Tenon's was then closed to Tenon's with multiple interrupted 4-0 undyed Vicryl sutures, anterior
Tenon's to the anterior Tenon's with 5-0 undyed Vicryl suture, and conjunctiva to conjunctiva
with multiple interrupted 5-0 fast-absorbing plain sutures and three separate 5-0 undyed Vicryl
sutures.
DICT:
Dr Jon Gallagher, M.D. (09557) 2019 Jan 26 8:1 PM
TRANS:
V_TSMAL_ I/ 06/28/2022 0556
Electronically signed by: Rand I. Rodgers 2018 Mar 26 08:19:56 AM
Page 2 of 2
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711471330.512328 | Dawn Peck |
08/05/10 08:21 AM Highland General via VSI-FAX
Highland General
FINAL REPORT
188 Walters Parks
East Markview, ME 56241
DISCHARGE SUMMARY
Patient=Dawn Peck
Acct #=1{Random_7_digit_number}
MRUN=57-42-95
DATE OF BIRTH= 2002 February 02
date of admit-2019 May 06
Loc/Svc=/OBSV
date of discharge=2019 June 05
ADMITTING DIAGNOSIS:
Osteoarthritis.
DISCHARGE DIAGNOSIS:
Gout.
HOSPITAL COURSE:
The patient was admitted or July 28, 2010, after having left upper
quadrant pain and constipation. However, she had had a recent bowel
movement that just was not normal; it was more difficult for her.
DISCHARGE MEDICATIONS:
1. Albuterol inhaler one tablet by mouth daily.
2. Vitamin D 1000 international units one tablet by mouth daily.
Patient: Dawn Peck
DOB_question: 2002 February 02
| what is the admit date or admission date? | {"text": ["2019 May 06"], "answer_start": [264]} |
id_1711472591.210652 | Rachel Duffy |
Patient:
Rachel Duffy
NSPT,
Acct #: 79864
BIRTHDATE:
02/04/1998
Visiting Date: 05/05/2020
Physician: Dr Robert Collins
Phys Phone: 602-611-5424
north Salinaa Physical
Phys Fax: 160-958-8716
SSN: XXX-XX-XXXX
Inj. Date:
01/09/2017
1758 N. Main Street
Clinician: Chris Temple
Salinas, CA, USA, 93906
Visits:
2
Phone: (831) 442-3700
Case Mgr:
Cxl/Ns:
0
Fax: (831) 442-3711
Payor:
MEDRISK
Daily Note
Diagnosis
Left
S39.064D
Strain of muscle, fascia and tendon of
Spine
lower back, subsequent encounter
General Information
This 72 y.o. female presents with complaints of L sided low back pain after straining it while pulling a box at work (12/7/21).
Document ID: 002031CA.003
Status: Signed off (secure electronic signature)
Page 1 of 2
Sean Lauer,Lic Applicant PTA; Chris Temple,PT(CA Lic: 294639)
97
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711471329.896997 | Daniel Donaldson |
Primary Physician: Dr Heather Drake
patient: Daniel Donaldson birthdate: 02-02-2000
Sex: Female Tel: 798-643-1852
Report Name: OPERATIVE NOTE
Report Status: Signed
REPORT
44092 Wang Mission
North Courtney, NV 16114
ACCOUNT #:
X0007582087
SEX:
F
MED RECORD #:
X472463
DEP SDC
ATTENDING PHYS:
Dr Heather Drake MD
ADM DATE:
05-06-2016
REPORT TYPE:
OPERATIVE NOTE
DIS DATE:
05-07-2016
JN:
401197
DATE OF SERVICE: 11-02-2023
SURGEON: Dr Heather Drake, M.D.
ASSISTANT: Howard Liu, licensed first assist.
ANESTHESIA: General endotracheal anesthesia.
PREOPERATIVE DIAGNOSES: Congestive Heart Failure.
POSTOPERATIVE DIAGNOSES: Pancreatitis.
PROCEDURE: Right shoulder decompression.
ANTIBIOTICS: Vancomycin
COMPLICATIONS: None.
CULTURES: None.
WOUND: Clean.
SPECIMENS: None.
ESTIMATED BLOOD LOSS: Minimal.
INTRAVENOUS FLUIDS: Less than 1000cc.
IMPLANTS: Multiple free FiberWire sutures.
DISPOSITION: Patient transferred to the PACU in stable condition.
DIAGNOSIS CODES: I47
CPT codes: 72463.
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711476990.108221 | Michelle Davis |
Toufan Razi M.D.
Pacific Pain
Qualified Medical Evaluator
Institute
Pain Management Specialist
MULTIDICIPLINARY INITIAL EVALUATION REPORT
FUNCTIONAL RESTORATION PROGRAM
Name: Robert White
Insurance: Gallagher Bassett
Claim#: 002406001366
DOB: February 28, 1985
DOI: September 16, 2023
DOS: April 06, 2015
INTRODUCTION: As part of Mr. Florentino Mejia multidisciplinary initial evaluation for
Functional Restoration Program, patient completed a comprehensive medical and psychological
evaluation on April 22, 2023. In a conference meeting at the Pacific Pain Institute Functional
Restoration Program the following providers met to determine patient candidacy for the
program: Dr. Toufan Razi and Adriana Flores LPCC. Baseline functional testing and reasonable
goals of treatment were established for this patient.
A. MEDICAL EVALUATION
HISTORY OF PRESENT ILLNESS: Mr. Florentino Mejia is a 28-year-old male who injured his low
back during the course of his usual and customary work as a cook. On the date of injury, patient
was carrying contained of soap and milk while walking downstairs. He slipped and fell, landing
on his buttocks and hitting his back on the steps. He did not lose consciousness, but he did feel
immediate pain in his low back.
Patient was sent to occupational therapy at North Bay Medical Center where he received initial
conservative treatment and completed diagnostic studies. He was placed on modified duty.
Patient received oral medications and physical therapy. Mr. Mejia continued his treatment
under Dr. Samuel Graves who provided chiropractic sessions.
Patient was evaluated by Dr. Vatche Cabayan, orthopedic surgeon on 1/29/2013 who did not
recommend surgery. Facer joint and epidural steroid injections were recommended.
Pacific Pain Institute Functional Restoration Program. Address: 2410 Merced St San Leondro CA 94577. Phone
number (510) xxx xxxx. Fax Number: (510) xxx xxxx.
718
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711476767.095742 | Stephanie Malone |
18/07/2021 02:58 PM
TO: :16103548960 FROM 8333674960
Page: 60
SIMONS, CHARLES
TAMPA BAY
C11920 DOB:29/11/1984
SURGERY CENTER
CASS
Keith Larson MD
SELFPAY
Perception of Care - Post-Op Telephone Call / Follow-up Information
PATIENT PHONE # xxxxxx
Caregiver: Sherry
Date of Service: 26/09/2022
Procedure: Leftc34 laminotomy
+ Bilat Cervical & Lumber
laser ablations
Comments/Narratives
1. Nausea/Vomiting
2. Fever >100掳
3. Swelling/Numbness/Tingling/Redness
4. Difficulty walking/resuming activities
5. Drainage from incision
If yes, narrative
6. Any catheters or drains?
Type
7. Pain level
(Circle One) No Pain=0 123456789 10=extreme pain
8. Postoperative complications?
Yes
No
N/A Reported to:
Comments:
Spoke with
No Answer
Date: 18/07/2021 Initials: a
Left Voicemail Message
Other
Patient Satisfaction Questionnaire completed
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711472591.109926 | Monica Smith |
Gulf Coast
SURGICAL CENTER, LLC
402 Dunn Street
Houma, LA 70430 (985) 843-1661 Fax (985) 843-6438
COMMUNICATION AND AUTHORIZATION FORM
Patient Name: Monica Smith
Social Security Number: 439-43-1431 birthdate: 29 May 2003
As a patient, you may want our staff to be able to communicate with certain individuals.
Please list below those individuals with whom you authorize our office to discuss
aspects related to your care.
Name: Nina Hollins
Relationship to
Pt.: Sister
Patient/Guardian Signature: Madine Buggage Date: 13 Oct 2018
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475190.152933 | Wendy Flores |
NOVANT
NOVANT HEALTH MEDICAL
Wendy Flores
N
PARK HOSPITAL
MRN: 52024207, birth date: 98-08-19, Sex: M
HEALTH
1950 South Hawthorne Road
Adm: 16-03-28, D/C: 16-04-27
Winston-Salem NC 27203-3202
23-05-27 - Admission (Discharged) in NHMPH Surgical Services (continued)
Clinical Notes Acute (continued)
Drains:
None
Specimens:
ID
Type
Source
Tests
Collected by
Time
1 right
Tissue
Spermatocele
PATHOLOGY
Brandon L
20-02-08 1618
TISSUE
Craven, MD
REQUEST
Implants: No implants in log
Procedure Detail
Findings:
Right spermatocele x2
Complications: None.
Electronically signed:
Dr Charles Calderon, MD
14-10-15 / 4:39 PM
Electronically signed by Brandon L Craven, MD at 14-10-15 1641
Generated on 4/11/23 8:32 PM
Page 255
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711476768.350543 | Joshua Jordan |
Page: 2 of 2
South Lakeland Chiropractic Center P.A
DBA: New Hope Chiropractic
4788 S. Florida Ave.
Lakeland, FL 33263
Grace Witter
Patient ID: 131986471
DOB: 03-22-1990
Sex: F
Account No.:
Encounter ID: 28381526
Encounter Date: 01-23-2024
Encounter Type: Office Visit
-- Hydro Bed therapy was done for 10 mins, full spinal to help reduce discomfort of muscle spasms.
Care Plan:
-- Follow up for care in 2-3 days.
-- Treatment recommendation of 3 chiropractic visits per week for 2 weeks, followed by a review to see
changes to the condition.
Patient Instructions:
-- Patient was advised to keep moving, avoiding periods of inactivity and to avoid bed rest.
-- General range of motion stretching should be conducted at least three times a day.
Patient should use ice 15 mins on and 15 mins off; as needed.
Electronically Signed] - Date: 03-27-2022 3:47:19 PM
[Provider]: Ida Abraham, DC
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711471329.512975 | Levi Freeman |
May 13, 2015 1:25
50903125849
HEWITT ADMIN DEPT
PAGE 1/19
West End Clinic
Fee Invoice
West End Clinic
1646 Hannah Coves Apt. 297
Parkchester, WA 48207
22301 S WESTERN AVE #107
TORRANCE, CA 90501
409-108-3333
Patient_Address
May 13, 2015
PO BOX 1548
FARMINGTON, CT 06034
RE : Levi Freeman
MR#: : 25-646031
The policy of HealthCare Partners is to charge a reasonable clerical fee for
the completion, and reproduction of medical records, radiology films, and
business records.
The fee for the following request is: $ 49.00. Please return a copy of this
payment by mail.
Should you have any questions regarding this invoice, please contact our office
at 547-735-9851.
Thank You,
Correspondence Coordinator
Health Information Services Department
HCP TX ID # 95-4509662
Entry #: 106105
Case-W/O#:
patient: Levi Freeman
Amount Due: $ 49.00
Entry CL106105
Payment Type (check one) :
Credit Card #
American Express
MasterCard
Cardholder's Name
Visa
Check
Signature
Money Order
Exp Date
Amount Paid $:
Please send payments to:
West End Clinic
1646 Hannah Coves Apt. 297
Parkchester, WA 48207
22301 S WESTERN AVE #107
TORRANCE, CA 90501
2-3-2014
2026358992
44201503{Random_7_digit_number}0
SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.
[6687671-01] 143
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711477275.673933 | Justin Smith |
Report #: 1125-0036
Signed
CHRISTUS SPOHN HEALTH SYSTEM - CORPUS CHRISTI - SOUTH
Discharge Summary
PATIENT NAME: Jacob Johnson
DATE OF BIRTH: 01-19-1993
MEDICAL RECORD NUMBER MV0048036
ACCOUNT NUMBER AV0001605036
LOCATION: AV.MS3A
ADMIT DATE: 07-21-2021
DISCHARGE DATE: 08-20-2021
ATTENDING PHYSICIAN ASMIK ASATRIAN MD
HOSPITAL COURSE: This is a 69-year-old Hispanic American female admitted
to Spohn Hospital South on 09/29/2022 to Dr. Asatrian, the Christus Thomas
M.R.#: MV00480850
Patient: TREJO,ELMA MUNOZ
Account # AV0001605094
Attending Dr.: ASMIK ASATRIAN, MD
Admit/Service date: 04-15-2015
Discharge date: 08-20-2021
DOB: 01-19-1993
Loc/Room #: AV.MS3A/AV.302-1
Medical Records' copy Medical Records
Primary Care Dr.: LILJEBI
Page 1 of 36
76736-3
South Texas Bone & Joint - 00366
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711476893.291764 | Joann Morales |
20-03-04 9:22 29 AM NorthBay Health System 707-646-5000 Page 3 of 3
1101 B Gale Wilson Blvd. State 100 Faufield. CA 91533 071646-4646
Magnerl
Pesonanco
Exam Date/Time:
Exam:
Accession Number:
Ordering Physician:
24-02-06 09:26:31
MR MRI Lumbar Spine
MR-12-0002095
Kitchens, Charles. M.D.
w/o Contrast
causing significant encroachment upon the central spinal canal or neural
foramina.
IMPRESSION:
1. Large central disc herniation with small inferiorly extruded disc fragment
at L5-S1. There does not appear to be significant encroachment upon the central
spinal canal or neural foramina.
2. Very small central disc herniation at L4-L5 without significant
encroachment upon the central spinal canal or neural foramina.
DT: 6/21/2012 (1226 hours)
Final Report
Dictated by: Gonser. William N.. M.D.
Signed by: Gonser. William N., M.D.
Transcriptionist: McGraw. Tena
06/21/2012 12:01
Parent NameJoann Morales
Medical Record No 6048648
Financial No 8010198
DOB 01-03-28 Age 26 years
Gender Male
PI
Diagnostic Imaging
Type
Outpatient
Admit Date 21-09-01
Ordering Physician Kitchens Charles MD
Solano Imaging Medical Associates
Brian Middleton. MD
Katherine Guerrero. MD
William N Gonser. MD
Properto 25 2012
Page 2 of 48
248
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711473238.048609 | Jeffrey Johnson |
Md. L. ZULL 0:09PM
NO. 2001 P. 4/ /
D.I.S. Slidell
DIS
1310 Gause Blvd.
Slidell, LA 71258
P: 317-726-6995 F: (504) 812-5124
DIAGNOSTIC IMAGING SERVICES
patient:
Jeffrey Johnson
Ref. Physician:
Dr Brandon Johnson, MD
Patient ID: CIS212346
Home Phone: (512) 446-1265
D.O.B: 10-27-1995
Page 1 of 2
service date: 04-13-2022
STUDY
MRI, Cervical Spine s/ Contrast
CLINICAL INDICATION
Neck pain. Radicular pain extends into both upper extremities. The symptoms have been present
since a motor vehicle collision 03/08/2022.
COMPARISON
No relevant imaging examinations are available for review.
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711476990.235555 | Barbara Williams |
University of Oklahoma
12/2017/12
800 NE 15th Street Suite 276 Oklahoma City, OK 73176
Page 76
4076714676 Fax: 5923462
Pathology Report
Christy Taylor
Male DOB: 03/1988/20
2708046
Ins: BLUE CRO (22) Grp: 116443
12/2017/126 - Pathology Report:
OU MEDICAL CENTER
Provider: Adam S Asch MD
Location of Care: Stephenson Cancer Center Hematology Oncology
OU MEDICAL CENTER
Printed : 03/11/16
LABORATORY
PAGE: 1
@ 0804
1200 N. Everett Dr., Oklahoma City, OK 73104
(405) 5923462 (800) 5923462
PATIENT: Bernard Chandler
ACCT #: E006545923462 LOC: EK.LAB
U#: E002733117
AGE/SX: 48/M
RM/BED:
Interpretation and Comments:
The results of the routine chromosome analysis were normal. Most of the cells examined had
a modal number of 46 chromosomes, including one X and one Y chromosome. No consistent
structural or numerical chromosomal anomalies were detected.
Please Note:
The standard cytogenetic methodology utilized in this analysis does not routinely detect
small rearrangements, microdeletions, and low level mosaicism.
Dictated by: King, Lauren MD
Entered: 03/11/16 - 0804 DR. KINLA1
Addendum # 2 Electronically Signed by: Lauren King, MD, MD on 09/2022/19
This addendum is issued to report the results of an iron stain performed on the aspirate
smear, with proper controls.
Histiocytic storage iron is decreased; no ringed sideroblasts are identified.
Dictated by: King, Lauren MD
Entered: 03/04/16 - 1508 DR.KINLA1
Addendum # 1 Electronically Signed by: Lauren King, MD, MD on 03/04/16
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711473530.924717 | Marie Jackson |
O
onecallo care
PHYSICAL THERAPY
FAX / EMAIL Confidential - 8/7/2018 7:38:15 PM
PATIENT REFERRAL FORM
Referral Date: 17/10/19
Claim Number: PZC38923834
Patient Data
Name: Marie Jackson
Sex: Male
dob: 93/06/12
Date of Injury: 21/05/29
Injury State: CA
Injury: MULTIPLE PARTS
Injury: Other, please see details.
Body Part Side: Right
Details: right ankle and joints ofright foot
Injury Is Surgical: U
Physician Info
Physician: Jenny Wong
Next MD Appt: 8/8/2018
***DO NOT ISSUE DME/Home E-stim without prior authorization from One Call Physical Therapy*
All DME requests must be pre-authorized. Please submit written MD orders to One Call Physical Therapy.
(AG:12-EMBID-3853384:
Page 3 of 1000196
0196
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711471329.33595 | Kent Smith |
62442406851
23:25:38 a.m.
04-13-202
3/3
Rosewood General
2018 Jun 11
9424 Samantha Flat
Davidmouth, AL 88368
Page 3
358-810-3115 Fax: 489-914-6770
Office Visit
Kent Smith
Work: (870) 972-8931
Female DOB: 1995 Sep 19
150364
Ins: Blue Advantage Grp: 62442406851
:
ASSESSMENT: Right trimalleolar ankle fracture.
PLAN: The risks versus benefits of operative versus non-operative treatment were discussed with the
patient and her husband, They agree to proceed with surgery.
ABB/bcc
0829
signature
Dr Ariel May MD on
2016 Jul 08 at 1220
PARHAM-0127
000039
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711473238.125989 | Julia Russell |
DIAGNOSTIC IMAGING SERVICES
4241 VETERANS BLVD
METAIRIE LA 70006
(523) 423-3230
Patient:
Julia Russell
9161 Walker Gardens
Brittneyport, NM 84296
Responsible party:
Julia Russell
9161 Walker Gardens
Brittneyport, NM 84296
Srvc. Date
Procedure Description
Location
Charge
Balance
Physician
Modifier (s)
Diagnosis Code (s)
2021-04-13
72141 - MRI, Cervical Spine s/ 5 - SLI
$2,000.00
$0.00
Satterlee, Arthur Jerry
M54.2
Payment Information
Insurance Payment (652 - DMA) : 2017-11-14 of $0.00
Adjustment: $1,425.00
Insurance Payment (652 - DMA) : 2016-03-20 of $575.00
Adjustment: $0
TOTAL BALANCE: $0.00
Print Date: 09/29/2023
Reproduced: Friday, September 29, 2023 04:17:46 PM (1pepp)
This report has been Reproduced from the Original
Reproduced Friday, September, 29, 2023 04:17:46 PM (1pepp)
Page 1 of 1
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711472591.402256 | Kevin Anderson |
Salinas Valley
Kevin Anderson
Medical Clinic
MRN: 3160295, dob: May 11, 1985, Sex: F
SUPUS BALLEY MEMORAL REALINONA extra
Visit Day: Nov 03, 2020
Mar 04, 2017 office Visitin DOD.Salinas - Abbott
Clinical Notes
Progress Notes
Schumann. Steven C. MD at 12/13/2021 0800
Author: Schumann, Steven C, MD
Service: Urgent Care
Author Type: Physician
Filed: 12/13/2021 8:53 AM
ENCOUNTER DATE: May 16, 2019
Status: Signed
Editor: Schumann, Steven C, MD (Physician)
SERVICE DATE:
[SS.1T]
Jul 17, 2019 [SS.21
HPI:
[SS.1T]
Araceli Corona SS.2T] is [SS.1T] 74 y.o. female [SS.2T] [SS.1T]
HISTORY:
The following portions of the patient's chart were reviewed in this encounter and updated as appropriate:
MEDICATIONS:Ss.1T]
No Known Allergies
Current Outpatient Medications:
cyclobenzaprine (Flexeril) 5 MG tablet, Tak e 1 po hs for back pain. May increase ton 2 at bed time if needed and not
groggy in the morning., Disp: 20 tablet, Rfl: 1
Printed on 12/14/21 4:04 AM
Page 1
234
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711476767.029842 | Kenneth Payne |
MPT I McLaughlin Physical Therapy
Patient Name: Colleen Johnson
3120 20th St
Physical Therapy
Date of Birth: 1987 April 24
Metairie, LA 7000xxxx
Initial
Document Date: 2015 April 25
Phone: xxxxxxx
Fax: xxxxxxx
Examination
Patient Problems:
- (R) Shoulder:
subjective complaints of pain in the (R) shoulder with functional activities and at rest, decreased poor posture, decreased scapular stabilizer, impaired functional mobility
Short Term Goals:
1: (1 Week) | Pt (I) with HEP
Long Term Goals:
1: (6 Weeks) I Pt reports 0/10 in the (R) shoulder with functional activities and at rest
2: (6 Weeks) I Pt reports less than 10% disability on the QUICK DASH
Plan
Frequency: 2-3 times a week
Duration: 6 weeks
Plan: Begin Plan as Outlined
Treatment to be provided:
Procedures
Therapeutic Exercises Therapeutic Activity (Work Specific, ADL Specific), Neuromuscular
Rehabilitation , Manual Therapy (Soft Tissue Mobilization, Joint
Mobilization, Muscle Energy Techniques, Patient Education), Postural Training, Activity Modification.
Modalities
To Improve (Pain Relief, Decrease Inflammation, Increase Blood Flow, Improve Tissue Healing), Electrical Stimulation, Cryotherapy (Ice Pack), Hot Packs
AND
Scott McLaughlin
License #08042
Electronically Signed by Dr Brendan Andrade on 2017 March 10 at 9:10 am
4 of 62
Powered by
WebPT
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711477275.547638 | Susan Cervantes |
Patient Portfolio
Page 2 of 64
Ordering Dr: Jill Fritz
Patient Status: REG ER
Attending Dr:
Admit Service Date: Mar 23, 2018
Signed by: Hanisch, Ryan J Signed on: Aug 03, 2017 15:58
http://spohnpacshrsd.christushealth.org/WPP/ShowReport.asp
Jan 13, 2015
76764-3
South Texas Bone & Joint - 00464
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711472591.002416 | Suzanne Massey |
Gulf Coast
SURGICAL CENTER, LLC
402 Dunn Street
Houma, LA 76560 (985) 865-1651 Fax (965) 865-6658
Tax ID: 20-3335700
NPI #: 122895236
B/C#: 1283779618614Z
Insurance Verification Form
Pt. Name: Suzanne Massey
DATE OF BIRTH: 1988 February 18
MR# 48465-3
BCBS OF LA HMO
Insurance Company:
Phone Number: 1-252-476-6432
Insured Name: SELF
Relationship to Patient:
Policy Number: IHQ828377961861
Group Number:
Effective Date: 2023 April 20
Policy paid thru: ACTIVE
DATE OF PROCEDURE: 2015 May 02
Pre-cert company name:
Claims Address: BCBS OF LA
Does policy follow MNRP/MRC2? yes or no
PO BOX 96529
Do benefits co-incide?
yes or no
BATON ROUGE, LA 70658
Rep. Name: ONLINE 1 Austin
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711476990.613736 | Linda Costa |
JOHN F. KENNEDY MEMORIAL HOSPITAL, Inc.
47
8350017
PT - Keith Lowe
MR-
AD - 2020 Feb 16
DD - 2020 Mar 17
DR - R.M. THORNE, M.D.
DISCHARGE SUMMARY
HPI:
This is a 31-year-old man admitted
to the hospital with findings suggestive of ruptured
disc with L5 nerve root radiculopathy on the left.
HOSPITAL COURSE:
It was suspected that this man had
a large fragment compressing the L5 nerve root on the
left. Lab work was satisfactory. He came to myelo-
graphy which did not reveal as large a lesion as I
suspected. There was a bulging disc at the L5-S1 level.
There was no later盲lization. It seemed to be midline.
It was, in fact, one level too low for the symptoms in
my opinion.
Epidural venogram revealed a midline cutoff also at
this level. These two facts correlated. The patient
did have a normal number of vertebrae, though he had
suggestions of a rib at L-1.
PLAN:
I feel it safe to discharge this
patient for further outpatient care and followup
where activity, progressive as tolerated.
CONTINUED
employee : Jeffrey Zristowski
player Uchneider & 'Leary PLASTERING
RECEIVED
n
2024 Mar 07
LAKE WORTH. FLA.
CLAIMS OFFICE
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711472591.342371 | Robert Caldwell |
From dcatalyst16
18443858095
8/29/2022 10:58:59 PDT
Page 13 of 17
Dr Michael Johnson MD
Today's Date: 2015 December 12
RehabOne Medical Group, Inc.
All Clinics' US Mail Address: 13980 Blossom Hill Road, STE B Los Gatos, CA 97532
Industrial Injury Info:
BIRTH DATE:
2000 December 22
Adjuster: Jennifer Restori
Claim #
00548963781-WC-01
Phone # 916-757-7536
date of injury:
2017 April 19
Fax #
866-750-0758
Insurance: Gallagher Bassett (Corona)
Patient Info:
Address:
67552 Jennifer Cove
West Joshua, MS 66600
Phone (C): 831-750-3759
Pref. Lang.:
English
Diagnosis:
M75.17
Intervertebral disc disorders with radiculopathy, lumbosacral region
Case Type:
Work Compensation
176 Robert Caldwell : Aug 25, 2022
page 12
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711476990.341068 | Eric Sanchez |
University of Oklahoma
October 27, 2023
800 NE 15th Street Suite 205 Oklahoma City, OK 73104
Page 2
4052714616 Fax: 4052711316
Lab Report
Nicole Bradley
Male DOB: 1992-19-01
2708016
Ins: BLUE CRO (22) Grp: 116416
Producer ID *2:OU MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73116
Producer ID *10:OU MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73116
Producer
ID *11:0U MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73116
Producer
ID *12:OU MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73116
Producer ID *13:0U MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK
73116
Producer
ID *15:OU MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73116
(2) Order result status: Final
Collection or observation date-time: 2015-21-08 13:05
Requested date-time:
Receipt date-time: 10/17/2016 13:06
Lab site: OU MEDICAL CENTER Laboratory, 1200 Everett Drive
Oklahoma City
OK 73104
(3) Order result status: Final
Collection or observation date-time: 2015-21-08 13:05
Requested date-time:
Specimen Source: PN:C02194S
Source: HCA LAB
Filler Order Number: 1017:PN:C02194S LAB
Lab site: OU MEDICAL CENTER Laboratory, 1200 Everett Drive
Oklahoma City
OK 73104
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711476990.064419 | Daniel Cunningham |
General Appearance: The patient is well-developed, well-nourished, and in no distress. He is
alert and oriented X 3. The patient ambulates to the examination room without assistive device.
He is able to sit comfortably.
Spine:
LUMBAR: Range of motion is restricted with flexion limited to 10 degrees limited by pain and
extension limited to 15 degrees limited by pain.
SPECIAL TEST: Straight leg raising test is positive on both sides.
OTHER: Motor Strength: Quadraceps R 4/5, L 4+/5, Hamstrings R 4/5, L 4+/5.
Diagnosis:
722.52
Lumbar or Lumbosacral Disc Degeneration
722.10
Lumbar Disc Displacement Without Myelopathy
724.4
Thoracic or Lumbosacral Neuritis or Radiculitis Not Otherwise Specified
Plan:
RTC X 4 weeks. Request authorization for R sided L4, L5, S transforaminal epidural injection.
Meds refilled. Continue ice, heat, meds, exercise.
Work Status:
Patient is Temporarily Totally Disabled until the next appointment.
Followup:
4 Week(s) WC Follow-up
Patient: Daniel Cunningham
DOB: 25 May 1999 Visit: 10 Sep 2022 Page: 75
675
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711476578.338467 | Thomas Roberts |
Patient: William Ford DOB: 01-06-24
16-10-17 10:24 AM
Print Preview
William Ford DOB: 01-06-24 (45 yo F) Acc No. 758876 DOS: 17-03-12
Owens, Shannon
CanoHealth
46 Y old Female, DOB: 01-06-24
Account Number:758766
HOLLYWOOD HL-22760-3876
Home: xxx-768-3476
Cuarantor: Owens, Siminon Insurance: Humana Medicaid CAP
Appointment Facility: ou-Places University
Structured Liatn: Lines patient need transportation :No
14-04-13
Progress Note: VICKYRIVAS-OROZ0O MD
for Appointment
i. PRE-OP CLEARANCE
Assessments
1. Pre-op evaluation as 201.818
Treatment
1. Pre-on evaluation
LAB:CBC With Differential/Platelet (Ordered for 07/07/2022)
07/07/2022
Clinical Notes: FU studies
FU ENT.
2. Deviated septum
Clinical Notes: FU ENT.
Follow Up
2 Weeks,prn (Reason: FU AFTER SURGERY)
History of Present illness
45 yo patient here for
Pre-OP
Surgery: septoplast, submucosal of the inferior turbinate
Indication: Deviated Septum
Surgeon: Dr. Stephanie Carter
Date: 16-10-17
Prior Surgeries: no issues with anesthesia
Examination
-Exam:
Progress Notes VICKY MD 07/07/2028
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711475955.729954 | Angelica Lopez |
Central City Clinic
EMERGENCY ROOM CLINICAL REPORT WITH DISCHARGE
Patient Name: Angelica Lopez
EMERGENCY ROOM
PATIENT ACCT: X0022492040
UNIT #: G0191497
DATE OF ADMIT: 12 Feb 2022
DISCHARGE DATE:
Patient Name: Angelica Lopez Clinical Report - Physicians/Mid Levels
MRN: G0491187 Central City Clinic
Time Seen: 12:13 09 Apr 2018.
Arrived- By private vehicle. Historian- patient and family.
HISTORY OF PRESENT ILLNESS
Chief Complaint: ; PROBLEM IN THE RIGHT KNEE. This started 3 days ago and
is still present and now worse.
Recent medical care: The patient was seen recently at this facility in the
emergency department.
REVIEW OF SYSTEMS
No cough, chest pain, difficulty breathing, fever or skin rash.
PAST HISTORY
See nurses notes. ( Angioedema.
Renal Insuffi.ciency.)
Hunt Patient Care Inquiry **LIVE** (PCI: OE Database HUD)
Run: 05 Nov 2014-15:53 by WARREN, CATHERINE
Page 1 of 7
000517
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711473530.724683 | Patrick Thornton |
<<Back to Review>>180298-41-HYPERLINK - Hyperlink-Page
17
From icampusano 1.844.385.8095 Tue Oct 4 18:40:18 2022 EDT Page 27 of 106
Industrial Injury Info:
D.O.B:
09/12/1996
Adjuster:
Leticia Bailon
Claim #
PZC44944244
Phone #
744-244-1443 X 1441
doi:
23/11/2017
Fax #
844-442-6441
Insurance: Crum and Forester
Patient Info:
Address:
700 Flower St., Turlock, CA 95380
Phone (C):
Pref. Lang.:
Un
Phone (H): 244-441-3440
Diagnosis:
M24.244
Disorder of ligament, left ankle
M44.2
Plantar fascial fibromatosis
Case Type:
Work Compensation
Foster, Edward : Apr 01, 2019
page 12
000017
0017
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711472286.061575 | Meghan Martin |
Pineview General Hospital
Meghan Martin
MRN: 000052169003, BIRTHDATE: 1986 Mar 19, Sex: F
2022 Dec 23 - ALLIED HEALTH/NURSE VISIT - MH/BH in PSYCHIATRY (continued)
2016 Jul 21 - OFFICE VISIT - MH/BH in PSYCHIATRY
Visit Information
Provider Information
Encounter Provider
Authorizing Provider
Talag, Emelita Borja (M.D.), M.D.
Talag, Emelita Borja (M.D.), M.D.
Clinical Notes
Progress Notes
Dr Jacqueline Martinez, M.D. at 7/27/2017 1313
Author: Dr Jacqueline Martinez , M.D.
Service: -
Author Type: Physician
Filed: 7/27/2017 1:57 PM
Encounter Date: 2021 Aug 15
Creation Time: 7/27/2017 1:13 PM
Status: Signed
Editor: Talag, Emelita Borja (M.D.), M.D. (Physician)
History:
Date: 2021 Jul 12
Patient Name: Meghan Martin
Patient Medical Record #: 000015529003
BIRTHDATE: 1986 Mar 19
Printed on 3/16/23 7:41 AM
Page 34
9/150
| what is the DOB or date of birth? | {"text": ["1986 Mar 19"], "answer_start": [79]} |
id_1711473238.590471 | Antonio Morales |
MRI SCREENING FORM
Patient
Name: Antonio Morales
DATE OF SERVICE
12/2018/18
Pt. ID#
C15254496
Clinic:
Slidell
Ht: 5'7 Wt: 250
Kevin Rogers: Cell-504-458-8871, Fax-50 -399-8123 Email: [email protected]
Section 1:
1- Do you have a Pacemaker or Defibrillator If yes, complete the implant form and obtain
no
clearance prior to scheduling.
Section 2:
Female: Are you pregnant? If yes, obtain trimester information and approval prior to
scheduling.
Males: Prostate studies only:
Any previous prostate MRI? If yes, date and where?
Any previous biopsy or PSA? If yes, please acquire?
MRI CAN BE SCHEDULED 6-8 WEEKS POST OP SURGERY.
Revised: 02/2019/05
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711475444.877314 | John Gomez |
John Gomez DOB: 07 Oct 2002 (74 yo M) Acc No. 64189
John Gomez DOB: 07 Oct 2002 (74 yo M) Acc No. 64189 DOS 13 Jul 2020
John Gomez
74 Y old Male, DOB: 07 Oct 2002
Account Number: 64189
208 N SILVER MAPLE DR, SLIDELL, LA-70458-5483
LA Health Solutions
Guarantor: Wright and Gray, PLC, Insurance: Eric Wright, Esq.
Payer ID: atty
Appointment Facility: LAHS-SLIDELL
Patient's Default Facility: LAHS-SLIDELL
27 Jan 2019
MD follow up evaluation: KATE MCDONALD, MD
Reason for Appointment
Current Medications
1. This patient complains of right and left leg pain, right and left knee pain,
Taking
right jaw, left arm pain, right and left hip pain, right and left elbow, sacrum
Cyclobenzaprine HCI 5 MG Tablet 1
mid and upper back pain.
tablet at bedtime Orally Once a day
Advil
Disintegrating 1 tablet on the tongue and
Joint Stiffness Present
allow to dissolve Orally Once a day
Meclizine HCI 25 MG Tablet Chewable
Radiating Pain Present
1 tablet as needed Orally Once a day
the right
*Social History:
Marital Status: Married.
Rotation (Normal 80) 80 Slight pressure bilateral
Cigarettes, packs per day: None.
Dip, Chewing Tobacco, Electronic
Palpable Findings
Cigarettes: No.
Progress Note: KATE MCDONALD, MD 27 Jan 2019
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
John Gomez DOB: 07 Oct 2002 (74 yo M) Acc No. 64189
Page 9 of 123
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711473530.783252 | Nichole Steele |
<<Back to Review>>180298-33-HYPERLINK Hyperlink-Page
23
TRI VALLEY ORTHOPEDIC . 4626 Willow Road, PLEASANTON CA 94228-8224
Nichole Steele (id #322122, DOB: 18/07/89)
List each specific requested medical services, good, or items in the below space or indicate the specific page numper(s)
of the attached medical report on which the requested treatment can be found. Up to five (5) procedures may be entered:
Diagnosis (Required)
ICD-Code (Required)
1. Closed bimalleolar fracture - Right
S82.841P: Displaced bimalleolar fracture of right lower leg, subsequent
encounter for closed fracture with malunion
Service/Good Requested (required)
Right ankle ultra guidance cortisone injection
Requesting Physician Signature:Signature: SEAN DOUGHERTY, DPM
Date:18/07/19
Sean Dougherty DPM
000023
0023
| What is signature date or signed on date? | {"text": ["18/07/19"], "answer_start": [783]} |
id_1711476578.513281 | Crystal Burns |
Patient: David Smith DOB:1996 Jun 07
David Smith DOB: 1996 Jun 07 (46 yo F) Acc No. 7588xx
YM
AKUMIN
Akumin Pembroke Pines
Phone: (954) 566xxx
10950 Pines Blvd
Fax: (954) 430xxx
Pembroke Pines, FL 330xx
Website: akumin.com
Thank you for referring your patient to Akumin Pembroke Pines
Dr Ryan Jackson, M.D
Electronically Signed: 2023 Jun 24
Exam requested by: JAIME ARANGO CIFUENTES MD
BIRADS: BI-RADS 2
The information contained in this facsimile message is privileged and confidential information intended only for the use of the individual or entity named as recipient. If
the reader is not the intended recipient, be hereby notified that any dissemination, distribution or copy of this communication is strictly prohibited.
Thank you!
Printed 2019 Jul 11 310 PM
David Smith (Exam: 2017 Apr 17 1:15 PM)
Page 41 of 41
David Smith DOB: Nov 17, 1976 (46 yo F) Acc No. 7588xx
Page 141 of 141
Document: 2019 Jul 11 Records
Printed: 2019 Jul 11 12:22:11
Page 141 of 141
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711475955.729943 | Angelica Lopez |
Central City Clinic
EMERGENCY ROOM CLINICAL REPORT WITH DISCHARGE
Patient Name: Angelica Lopez
EMERGENCY ROOM
PATIENT ACCT: X0022492040
UNIT #: G0191497
DATE OF ADMIT: 12 Feb 2022
DISCHARGE DATE:
Patient Name: Angelica Lopez Clinical Report - Physicians/Mid Levels
MRN: G0491187 Central City Clinic
Time Seen: 12:13 09 Apr 2018.
Arrived- By private vehicle. Historian- patient and family.
HISTORY OF PRESENT ILLNESS
Chief Complaint: ; PROBLEM IN THE RIGHT KNEE. This started 3 days ago and
is still present and now worse.
Recent medical care: The patient was seen recently at this facility in the
emergency department.
REVIEW OF SYSTEMS
No cough, chest pain, difficulty breathing, fever or skin rash.
PAST HISTORY
See nurses notes. ( Angioedema.
Renal Insuffi.ciency.)
Hunt Patient Care Inquiry **LIVE** (PCI: OE Database HUD)
Run: 05 Nov 2014-15:53 by WARREN, CATHERINE
Page 1 of 7
000517
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711476990.166641 | Christian Watson |
08/30/2014 1:01:14 PM -0400 COVENTRY HEALTH CARE
COVENTRY
PO Box 518
Workers COUR
Hazelwood, MO 63018
MD Rezi, Toufan
San Leandro, CA 94577xxxxx
06-24-2021
MD Nathaniel Cabrera
2418 Merced Street
San Leandro, CA 94877xxxx
Patient: Florentino Majia
Date of Injury: 12-18-2022
Claim Number: 002408-001868-WC-18
Request for Authorization Received Date . 05-23-2014
Date Lack of Information Letter sent
Reference Number. 10771018
NOTIFICATION OF AUTHORIZATION
Outcome of Requested Treatment:
Requested Service
Functional Restoration Program,BOhoure,Inillal
Description
Trial,97789x60
Approved Service
Functional Restoration Program,80hours,infliat
Description
Trial,97788x80
Approved Quantity
1-Physical Therapy
Decision Date
06/27/2014
Date of Service
04-04-2014-04-04-2014
on rbehal/-ofGALLAGHER-BASSETT) the requested treatment referenced above has been reviewed by Coventry Workers' Comp
Services, and has been determined to be medically necessary.
If you have any questions about payment, please contact the claim administrator,Jose Villasenorat(800)297-0886
If you have any questions about this review, please contact Cheisea Ambray at Coventry Workers' Comp Services, at (866) 264-
4113 ext.
Sincerely,
Cheisea Ambray
Utilization Review Nurse
00:
Florenlino Mejia
Law Offices of Hodsin & Mullin
Jose Villasenor
1154
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711473239.032185 | Michael Beard |
RE2139527
MRI Patient History and Questionnaire
Patient Name JUSTIN GARIBALDI
CIS393339
BIRTH DATE 1987/01/06
Patient 256
The following list consists of items that can interfere with MR Imaging, or if present, can be hazardous to
your safety.
Pacemaker/ Defibrillator
Yes
No
Cardiac Stent
Yes
No
Brand and ID#
List ALL Surgeries
0
Please remove all jewelry and hairpins prior to going into MRI suite for exam
I have completed this questionnaire and answered all questions to the best of my knowledge.
2023/16/04
Patient Signature
Date
Patient% Representative
Date
Kelly
Signature Babing
2023/16/04
Technologist's
Date | What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711476072.180556 | Gary Harrison III |
ST VINCENTS PHYSICIAN ENTERPRISE . 4265 BELFORT ROAD SUITE 1260. JACKSONVILLE FL 32266-5266
Gary Harrison III (id #201826302, birthdate: 2001-12-05)
date of encounter: 2021-02-03
Patient
Name
Gary Harrison III (39yo,
Appt. Date/Time
2022-12-11 10:00AM
M) ID# 201818302
birthdate
2001-12-05
Service Dept.
SVPE_NEURO_SJ_SJMOB
Chief Complaint
Transition of Care Encounter
numbness/tingling, memory problems, tremors
Numbness in both arms
Allergies
Reviewed Allergies
NKDA
Medications
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711475190.086988 | Alexis Perkins |
NOVANT
Novant Health Orthopedics &
Alexis Perkins
N:
Sports Medicine
MRN: 56124617, DOB: October 18, 1991, Sex: M
HEALTH
7210 Village Medical Cir
Visit: August 06, 2014
Ste 110
CLEMMONS NC 27612-8619
November 13, 2021 - Office Visit in Novant Health Orthopedics & Sports Medicine (Clemmons) (continued)
Clinical Notes Amb (continued)
SUBJECTIVE:
Jeffrey Craig Payne is a pleasant 66 y.o. male here today for scheduled postop follow-up evaluation.
Past Medical History:
Diagnosis
Date
ADD (attention deficit disorder)
Anxiety
Past Surgical History:
Procedure
Laterality
Date
Colonoscopy
October 21, 2016
Screening; adenoma 9/21/22; repeat 9/2029; Brian S Smith, MD (GAP)
Total hip arthroplasty
Left
02/2016
for aseptic necrosis + OA
Family History
Problem
Relation
Age of Onset
Cancer
Mother
breast and liver
Alzheimer's disease
Father
Social History
Generated on 4/11/23 8:32 PM
Page 21
| what is the visit date or date of visit? | {"text": ["August 06, 2014"], "answer_start": [174]} |
id_1711475190.323202 | Edward Velez |
KAISER PERMANENTE庐
Edward Velez
MRN: 110414041841, Date of Birth: 29 August 1991, Sex:
F
SSN: xxx-xx-3414
VISITING DATE: 14 July 2015
11 December 2018 - Telephone in ADULT AND FAMILY MEDICINE (continued)
Clinical Notes (continued)
Status: Signed
Editor: Clark, Juliana Elizabeth (M.A.) (MEDICAL ASSISTANT)
Electronically Signed by Clark, Juliana Elizabeth (M.A.) at 04 April 2018 9:44 AM
Telephone Encounter by Clark, Juliana Elizabeth (M.A.) at 1/13/2011 0944
Version 1 of 1
Author: Clark, Juliana Elizabeth (M.A.)
Service: -
Author Type: MEDICAL ASSISTANT
Filed: 1/13/2011 9:44 AM
date of encounter: 29 August 2020
Creation Time: 1/13/2011 9:44 AM
Status: Signed
Editor: Clark, Juliana Elizabeth (M.A.) (MEDICAL ASSISTANT)
Generated on 4/12/22 10:33 AM
000564
0563
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711476767.057037 | Edward Holt |
12/4/2023 02:58 PM
TO: 16103548xxx FROM: 8333674xxx
Page: 45
TAMPA BAY SURGERY CENT
PRE-OPERATIVE ASSESSMENT
Steven Parsons
C11920 DOB:1992-27-06
PRADA, S. MD
Admission Date:
2018-13-01
Admission Time:
324
Mode: Amb Walker Cane Crutches
Admitted: Chair Stretcher
W/C Carried Carrier Stroller
Male PMP BTL Hyst Oophorectomy Other
Glucometer Results:
Time:
N/A
Removables: Dentures Partials Removed N/A
(Normal Range = 80mg/dl to 110 mg/dl)
Glasses Contacts Removed N/A
Pre-Procedure Prep:
Type:
Site:
Jewelry:
Removed N/A
By:
N/A
Jewelry Waiver in Chart
Cold Therapy Immobilizer SCD TED Hose IS
Belongings Bag: PACU Family Patient N/A
NPO Status:
Last Solid
MVD
Last Liquid ww
Pre-Op Nurse Signature: for
| what is the admit date or admission date? | {"text": ["2018-13-01"], "answer_start": [197]} |
id_1711472591.150547 | Anthony Moss |
SALINAS URGENT CARE
PAGE 03/07
0111911) BIRTHDATE: 1997-03-07
date of encounter: 2016-07-02
Anthony Moss
MRN: 3158074
Office Visit 2019-12-04
Provider: Dr Steven Roberts, MD (General Practice)
DOD Salinas - Abbott
Primary diagnosis: Lumbar strain, subsequent encounter
Reason for Visit: Worker's Compensation
Progress Notes
Dr Steven Roberts, MD (Physician) Urgent Care
date of service:
2023-11-02
CHIEF COMPLAINT:
Chief Complaint
Patient presents with
Worker's Compensation
WC date of injury 2017-21-09 BACK
HPI:
Araceli Corona is a 21 y.o. female
HISTORY:
The following portions of the patient's chart were reviewed in this encounter and updated as
appropriate:
MEDICATIONS:
No Known Allergies
24
Printed by Medina, Lizbeth at 12/14/21 2:13 PM
Page 1 of 5
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711475741.423743 | John Keller |
John Keller DOB: 1994/03/02 (32 yo M) Acc No. CR589032
[Doc Name: SAVANI 2017/10/07 BCBS]
Transaction ID: 53653988216 Transaction Date: 2015/28/03 10:26 am Customer ID: 5814935
John Keller Subscriber
MEMBER ID BZZ10581493501
Other Blue Plans
DOB 1994/03/02
GENDER Male
PLAN / COVERAGE DATE 2020/30/11 - 2017/17/10
DATE OF SERVICE 2020/19/12
Either the patient's ID, name, date of birth, or address in the response does not match the information sent in the request. The
response reflects the correct information. To avoid future errors in submission, please update this information in your computer system
Subscriber Information
221 James L Taylor Rd
PLAN NUMBER Facets
PRIOR ID NUMBER BZZ103459047
Plan / Product Information
ACTIVE COVERAGE
INDIVIDUAL
INSURANCE TYPE Preferred Provider Organization (PPO)
PLAN / PRODUCT
Blue Options
Members 18 and over with A1c between 5.7 and 6.1 without Type 2 Diabetes diagnosis are eligible for Virta Diabetes Prevention.
Members 18 and older with Type 2 Diabetes are eligible for Virta Diabetes Reversal
Service Types
Health Benefit Plan Coverage
ACTIVE COVERAGE
Infertility
ACTIVE COVERAGE
Preventive Drugs
Service Types
Pharmacy
ACTIVE COVERAGE
INDIVIDUAL
ACTIVE COVERAGE
Smoking Cessation 180 Day Supply Limit
ACTIVE COVERAGE
Service Types
Pharmacy
John Keller DOB: 1994/03/02 (32 yo M) Acc No. CR589032
Page 101 of 166
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711473237.455874 | Brandy Young |
NORTHWELL HEALTH
LONG ISLAND JEWISH MEDICAL CENTER
256-05 56th AVENUE, NEW HYDE PARK, NEW YORK, 11560 (556) 456-7560
patient name: Brandy Young
DATE OF OPERATION, OPERATION DATE, OPER DATE: July 27, 2019
MEDICAL RECORD #: 000020679641
ENCOUNTER #: 184900201001
SURGEON: I. RAND RODGERS LJ056127
Date of Birth: December 14, 1984
OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS: Blind phthisical left globe following trauma.
OPERATIONS: Left globe enucleation with insertion of 20 mm Medpor spherical implant
and left lateral tarsorrhaphy.
POSTOPERATIVE DIAGNOSIS: Blind phthisical left globe following trauma.
ANESTHESIA: General endotracheal, local 1% Xylocaine with epinephrine mixed 1:1 with
0.5% Marcaine with epinephrine.
INDICATIONS: This patient sustained significant left ocular trauma as one of many injuries
she recently sustained.
PROCEDURE: With the patient supine on the operating table, the appropriate monitoring
devices applied and intravenous line started, antibiotics administered, and a general
endotracheal anesthetic satisfactorily administered.
Page 1 of 2
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711475444.293877 | Phyllis Johnson |
24-06-2019 FROM- CWFMD
936-703-5455
T-252 P0031/0063 F-236
Conroe Regional Medical Center - Women's Imaging
504 Medical Center Blvd.
Conroe, TX 77304
Patient:
Phyllis Johnson
Facility ID:
BH80386221/AA
DOB_question:
22-04-1999
Height / Weight:
65.0 in. 100.0 lbs.
Measured:
23-10-2021
Sex / Ethnic:
Female White
Analyzed:
23-10-2021
AP Spine Bone Density Trend
Densitometry Ref: L2-L4 (BMD)
Trend: L2-L4 (BMD)
BMD (g/cm2)
YA T-score
%Change vs Baseline
1.456
Normal
Trend: L2-L4
1
Change vs
Measured
Age
BMD
Previous
Previous
Date
(years)
(g/cm2)
(g/cm2)
(%)
23-10-2021
46.7
0.965
COMMENTS:
-0.155
-13.8'
23-10-2021
37.8
1.120
GE Healthcare
Lunar iDXA
ME+200592
Name: Phyllis Johnson
DATE OF BIRTH: 22-04-1999
| what is the DOB or date of birth? | {"text": ["22-04-1999"], "answer_start": [242]} |
id_1711477275.309086 | Jessica Schwartz |
C-REACTIVE PROTEIN 09/22/2022
(#5428552, Final, 09/21/2022 3:19pm)
Ordering Provider
JOHN MASCIALE, MD
Performing
CLINICAL PATHOLOGY LABORATORIES - MAIN LAB (BLOOD NOT DRAWN AT THIS LOCATION)
Lab
VISIT CPLLABS.COM FOR LOCATION NEAREST YOU
AUSTIN TX 787xx
Specimen/Accession
WH830980
Specimen
ID
Source
Specimen Coll. Date
12/08/23 15:38
Result
Final
Status
Specimen Rec. Date
14/04/18 19:46
Report
Status
Specimen Reported
09/02/22 04:47
Date
SEDIMENTATION RATE 09/22/2022 (#5428552, Final, 09/21/2022 3:19pm)
Ordering Provider
JOHN MASCIALE MD
Performing
Lab
CLINICAL PATHOLOGY LABORATORIES - MAIN LAB
AUSTIN TX 787xx
Specimen/Accession
WH8309xx
Specimen
ID
Source
Specimen Coll. Date
12/08/23 15:38
Result
Final
Status
Specimen Rec. Date
09/02/22 19:46
Report
Status
Specimen Reported
09/02/22 04:03
Date
Report
76752-3
South Texas Bone & Joint - 00052
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711473365.827181 | Sara Wolf |
Electronic Physician Orders
Order: Activated Partial Thromboplastin Time (APTT)
Order Date/Lime 03-11-2016 09:56 EST
Order Status: Completed
Activity Type: General Lab
End-state Date/Time 12/4/2021 3:25 EST
Electronically Signed by: FERNANDEZ OLIVERO SR MD,
Consulting Physician:
GERARDO ANDRES
Entered By: Contributor system.FLHO MISYS on 12/4/2021 09:56 EST
Order Details: Routine collect, 06-10-2022 9:55:00 AM EST, Lab Collect
Order Comment:
patient:
Sara Wolf
MRN: 73026305
FIN#: 93010305
Printed On:
10/30/2023 05:11 EDT
Page 128 of 516
Report Request ID#: 330333098
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475955.828168 | Brittany Jenkins MD |
27-08-2020 12:27 FROM- CWFMD
936-703-5455
T-236 P0003/0048 F-222
HIPAA AUTHORIZATION TO RELEASE PROTECTED HEALTH INFORMATION
(Medical Records)
Medical Provider Name: Conroe Willis Family Medicine
Patient Name: Brittany Jenkins MD
Date of Birth:
14-05-2003
Address:
9851 FM 1097 Rd. West. Suite 120. Willis, TX 77318
Dates of care:
10-07-2015 to present
I authorize and direct Covered Entity/Medical Provider to disclose and to supply copies of my protected
health information (medical records) described below to any member of Levin, Papantonio, et al. 316
S. Baylen St., Suite 600, Pensacola, Florida 32502. and/or their agents, for the purpose of litigation.
Information to be disclosed:
X
Copy of the complete medical record
Surgical Report
Discharge Summary
Radiology Report
Face Sheet
Physical Therapy Notes
History & Physical Report
Laboratory Reports
Other (specify)
Expiration
This authorization will expire two years from the date of patientine signature.
I
acknowledge, and hereby consent to such, that the released information may contain alcohol, drug
abuse, psychiatric, HIV testing. HIV results or AIDS information
(Initial)
DATE 14-11-2023
Signature of Patient of Representative
Authority of Patient (parent of minor,
guardian, etc); Copies of documentation such as a
Healthcare Power of Attorney may be attached.
Brittany Jenkins MD
Print Name of Patient or Authority of Patient
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711475955.57712 | Robert Schmitt |
28 Apr 20218 PM
TO:74670242390 FROM: 8203430703
Page: 67
Account No: 22701
Citrus Cardiology - 308 Inverness
308 W HIGHLAND BLVD
INVERNESS, FL 34452-4716
Tel: 352-726-8353
Fax: 352-726-5038
Progress Note: KACI DYMOND 21 May 2015
Note generated by eClinicalWorks EMR/PM Software (www.CCirica/Works.com)
M 61
Robert Schmitt
DOS : 18 Aug 2021
DOB: 20 Dec 2003
Acct: C11920
PrimProv: Prada, Stefan, MD
To: 360 Ortho and Spine. Subject: Progress Notes, Fax#: 833-367-4968. SendDate: 28 Apr 202152:47, page 3/3 [-ufg2.4.1.12in]
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
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