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id_1711476893.046217 | Joseph Shaffer |
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:
2022 May 03 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: 1998 January 17
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.
2015 January 24 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: Debra Jones
Medical Record No: 608698 Financial No: 010998039
Medical Records
DOB: 1998 January 17 Age: 28 years Sex: Male Pt Type: Emergency
N/A
Admit Date: 2024 January 30 Discharge Date: 2024 February 29
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 Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711476578.539746 | Kristen Wilson |
INBOUND NOTIFICATION FAX RECEIVED SUCCESSFULLY
TIME RECEIVED
REMOTE CSID
DURATION
PAGES
STATUS
2015 September 20 at 3:41:29 PM EDT
SVMC
243
Received
SVMC
2015 September 20 12:37:28 PM PAGE
Fax Server
DOD Salinas - Abbott
Lance Jones
558 Abbott St Ste A
MRN: 3111xxx, DOB: 1984 June 21, Sex: F
DOCTORS
Salinas CA
Visit date: 2020 June 30
ON DUTY
HIM ROI Letters Report
Review of Systems
Constitutional: Negative for chills and fever.
Respiratory: Negative for shortness of breath.
Cardiovascular: Negative for chest pain.
Gastrointestinal: Negative for abdominal pain.
Musculoskeletal: Positive for arthralgies, back pain.
stiffness.
Physical Exam
Vitals reviewed.
Constitutional:
Appearance: Normal appearance.
HENT:
Head: Normocephalic and atraumatic.
Eyes:
Conjunctiva/sclera: Conjunctivae normal.
Effort: Pulmonary effort is normal.
Breath sounds: Normal breath sounds.
Musculoskeletal:
General: No swelling or deformity. Tenderness: Normal range of motion.
Right knee: No effusion
Instability Tests: Anterior drawer test negative.
Left knee: No effusion or bony tenderness.
Instability Tests: Anterior drawer test negative.
Right lower leg: No edema.
Left lower leg: No edema.
Comments: L knee: + Thessaley test
Skin:
General: Skin is warm and dry.
Neurological:
Mental Status: She is alert.
Generated on 2022 February 27 12:34 PM
Page 24
118
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711475620.870365 | Katherine Gibson |
V
VITRO MOLECULAR
LABORATORIES
www.vitromolecular.com
Patient Name: Katherine Gibson
Physician: Robert Jacobson, MD
Accession #: S22-04715
Sex: Male
Specialty Group: The Gables Surgical Center
Collected: 28-09-2018
DOB: 21-04-1986 (21)
Received: 28-09-2018
Reference #: S22-04715
CC:
Reported: 22-11-2014
Surgical Pathology Report
Clinical History
Previous Vitro pathology report:
*S21-12983, 12-09-2018 A)Lumbar disc, L4-5; discectomy:Cartilage and disc material with degenerative changes;
*S21-15703, 24-12-2023 A)Disc, C4-C5, discectomy:0 Cartilage with degenerative changes
DIAGNOSIS
A. DISC L4-5:
- Fibrocartilaginous tissue with degenerative changes
- Negative for atypia or malignancy in this sample
Images
Gross Description
A. Received in formalin there are multiple white fibrocartilaginous tissue fragments measuring 2.5 X 2.0 X 0.3 cm in aggregate. Specimen is submitted in
toto in one green cassette. IG/rms
Electronic Signature Hadi Yaziji, M.D.
CPT Code(s): 88304 (1)
***
END OF REPORT
E-MAILED
09-10-2020
Vitro Molecular Laboratories
8700 West Flagler Street, Suite 100, Miami, FL 33174
Tel: 305-267-7979
Fax: 786-513-0175
CLIA: 10D1055514
Page 1 of 1
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711475189.970367 | Amanda Gonzalez |
NOVANT
Novant Health North Point
Amanda Gonzalez
N
Medical Associates
MRN: 51024107, birthdate: 1992 June 20, Sex: M
HEALTH
1105 Bethabara Road
visiting date: 2015 April 20
Winston-Salem NC 27106-3105
2018 December 27 - Office Visit in Novant Health North Point Medical Associates (continued)
Outpatient Medications as of 4/5/2023:
alprazolam (XANAX) 1 MG tablet, Take one tablet (1 mg dose) by mouth 3 (three) times a day as needed.
Signature Dr Joshua Vasquez, MD at 2018 June 28 1954
03/28/2023 - GWSM REHAB PT CONTINUOUS APPT in Novant Health Rehabilitation Center Kernersville
Visit Information
Provider Information
Encounter Provider
Referring Provider
Erika Klein, PT
Ana A Frunza, MD
Generated on 4/11/23 8:32 PM
Page 7
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711475444.72752 | Jessica Hill |
Jun 25, 2019 FROM- CWFMD
936-703-5455
T-252 P0053/0063 F-236
Methodist Server P11 Mar 29, 2018 4:53:01 PM ACST PAGE
2/002
Fax
Server
HOOSTON'
XR HIPS BILATERAL AP LATERAL W AP PELVIS
Methodist
LEADING MEDICINE
Jessica Hill
MRN: 108987192, Legal Sex Female, Jun 07, 1984 (51 yrs), Outpatient
Accession #: IM95386381
Final Result
Appointment Info
EXAMINATION: XR HIPS BILATERAL AP LATERAL W AP PELVIS
Exam Date
Nov 26, 2020
INDICATION: M25.552 Pain in left hip, M25.511 Pain in
right shoulder, M25,552 M25. 51
Department
COMPARISON: None
111-111-1111
4015 I-45 NORTH SUITE 120
IMPRESSION:
CONROE TX 77304-5076
No visible fracture or dislocation.
Reason for Exam
No significant joint space narrowing of the right or
M25.552 M25.51
left hips.
Bone island of the left femoral neck.
Diagnoses
Left hip pain
1SB1RAD_PS01
Right shoulder pain, unspecified
Signed by Trakhtenbroit, Michael Alan, MD on Aug 14, 2014 4:18 PM
chronicity
00
Jessica Hill MRN: 108987192 ACC: IM95386381 XR Hips Bilateral Ap Lateral W Ap Pelvis
Page 1 of 1
:
Name: Jessica Hill
DOB: Jun 07, 1984
Date:
| what is the DOB or date of birth? | {"text": ["Jun 07, 1984"], "answer_start": [286]} |
id_1711473366.118966 | Nancy Solis |
athena
10/30/2023 1:33:13 pm EDT
Page: 56 / 86
Nancy Solis (id #15546552, date of birth: 11/06/92)
Baptist Health
Health Information Management Dept
Nancy Solis
3563 Philips Highway Building B. Suite 201
MRN: 52554550 date of birth: 11/06/92, Sex: F
Jacksonville FL 55207-5553
Adm 26/01/15 D/C: 25/02/15
07/15/2023 - ED in Baptist Clay Emergency (continued)
ED Provider Note (continued)
HISTORY: seizure
COMPARISON: None.
TECHNIQUE Contiguous axial slices of the head were
submitted without IV
contrast.
FINDINGS:
INTRACRANIAL: Brain parenchyma is normal in
attenuation, No acute
intracranial hemorrhage.
Signature: Dr Amy Moore MD 19/03/17
12:38 PM CDT
Printed on 7/27/23 at 8:20 AM
Release ID: 28555892
| What is signature date or signed on date? | {"text": ["19/03/17"], "answer_start": [680]} |
id_1711476893.13366 | Patrick Roberts |
1010700320067
13f377905001
Claim Number 2
Claim Number 3
PLEASE ANSWER THE FOLLOWING QUESTIONS FULLY:
How was your evaluating doctor selected? (check one)
From a list of doctors provided by the State of California, Division of Workers' Compensation.
Other (explain)
What is the of the doctor who will be doing the evaluation? Paulette Cass, ,D.C.
name
When is your examination scheduled?
2014 Nov 14
What were your job duties at the time of your injury?
COOK,
What is the disability resulting from your injury?
Injury to back, rightarm right shoulder.
How does this injury affect you in your work?
Aggravated with bending, lifting, pushing, pulling standing,
walking, reaching.
Have you ever had a disability as a result of another injury or illness?
no
If so, when?
Please describe the disability?
Date
2024 Jan 06
Signature Florentino Mejia
Gallegos
MM/DD/YYYY
DWC-AD form100 (DEU) Page 2 (REV. 11/2008)
DWC-AD form 100 (DEU)
375
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711475741.396322 | Alicia Henry |
The Gables Surgical Center
IMMEDIATE POST PROCEDURE PROGRESS NOTE
Date: 10/12/16
PRIMARY SURGEON:
Berti
ASSISTANTS: NONE / NAME: Secular
PRE-OPERATIVE DIAGNOSIS:
L4-5diss diguster + instality
POSTOPERATIVE DIAGNOSIS SAME LOTHER, LIST:
TECHNICAL PROCEDURES (PROCEDURES PERFORMED):
Q Ly-5 pedrle seven 50 X 7 Am
2,445 interbody optimest
SPECIMEN(S) REMOVED AND SENT TO LAB PER POLICY: NONE / YES, LIST:
Lyndhi
COMPLICATIONS DURING PROCEDURE: NONE YES, EXPLAIN:
DRAINS: NONE/YES, DETAIL:
ESTIMATED BLOOD LOSS (EBL): MINIMAL LOTHER, DETAIL:
ANESTHESIA TYPE: GENERAL + MAC / LOCAL Immunity
PLEASE INDICATE LATERALITY WHEN APPLICABLE
Physician's
Operative Signature: note to be dictated John immediately following procedure
ID / Visit: 117744 / 4
DOS: 04/04/21
Alicia Henry
Sex: M
DOB: 27/08/03
Age: 33
Phys: Jacobson, Robert
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711471328.219405 | Kayla Potter |
24/18/01 10:08:03 EDT
To: 18003806151
Page: 24/33
From: 8332845756
Fax: 8332845756
Initial Evaluation Note
Patient:
Kayla Potter
dob:
27/99/04
Sex: F
Date of Visit:
12/22/02
Visit # 1
Provider:
Brandon Bensing
NPI # 1225662943
Clinic Details
Case Details
Clinic
Address
Injury Description
Injury Onset Date
Lakefront Health
4125 Dick Pond Road
Back Pain
24/18/01
Phone #
Myrtle Beach, SC 29588-6807
Diagnosis Codes
I50
Fax #
8332845756
Referring Physician
Ashley Maybin
Subjective Analysis
Previous History of Symptoms
YES
Patient Chief Complaint
Patient Goals
Patient Problem List
Patient suffers from or currently has Thyroid Disorder
Thyroid problems, Arthritis, Other orthopedic problems,
Osteporosis, Chronic pain, Chronic migraines
Treated by Dr Jacqueline Lozano (License #10144)
DOS: 12/22/02
Page 1 of 6 of Initial Evaluation Note
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711475190.508558 | Dennis Ruiz |
<<Back to Review>>194126-2 HYPERLINK-Hyperlink-Page
188
KAISER PERMANENTE庐
Dennis Ruiz
MRN: 110184071888, Date of Birth: 29/08/99, Sex:
F
SSN: xxx-xx-3184
Visit Day: 29/07/22
21/04/20 - Work Comp in OCC PHYSICAL THERAPY -STE 5038
All Charges for This Encounter
Code
Description
Service Date
Service Provider
Modifiers
Qty
97014
APPLICATION MODALITY TO 1 OR MORE
21/07/19
Lattupally, Shirisha (P.T.)
1
AREAS; E-STIM
Physical Medicine Notes
THERAPIST, PHYSICAL
Progress Notes by Lattupally, Shirisha (P.T.) at 9/25/2007 1010
Version 1 of 1
Author: Lattupally, Shirisha (P.T.)
Service: -
Author Type: THERAPIST, PHYSICAL
Filed: 9/25/2007 10:10 AM
DATE OF ENCOUNTER: 21/07/18
Creation Time: 9/25/2007 10:10 AM
DOI: 27/08/18
Generated on 4/12/22 10:33 AM
000188
0187
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711476892.988252 | Justin Pierce |
NORTHBAY MEDICAL CENTER
NorthBay Hospital Campus: 1200 B. Gale Wilson Blvd.
Fairfield, CA 94533 (707) 10536
General Diagnostic
Exam Date/Time:
Exam:
Accession Number:
Ordering Physician:
2018-03-15 23:45:54
DX Chest 2 views
DX-11-0010536
Ankney. William A M.D.
Reason for Exam
Trauma
Read
PA and lateral chest.
FINDINGS:
Soft tissues and bony structures are unremarkable. Lungs are clear and costophrenic angles are sharp.
IMPRESSION: Normal chest without comparison.
DT: 12/07/2011 ( 1902 hours)
Final Report
Dictated by: McMahon, James F., M.D.
Signed by: McMahon. James F., M.D.
Transcriptionist: Murray. Joanne B.
12/07/2011 17:23
Exam Date/Time:
Exam:
Accession Number:
Ordering Physician:
2018-03-15 23:45:54
DX Hip Complete Unilateral
DX-11-0051911
Ankney. William A M.D.
Right
Reason for Exam
Trauma
Read
Two views.
FINDINGS:
Patient Name: Linda Obrien
Medical Record No: 608698 Financial No: 010998039
Medical Records
DOB: 2001-04-05 Age: 28 years Sex: Male Pt Type: Emergency
N/A
Admit Date: 2016-11-19 Discharge Date: 2016-12-19
Admitting Physician:
Attending Physician: Ankney. William A M.D.
Printed 2022-01-12 at 11:14 AM
(Page / of 12)
ED-NB
112
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711476990.140041 | Mr. Jerry Terry DVM |
(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: Craig Dominguez
Insurance: Gallagher Bassett
Claim#: 002406001366
DOB: 22 February 1985
DOI: 08 March 2015
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: 2439 Merced St San Legndro CA 94539. Phone
number. (510) 94249 Fax number: (510) Random_5_digit_number
1139
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711472286.533364 | Sheila Watts |
Sheila Watts
MRN: 5603513
06/05/2023 - Telephone in MultiCare Rockwood Orthopedics & Sports Medicine
MultiCare Health System
PATIENT NAME: Sheila Watts
MRN: 5603513
CSN: 296358619
Account Information
Admit Date
HAR#
Pt Class
Hospital Svc
Bed
02/08/18
No service for
Admitting Physician:
Chief Complaint:
Forms
Adm Dx:
Gestational Age: <None>
Patient Information
Home Address:
1835 E 8th Ave
Telephone Information:
Spokane WA 99202-3409
Home Phone
Not on file.
Work Phone
Not on file.
SSN:
xxx-xx-8028
Mobile
509-993-4659
Age:
52 year old
Employer:
UNITED PARCEL SERVICE
dob:
07/10/93 (30 yrs)
United Parcel Service
Sex:
male
Marital Status:
Significant Other
RIVER VIEW CORPORATE
Sheila Watts
CENTER
MRN: 5635313, dob: 07/10/93, Sex: M
16201 East Indiana Ave
DATE OF VISIT: 23/08/15
SPOKANE VALLEY WA 99216-
1882
Page 20
Printed by 414221 at 7/17/23 9:40 AM
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711473365.742487 | Timothy Ho |
Discharge Information
Attestation
Attestation to: I personally interviewed the patient, I personally examined the patient, I certify that the services
provided were clinically indicated and medically necessary for the care of this patient.
Electronically signed by: GO MD, JENSEN L
On 05-16-2023 20-04
Electronically Co-Signed By:GO MD, JENSEN L
On: 12-14-2016 08:10
Patient name:
Timothy Ho
MRN: 73126315
FIN#: 93110315
Printed On:
10/30/2023 05:11 EDT
Page 37 of 516
Report Request ID#: 323134318
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711472786.951553 | Micheal Morgan |
MEDICAL IMAGING CENTER
Name: MORRIS, ANN CHRISTINE
1830 Town Center Drive #110
Phys: Dr Tina Kennedy MD
Reston, VA 20190
D.O.B: August 06, 1985 Age: 30
Sex: F
PHONE #: (703) 178-3171
Exam Date: April 01, 2015 Status: REG CLI
FAX #: (703) 177-5176
Radiology No:
Unit No: K000658700
EXAMS:
002658703 CT CHEST W IV CON
<Continued>
ELECTRONICALLY SIGNED BY M.D. Dr Tina Kennedy on March 23, 2021at 1428
**
Reported and signed by: DAVID DUBOIS, M.D.
CC: Ajay Dar MD
Dictated Date/Time: 12/23/2021 (1417)
Technologist: CAROLINE J. TOURTELLOTTE, RTRM
Transcribed Date/Time: 12/23/2021 (1417) By: DR.DUBDA
Printed Date/Time: 12/23/2021 (1500) BATCH NO: N/A
PAGE 2
Signed Report
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711471328.849264 | Robert Peterson | patient
Robert Peterson
Gender
Female
MR #
0001143894
admitting date/Time
22-10-30 7:11:00 AM
Reg #
096291118385
Visit Status
DSC
D.O.B
91-06-24 12:00:00 AM
DISCHARGE DATE/Time
22-11-29 9:31:00 PM
1. Adult Plan of Care
14-09-26 2:10
Entered By
Individualization (Mutuality/Preferences)
Individualization/Preferences / pt
pt goes by "Cierra"; lives at home with her grandparents
SEB
goes by "Cierra"; lives at home with
her grandparents
Comments :
CLINICAL PRACTICE GUIDELINES
Precaution Precaution
SEB
coping,genitourinary,peripheral/neurovascular,reproductiv
e,safety,skin
Comments :
Nursing Goal #1 Related To Nursing
Cellulitis
SEB
Diagnosis/CPG
Comments :
Nursing Goal #1 Goal
pt will be able to maintain temperature WNL < 100.4
SEB
degrees F during hospitalization
Comments :
Nursing Goal #1 Goal Established
01/10/2023
SEB
(mm-dd-yyyy)
Comments :
Nursing Goal #1 Time Frame
By Discharge
SEB
Comments :
14-09-26 1:03:00 PM
Page 72 of 12
SVI 0885 | What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711472787.209963 | Stephanie Clark |
Date Visit: 03/2017/10
Page 2 of 2
Name:Stephanie Clark
DOB:12/1986/16
Cardiovascular: chest discomfort.
Constitutional review of systems are normal except as noted in HPI.
Vitals
Vitals - PULM
Recorded: 15Sep2022
12:17PM
Systolic
128
Diastolic
76
Physical Exam
Constitutional: no acute distress
Procedure
CXR: small left apical ptx and possible small LLL ptx as well? no focal consolidation or pleural effusions, cardiac silhouette appears
normal.
Assessment
Pneumothorax, left (512.89) (J93.9)
Plan
Cough
Xray Chest 2 Views PA/Lat; Status:Active; Requested for:15Sep2022;
Electronically signed by : Dr Sharon Lee, MD; 09/2021/16 8:40PM EST (Author
| what is the DOB or date of birth? | {"text": ["12/1986/16"], "answer_start": [68]} |
id_1711476990.556088 | Jason Baldwin |
May 09, 2014 10:13:54
Oklahoma Spine 4058789447
2/47
Elizabeth Williams, M.D., F.A.C.R.
RE:
James Parry
DOB: May 12, 1991
DOS: Feb 13, 2017
X-RAY REPORT:
X-rays of the cervical spine. Two views were obtained. Mild DDD at C4-5 through C6-7 with
small bone spurs. Artifact due to dental work.
X-rays of the thoracic spine were obtained in two views.
X-rays of the Jumbar spine were obtained in two views. Moderate-to-severe DDD at T12-L1. L1-
2. Severe DDD L2-3. Mild-to-muderate DDD L3-4 through L5-S1 with small bone spur
anteriorly and laterally. getting worse since 12/2021. Mild ankylosing right L1 and 1.2.
Questionable bilateral sacroilitis Left femoral artery graft. not new.
X-rays of the both knees were obtained in two views and weightbearing. Unremarkable
X-rays of the both feet and ankles were obtained in three views and weightbearing Mild primary
OA of the bilateral first MTP joint, new. Left hammertoes. Bilateral plantar heel spur. Ankles
are unremarkable Osteopema.
The patient was explained all the findings. abnormalities and changes of the x-rays. which he
voiced understanding.
Thank you for the consultation.
for
Elizabeth Williams, M.D., F.A.C.R.
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711477090.63638 | Todd Fisher |
2015-05-15 04:45 PM
TO: 16103548946 FROM: 8392327968
Page: 90
Advanced Rx
360 Ortho and Spine
Stefan Prada, MD
Optimizing Provider Care鈩
DEA # BP3793696
11809 N Dale Mabry Hwy
Tampa, FL 33618
Patient Name: Todd Fisher
DOB: 1995-07-13 DOI: 2023-12-07
Address: 1119 CR 457 Lake Danasoffhee FC 33538
ICD-10: HS4.2
Physician Signature:
RO,
Date: 2017-09-03
(MM/DD/YYYY)
Patient Signature: Heather Fowler
2017-01-01
Date:
(MM/DD/YYYY)
www.Advanced-Rx.com I Phone 88892327 I Fax 92592327
2430 Camino Ramon, Suite 120, San Ramon, CA 94549
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711475955.882396 | Blake Torres |
30/05/15 13:59 FROM- CWFMD
936-703-5455
T-240 P0073/0078 F-226
Page 1 or 2
Conroe Willis Family Medicine PLLC
Blake Torres
Order Date: 29/12/18
4015 145 North
14570 Trero Lane
Order #: PRO36382
Conroe, TX, 773045074
Willis, TX, 773784394
Person #: 744, MRN: 5211
Sex: F
DOB: 12/08/84
Ordering: Dubose PA-C, Joshua
Performing #: LabCorp
Location: Willis CWFM 1
Component
Result Units
Flag
Range
Comment
Result 1
No
growth
Urine Culture, Routine
Final
report
Urinalysis, Complete (Collection Date: 13/06/17 14:50. Status: Final)
Performed At: 01, LabCorp Houston
7207 North Gessner, Houston, TX, 770403143
Kyle, Eskue, MD, Phone: 7138568288
Component
Result Units
Flag
Range
Comment
Microscopic Examination
Microscopic Examination (Collection Date: 13/06/17 14:50, Status: Final
Performed At: 01, LabCorp Houston
7207 North Gessner, Houston, TX, 770403143
Kyle, Eskue, MD, Phone: 7138568288
Patient: Blake Torres, DOB: 12/08/84
| what is the DOB or date of birth? | {"text": ["12/08/84"], "answer_start": [308]} |
id_1711471328.336822 | Jordan Gonzalez |
Prairie Hill Hospital
213 East Washington Ave Jonesboro, AR 71301
870-913-4100
Patient name: Jordan Gonzalez
Room #:
Age/Sex: 30 F
Med Rec #: SM47960592501
date of birth: 08 March 2015
Account #: SV47960592501
Attending Doctor: Dr Katrina Mendez MD
Hospital Service:
Ordering Doctor: Jennifer Bond MD
date of admit: 13 October 2023
Primary Care Provider:
Patient Status: REG CLI
Primary Insurance: BLUE ADVANTAGE
IMAGING SERVICES
STATUS: Signed
Report #: 0413-0181
6700459.001 ECG/Electrocardiogram
DATE OF EXAM: 09 June 2018
Test Reason :
Blood Pressure :
/
mmHG
Vent. Rate : 13 BPM
Atrial Rate : 13 BPM
P-R Int : 113 ms
QRS Dur : 13 ms
QT Int : 136 ms
P-R-T Axes : 42 13 15 degrees
QTc Int : 413 ms
Disease: Cholecystitis
Cannot rule out
Anterior infarct
, age undetermined
Nonspecific T wave abnormality
Abnormal ECG
No previous ECGs available
ELECTRONICALLY SIGNED BY Tom Reyes (1032) on 27 February 20191:01:38 PM
Referred By: Tom Reyes
Confirmed By: Tom Reyes
ELECTRONICALLY SIGNED BY:
Brent Adams, MD
Transesophageal Echocardiography (TEE)
Page 1 of 13
PARHAM-0137
000013
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711472286.531502 | Sandra Reyes |
Sandra Reyes
MRN: 5606513
06/05/2023 - Telephone in MultiCare Rockwood Orthopedics & Sports Medicine
MultiCare Health System
patient: Sandra Reyes
MRN: 5606513
CSN: 296658619
Account Information
Admit Date
HAR#
Pt Class
Hospital Svc
Bed
31/18/03
No service for
Admitting Physician:
Chief Complaint:
Forms
Adm Dx:
Gestational Age: <None>
Patient Information
Home Address:
1835 E 8th Ave
Telephone Information:
Spokane WA 99202-3409
Home Phone
Not on file.
Work Phone
Not on file.
SSN:
xxx-xx-8028
Mobile
509-993-4659
Age:
52 year old
Employer:
UNITED PARCEL SERVICE
date of birth:
22/86/10 (50 yrs)
United Parcel Service
Sex:
male
Marital Status:
Significant Other
RIVER VIEW CORPORATE
Sandra Reyes
CENTER
MRN: 5665313, date of birth: 22/86/10, Sex: M
16201 East Indiana Ave
DATE OF VISIT: 07/18/11
SPOKANE VALLEY WA 99216-
1882
Page 20
Printed by 414221 at 7/17/23 9:40 AM
| what is the admit date or admission date? | {"text": ["31/18/03"], "answer_start": [267]} |
id_1711477275.72027 | Billy Garcia |
She is to keep a followup appointment with the office of
Dr. Masciale for on or about 2022 June 23
DICTATED BY: JOHN P. MASCIALE, MD
BT/NTS
D: 2022 June 23 11:11:39 AM
T: 2022 June 23 01:09:24 PM
DOC#: 32961818
JOB#: 278417818
Electronically Authenticated and Edited by:
JOHN P MASCIALE, MD on 2018 October 16 04:00 PM CST
cc:
Patient Status: DIS IN
M.R.#: MV00480818
Patient: TREJO,ELMA MUNOZ
Account #: AV0018 1605018
Attending Dr.: Amanda Howard, MD
Admit/Service date: 2019 February 16
Discharge date: 2015 February 26
DOB: 2002 December 30
Loc/Room #: AV.MS3A/AV.302-1
Medical Records' copy Medical Records
Primary Care Dr.: LILJEBI
Page 3 of 18
76718 -3
South Texas Bone & Joint - 00318
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711475741.539633 | James Castaneda |
James Castaneda DOB: Aug 10, 1992 (61 yo M) Acc No. CR454556
[Doc Name: Jul 16, 2023 MRI CERVICAL SPINE]
CR172462
James Castaneda (MRN6325435)
UF Health Radiology
JP UF HEALTH JTB KERNAN
Imaging Result Report
Patient:
James Castaneda
MRN #:
6325435
DOB:
Aug 10, 1992
Ord #:
618102455
Sex:
Male
Acc #:
J11881056
Att Prov:
Auth Prov:
Roberts, Christopher
10475 CENTURIAN PKWY NORTH
SUITE 201
JACKSONVILLE FL 32256
Final Report
MRI C Spine w/o Con
Exam Date & Time: Jun 03, 2023 12:12 PM
Reason For Exam: None Specified
Ordering Diagnosis: Cervical radiculopathy
Mri of the cervical spine without contrast
HISTORY: 52 years Male Cervical radiculopathy
COMPARISON: None
Technique: Multiplanar multi-sequence MR images were obtained of the cervical spine without
contrast material.
Findings:
There is a small Schmori's node at the superior endplate of C7 otherwise the vertebral body
heights are maintained.
C4-C5: There is mild broad-based disc bulging causing mild impression on the ventral spinal
Jun 03, 2023 4:19 PM
Page 1 of 2
James Castaneda DOB: Aug 10, 1992 (61 yo M) Acc No. CR454556
Page 72 of 166
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475190.287075 | Tina Moore |
<<Back to Review>>194126-2 HYPERLINK- Hyperlink-Page
306
KAISER PERMANENTE庐
Tina Moore
MRN: 110804080880, Date of Birth: 03/87/09, Sex:
F
SSN: xxx-xx-3804
Date of Visit: 05/22/03
09/21/05 - Work Comp in OCC PHYSICAL THERAPY -STE 5038
Physical Medicine Notes
THERAPIST, PHYSICAL
Progress Notes by Lattupally, Shirisha (P.T.) at 1/3/2008 0952
Version 1 of 1
Author: Lattupally, Shirisha (P.T.)
Service:
Author Type: THERAPIST, PHYSICAL
Filed: 1/3/2008 9:52 AM
Date of Encounter: 28/16/12
Creation Time: 1/3/2008 9:52 AM
Status: Signed
Editor: Lattupally, Shirisha (P.T.) (THERAPIST, PHYSICAL)
PT visits: 7/8.
Injury Date: 10/17/11
Left knee contusion.
Generated on 4/12/22 10:33 AM
000306
0305
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711471329.68641 | Phillip Moore |
Page: 2 Surgical Case Record
Patient Name: BP00046620 Phillip Moore
DOB: 28/10/1990
Account No: BP40131499268
Age: 54
Physician: Dr Robert Mayo MD
Sex: F
Specialty: ORS-Orthopaedic Surgery Room-Bed/T.Loc:
O.R.: POR04-OPERATING ROOM #4
Date of Operation, Operation Date, Oper Date: 04/06/2017
Meadowlark General
Primary Procedure: LEFT KNEE MANIPULATION
Case Close/ Run Date: 29/10/2019
Transmitted: 12/23/22 1222 P.SUR.DP Peterson, Deloras
Run Time: 1944
PRE-OP ASSESSMENTS
Occurred 12/22/22 1144 Landry, Courtney Recorded 12/22/22 1144 Landry, Courtney
Physiological problem/alteration in: Musculoskeletal Infection - - MUSCULOSKELETAL ALTERATION - - Musculoskeletal alteration problem expected to: Improve/Resolve
Inserted 12/22/22 0830 - - Instance list status: Active IV/IO/Subcutaneous line status: Start Inserted by,
if other than current documenter: Nurse Number of attempts: 2 Skin prep used: Chlorhexidine/Alcohol
IV site dressing: Transparent IV site dressing clean, dry and intact: Yes IV site absent of redness, heat or edema: Yes <End>
DOCUMENTATION IV summary: Venous Left Antecubital 20 g Inserted 12/22/22 0830 IV type:
CONTINUED ON PAGE 3 *** Patient Name: Phillip Moore MRN:BP00043554 Encounter:BP0001107108 Page 2 of 29 73797-42 Meadowlark General -00072
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711475741.366995 | Robert Jones |
THE GABLES SURGICAL CENTER
401 S.W. 42nd Avenue, Suite 201
Miami, Florida 33134
Tel: (305) 447-0882 Fax: (305) 447-0213
OPERATIVE REPORT
PATIENT NAME: Robert Jones
MEDICAL RECORD #: 4444471
DATE OF BIRTH: 31/03/85
PHYSICIAN: ROBERT JACOBSON, M.D.
DATE OF SURGERY: 16/02/16
and expanded filling the cavity fo disc space across midline and expanding the colipase to the right. that
the position was across the midline. This crossed the disc space. This was removed. Then, an OptiMesh
was placed in the disc space and then 3.5 pipettes of bone was impacted into the disc space.
X
Aldo Berti M.D.
JOB#: 537954 RJ: med: anu/nss/im DD: 30/08/14
DT: 30/08/14
OPERATIVE REPORT - PAGE 2 of 2
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711475741.364391 | Regina Payne |
THE GABLES SURGICAL CENTER
401 S.W. 42nd Avenue, Suite 201
Miami, Florida 33134
Tel: (305) 447-0882 Fax: (305) 447-0213
OPERATIVE REPORT
PATIENT NAME: Regina Payne
MEDICAL RECORD #: 8756500
DATE OF BIRTH: 12/1988/01
PHYSICIAN: ROBERT JACOBSON, M.D.
DATE OF SURGERY: 06/2018/19
and expanded filling the cavity fo disc space across midline and expanding the colipase to the right. that
the position was across the midline. This crossed the disc space. This was removed. Then, an OptiMesh
was placed in the disc space and then 3.5 pipettes of bone was impacted into the disc space.
X
Aldo Berti M.D.
JOB#: 537954 RJ: med: anu/nss/im DD: 11/2018/14
DT: 11/2018/14
OPERATIVE REPORT - PAGE 2 of 2
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711473530.611089 | Amy Smith |
KNMH EMERGENCY DEPARTMENT
Amy Smith
180 W Esplanade Ave
MRN: 8198198, birthdate: 01/1998/20, Sex: M
Kenner LA 71965
Acct #: 81901981961
Adm: 08/2019/11
08/25/2022 - ED in Kenner - Emergency Dept (continued)
Medication Administrations
ibuprofen tablet 800 mg [819231922]
Ordering Provider: Dayna G. Toscano, NP
Status: Completed (Past End Date/Time)
Ordered On: 04/2018/03 1119
Starts/Ends: 08/25/22 1200 - 08/25/22 1119
Ordered Dose (Remaining/Total): 800 mg (0/1)
Route: Oral
Frequency: ED 1 Time
Admin Instructions: DO NOT CRUSH OR CHEW; SWALLOW WHOLE.
Discharge Orders (720h ago, onward)
None
ED Prescriptions
Medication
Sig
Dispense
Start Date
End Date
Auth. Provider
LIDOcaine (LIDODERM) 5 % (Expired)
Place 1 patch onto
7 patch
8/25/2022
9/1/2022
Dayna G. Toscano, NP
the skin once daily.
Generated on 10/3/22 11:37 AM
Page 28
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711477090.346496 | Louis Fox |
CASA COLINA
Hospital and Centers for Healthcare
CASA COLINA MEAL PERIOD AGREEMENT
This will certify that I am an employee regularly scheduled to work an eight or ten
hour shift (ten hours under a certified alternative work week schedule), and that should
a time arise when my shift exceeds 10 hours, I wish to waive my entitlement to a
second meal period. I understand that I am entitled to have this meal period under
California Law. However, I hereby voluntarily agree to waive one- of the two meal
periods.
I understand that, as a result of this waiver, I will receive only one meal period
during each day of work and will be paid for all working time, but not for the one duty-
free meal period receive.
I also understand that I or the hospital may revoke this "Meal Period Waiver" at
any time by providing at least one day's advance notice in writing of the decision to do
so. This waiver will remain in effect until 1 exercise, or the hospital exercises, the option
to revoke it.
The decision not to waive one on-duty meal break will result in an additional
unpaid meal period of thirty (30) minutes and the extension of my workday by the same
thirty (30) minutes.
I acknowledge that I have read this waiver, understand it, and voluntarily agree to
its provisions.
In addition, I understand that while it is my employer's obligation to make the
meal period and rest periods available to me, it is my responsibility to ensure 1 take
them.
(Please reference HR Policy C2-302 Hours of Work for additional details)
aim
Signature
Ernest Trevino
Print Name
Dec 19, 2020
Date
Updated: Nov 02, 2021 (file located In: S Drive/Human Resources/Forms/Meal Period Agreement)
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711477090.52825 | Mr. Tyler Johnson DDS |
Health survey and History
Please describe your injuries:
Please Mark the area of your pain on the drawings below
Left shoulder Rotator cuff tom
x
What medications do you take?
Acetaminophen 500mg as needed
Diclofenac Sod. 50mg as needed
How often and how much?
as need i tab
Did you return to work? ( ) Yes
No
If yes, how long were you off?
Cowecks.
Please Make the degree of all conditions which you have, or have had. Using the following letters to rate your condition:
Nervous System
Cardio-Vascular
o = Occasional
Eyes, Ear, Nose & Throat
F = Frequent
Dizziness
Chest pain
Eye Strain
C = Constant
Walking problems
Patients[Signature)
Date: 2014/07/10
(If minor, parents or guardian's signature)
Doctors Signature:
Date: 2016/05/12
Dt: Abraham Chiropractic Playsician
Address. 4788 S Florida Ave. Lakeland, FI 33813 Pnone. 863.649.1490 Fax. 863.649.1049
| What is signature date or signed on date? | {"text": ["2016/05/12"], "answer_start": [787]} |
id_1711475190.087007 | 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 Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711471328.919503 | Courtney Taylor |
Valley Medical Center
31097 Benitez Points
Mariehaven, UT 63717
Facility Phone #: 378-469-6815
patient name: Courtney Taylor
DATE OF BIRTH 1995-04-09 Age: 22 years
Sex M
MRN: 3841981753(SBM)
ADMITTING DATE: 2020-26-02
Acct #: 71064685012
Disch Date: 2020-27-03
Pt loc: SBMC 6TNS; 643;66
Physician:
Dr Thomas Moore DO
PCP:
PCP,Not on Staff
Operative and Procedure Reports
Electronically Signed By:
Dr Gary House MD
On 2023-18-03 1:57
Co Signature By:
Dr Debra Myers MD
On 2023-18-03 1:57
Modified Signature By:
Dr Gary House MD
On 2023-18-03 1:57
Date/Time Printed 2016-06-06 12:52 PST
Report Request ID: 233133513
Page 245 of 379
97
| what is the DOB or date of birth? | {"text": ["1995-04-09"], "answer_start": [146]} |
id_1711475190.217889 | Courtney Porter |
Novant Health Urology
Courtney Porter
N
NOVANT
2320 Baldwin Lane
MRN: 53224327, D.O.B: 23/02/1985, Sex: M
HEALTH
Winston-Salem NC 23203-5326
DATE OF VISIT: 01/11/2022
23/10/2018 - Office Visit in Novant Health Urology - Baldwin (continued)
Clinical Notes Amb (continued)
Supervising Physician: Dr Jacob Smith
History of Present Illness:
Jeffrey Craig Payne is a 57 y.o. male with a history of
Patient Active Problem List
Diagnosis
Human immunodeficiency virus (HIV) disease (*)
Patient presents today for follow up of right epididymal cyst. This has been monitored via ultrasound.
Physical Examination
Constitutional
Vitals:
08/03/22 1531
BP:
99/61
Pulse:
64
Generated on 4/11/23 8:33 PM
Page 311
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711475741.072654 | Jamie Contreras |
Jamie Contreras DOB: February 16, 1997 (81 yo M) Acc No. CR728935
[Doc Name: Othro One DOS January 31, 2023 - 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#: 2352532
PATIENT ACCT#:
PATIENT NAME: Jamie Contreras
DATE OF BIRTH: February 16, 1997
REFERRING PHYSICIAN:
EXAMDATE: March 10, 2018
ACCESSION NUMBER: 7289367
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
Jamie Contreras DOB: February 16, 1997 (81 yo M) Acc No. CR728935
Page 162 of 166
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711471329.118168 | Kimberly Ward |
ciox
Fee Approval Request
HEALTH
CIOX HEALTH
Please deliver this to the following medical record requester:
Attention :
Facility:
Silverlake Medical Center
Requester :
TScan
Site :
20331
Address :
8458 Theresa Curve Apt. 978
Klineport, VI 47154
Address :
8458 Theresa Curve Apt. 978
Klineport, VI 47154
City, State,
City, State,
Zip :
Seattle, WA 98199
Zip
Detroit, MI 48201
Rep
Telephone :
719-456-3302
CIOX Rep:
Vernette Gordon
#:
825121
Fax :
844-102-9434
Fax to:
Records
CIOX HEALTH REP Vernette Gordon
Fax Number: 313-993-0763
Phone: 313-745-3021
Dear Medical Record Requester :
Date: 01/2023/19
CIOX HEALTH has contracted with Silverlake Medical Center (Medical Facility/State) to copy
it's authorized requests for medical records.
03/28/2019
Patient :
Kimberly Ward
birthdate :
09/1990/01
Soc. Sec. # :
service date
11/2015/04
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
11/2018/12
(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 the DOB or date of birth? | {"text": ["09/1990/01"], "answer_start": [875]} |
id_1711477090.321557 | Jennifer Jackson |
IVICIN
2764 Napoleon Avenue
Briana Young
New Orleans LA 70115
MRN: 1645364, DOB: 08/2001/05, Sex: F
Acct #: 64002782564
Adm: 09/2016/18
10/2015/11 - ED in Baptist - Emergency Dept (continued)
Scans for Entire
Hospital Authorization - Electronic signature on 12/2016/24 7:21 AM (effective from 02/2023/21) - E-signed
Karen Marie Johnson
Ochsner
MRN: 1645364
DOB: 08/2001/05
Health
Age: 59 y.o.
Sex: female
HOSPITAL AUTHORIZATION
A.
Health Consent for Examination and Treatment: I hereby authorize the providers and employees of Ochsner
System ("Ochsner") to provide medical treatment/services which includes, but is not limited
not performing limited and administering tests and diagnostic procedures that are deemed necessary, including, to, but
the to, imaging examinations, blood tests and other laboratory procedures as may be required by
special instructions of my physician(s).
1.
I understand and agree that this consent covers all authorized persons, including but not limited to
residents, nurse practitioners, physicians' assistants, specialists, consultants and independently
procedures and medical or surgical treatment.
contracted physicians who are called upon by the physician in charge to carry out the diagnostic
2. I hereby authorize Ochsner to retain or dispose of any specimens or tissue, should there be such
remaining from any test or procedure.
Generated on 02/2023/21 4:20 PM
Page 164
| what is the admit date or admission date? | {"text": ["09/2016/18"], "answer_start": [141]} |
id_1711473237.921333 | Trevor White |
10/24/2023 1:29:08 PM -0400 FAXCOM
PAGE 55
OF
133
Trevor White (MRN 980825122) BIRTH DATE: 92/10/08
Encounter Date: 18/06/01
Facility
OSU WEXNER MEDICAL CENTER
Patient Demographics
patient
Legal
BIRTH DATE
Trevor White
Sex
92/10/08
Female
Op Note by Dr Brittany Moore, MD at 4/2/2018 9:43 AM
Author Dr Brittany Moore, MD
Service OPHTHALMOLOGY - Notes Only
Author Type: Physician
Filed 4/2/2018 10:41 AM
Service Date 14/05/31 9:43 AM
Status: Signed
Editor: Thomas F Mauger, MD (Physician)
4/2/2018
Trevor White
Operative Report:
PREOPERATIVE DIAGNOSIS: Cataract left eye.
POSTOPERATIVE DIAGNOSIS: Cataract left eye.
PROCEDURE:
The patient was taken to the holding area in good condition.
Page 1 of 2
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711475741.423771 | 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 Procedure Date? | {"text": [], "answer_start": []} |
id_1711473237.427875 | Tammy Hall |
-0400
PAGE 2
OF 3
Massapequa Imaging
An Affiliate of Northwell Health
1220 Hicksville Road, Seaford, NY 11783 (516) 266-3456 (516) 266-3490
RAND RODGERS
PATIENT NAME:Tammy Hall
1000 NORTHERN BLVD
AKA: Tammy Hall
GREAT NECK, NY 11021
MR#: 12657083
EPI #: 3465708
D.O.B: 2000/05/10
AGE: 71Y FEMALE
Acc#: 57657083
EXAM: 57657083 - CT ORBITS - ORDERED BY: RAND RODGERS
PROCEDURE DATE: 2017/03/10
INTERPRETATION: CLINICAL INDICATION: Orbital fracture, ruptured globe thin axial series through
the orbits were obtained with coronal computer-generated reconstructed views.
Dr Austin Hudson MD; Attending Radiologist
Page 1 of 2
Date Printed: 6/20/2022 4:47 PM
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475444.553456 | Heather Walters |
02/14/09 FROM- CWFMD
T-252 P0024/0063 F-236
DISCHARGE INSTRUCTIONS
Heather Walters
BH9026517790/BH00288051
For Patients Who Smoke
You should quit. It is the most important thing you can do for your health.
Here are other FREE resources you can use.
The American Cancer Society:
1-800-227-2345
The American Lung Association:
1-800-548-8252
Internet site:
http://smokefree.gov
DISCHARGE MEDICATIONS
Please refer to the discharge medication list provided by the nurse at the time of
discharge. Please be sure to take this list with you to your next physician office
visit.
I understand that a copy of my home medication list as well as the medications I received
during this hospital stay will be provided to my next health care provider.
HCA Houston Conroe
Name :
PRICE,ERICA NICOLE
Acct #: BH39094362699
Room/Bed: B.265/1
Unit #: BH00288051
DATE OF ADMIT: 23/18/04
Admit Physician: Punsalan, Tricia Leonora
Name: Heather Walters
DOB: 17/98/12
Date:
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711472787.238863 | Rhonda Rich |
DATE OF VISIT: 11 December 2019
Page 2 of 3
Name:Rhonda Rich
BIRTH DATE:11 August 1991
Vitals - PULM
Recorded: 29 October 2023
9:40PM
Systolic
111
Physical Exam
Constitutional: no acute distress
Cardiac: normal s1, s2
Procedure
EXAM: 91975263 - CT CHEST - ORDERED BY: DENA M DAGLIAN
date of procedure 11 November 2019
INTERPRETATION: INDICATION: Follow-up left pneumothorax
TECHNIQUE: Volumetric images of the chest without intravenous contrast. Maximum intensity projection images were generated.
COMPARISON: None.
FINDINGS:
LUNGS/AIRWAYS/PLEURA: Patent trachea and bronchi. 2 mm nodule in the left lower lobe. No pleural effusion or pneumothorax.
IMPRESSION:
No pneumothorax.
Very small likely benign left lower lobe nodule.
180 Community Drive " Manhasset, NY, 11801Tel (186) 185-5183 Fax (518) 185-5183
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711472286.532369 | Christie Perry |
Christie Perry
MRN: 5604713
06/05/2023 - Telephone in MultiCare Rockwood Orthopedics & Sports Medicine
MultiCare Health System
Patient Name: Christie Perry
MRN: 5604713
CSN: 296478619
Account Information
Admit Date
HAR#
Pt Class
Hospital Svc
Bed
12/2022/22
No service for
Admitting Physician:
Chief Complaint:
Forms
Adm Dx:
Gestational Age: <None>
Patient Information
Home Address:
1835 E 8th Ave
Telephone Information:
Spokane WA 99202-3409
Home Phone
Not on file.
Work Phone
Not on file.
SSN:
xxx-xx-8028
Mobile
509-993-4659
Age:
52 year old
Employer:
UNITED PARCEL SERVICE
date of birth:
10/2002/12 (44 yrs)
United Parcel Service
Sex:
male
Marital Status:
Significant Other
RIVER VIEW CORPORATE
Christie Perry
CENTER
MRN: 5647313, date of birth: 10/2002/12, Sex: M
16201 East Indiana Ave
visiting date: 12/2019/08
SPOKANE VALLEY WA 99216-
1882
Page 20
Printed by 414221 at 7/17/23 9:40 AM
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711476578.652392 | Cheryl Smith |
From Injury Treatment Center New Orie
15046559316
14-01-2023 06:33:42 pryr.
Page 3 of 16
INJURY TREATMENT CENTER
NEW ORLEANS
THE INJURY RELIEF SPECIALISTS
3716 Airline Drive, MetaRic, LA 700xx
Phone: 504xxxx Fax: 844xxxx
DOB: 03-12-1999
Sex: F
Patient: Cheyenne Smith
Provider: Injury Treatment Center New Orleans
Visit: 20-06-2018 11:00AM
Chart: JOKA0000xx
14-01-2023
189.00 lbs
Weight
BMI
29.16 kg/mD
Palo
8/10
Plan:
Type
Code
Modifiers
Quantity
Description
CUSTOM
PHONE
1.00 UN
New Clinical Form:
PROCEDURE:
1) C7-T1 Epidural Steroid Injection
2) Fluoroscopic needle localization of above.
ANESTHESIA: local
BLOOD LOSS: minimal
PROCEDURE IN DETAIL: Informed consent was obtained, explaining risk, benefits, and alternatives of the
procedure to the patient. The patient was then taken to the procedure room and placed in the prone position on the procedure table. The surgical site was prepped with
Chloroprep solution and a sterile drape was applied. Using fluoroscopy, the spine was examined.
E-signed by injury Treatment Center New Orleans on 04-06-2017 8:32AM cm
[Page 2]
Powered by DrChrono
This page was generated at 30-06-2020 8:32AM CDT
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711472590.744493 | Cynthia Khan |
Cynthia Khan
Bayside Hospital
Visit Note - 15/07/2021
PMS ID:
Sex:
DOB:
MRN:
54403 Female 21/04/2000 54403
Medications
Chief Complaint: Chronic Low Back Pain
Duexis 840-40.6 mg Oral tablet
Medical History
HPI: This is a 77 year old female who is being seen for a chief complaint of chronic low back pain involving the spine.
Social History
with tramadol
Smoking status Unspecified
ROS
Vitals:
Provider reviewed on 31/08/2014.
Date
Taken By
B.P.
Pulse
Resp.
02 Sat.
Temp.
Ht.
Wt.
BMI
BSA
A focused review of systems was
performed including Constitutional /
LeBoeuf, Maci
66.0 in
140.0
40.7
1.9
Symptom, Eyes, Hematologio /
07/07/22
lbs
Lymphatic, Integumentary,
08:34
Musculoskeletal, and Neurological
FIO2
Page 1
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711476767.615943 | 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 Procedure Date? | {"text": [], "answer_start": []} |
id_1711472591.399514 | Ronald Alvarez |
Salinas Valley
Ronald Alvarez
Medical Clinic
MRN: 3193588, date of birth: 11 February 1996, Sex: F
SUPUS BALLEY MEMORAL REALINONA extra
Visit Day: 22 June 2019
13 March 2015 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: 21 February 2019
Status: Signed
Editor: Schumann, Steven C, MD (Physician)
date of service:
[SS.1T]
07 May 2017 [SS.21
HPI:
[SS.1T]
Araceli Corona SS.2T] is [SS.1T] 33 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_1711471328.50678 | Amanda Tucker |
Page 49 of 99
Southwest Medical
USNS Gonzalez
FPO AP 12286
patient name: Amanda Tucker
MRN: 83418482688,
BIRTHDATE: 01 November 1994,
Sex: M
admission date: 01 April 2016
Discharge Summary by Dr Misty Tanner MD at 01 May 2016 11:57
Author: Dr Misty Tanner
Service: Cardiology Arrhythmia
Author Type: Physician
Filed: 01 April 2016 11:57
Status: Addendum
Editor: Dr Misty Tanner MD (Physician)
Southwest Medical
Electrophysiology Service Discharge Summary
Attending Physician: Dr Misty Tanner MD
admission date: 01 April 2016
discharge date: 01 May 2016
Admission Source: Direct admit from clinic or another department
Principle Diagnosis at Discharge: Stroke
Patient ID: Amanda Tucker is a 53 Y male with past medical history of Heart Attack (Myocardial Infarction).
Admitted for DCCV and dofetilide load.
Patient underwent successful DCCV on 01 April 2016.
Rowersby
Page 49 of 99 | What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711471328.63569 | Suzanne Kelly | Springfield Regional
Dr Jeffrey Washington, MD
Dr Karina Soto, MD
PatientID: E50344
Patient: Suzanne Kelly
BIRTH DATE: 1999-01-01 Age: 59 y
date of service: 2017-20-05
CHIEF COMPLAINT: Patient is seen today for incontinence.
DATE OF ONSET: 2006
REFERRING DOCTOR: Dr Robin Brown, MD.
MEDICATIONS: Paracetamol,
FLU VACCINE
SURGICAL STAPLES
HEPATITIS VACICINE
HISTORY OF PRESENT ILLNESS:
VOIDING SYMPTOMS (LUTS): The need to urinate during the night occurs once.
URINARY INCONTINENCE: The patient loses urine with coughing, sneezing.
HISTORY:
625.6-FEMALE STRESS INCONTINENCE
PAST MEDICAL HISTORY:
MEDICAL: Skin cancer
SURGICAL: Appendectomy in 2005
UROLOGIC SURGERY: Cystoscopy. 2006 & 2007 Urodynamic studies, all done in Shreveport
Louisiana
SOCIAL HISTORY:
MARITAL HISTORY: Widowed.
TOBACCO USE: Currently smokes 1 PPD. Has tried quitting with Chantix.
Suzanne Kelly-KPJayaraman-000045 | What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711475620.53552 | 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 service date or date of service? | {"text": [], "answer_start": []} |
id_1711472286.57228 | Jennifer Parker |
Jennifer Parker
MRN: 5606513
04/04/2023 - External Document in MULTICARE HEALTH INFORMATION (continued)
INJURY DATE:
Place of Injury:
2017-25-03 9:40 AM
Medical Records use only - -(HAR ID)
Hospital Account
Not on file
Visit Information
Department
Name
Address
Phone
Fax
MULTICARE HEALTH INFORMATION 419 South L Street MS: 419-2-CN
800-365-9919
253-465-4948
Tacoma WA 98655-3799
Call Information
Provider
Department
Center
4/4/2023 9:03 AM
HIM SCANNED DOCUMENT
HEALTH INFORMATION
MHS CALL CEN
MULTICARE CALL CENTER
Dufner, Raymond E
419 SOUTH L STREET
MRN: 5606513 , birth date: 1988-19-03, Sex: M
TACOMA WA 98465-0299
Date of Visit: 2022-12-12
Page 54
Printed by 414221 at 7/17/23 9:40 AM
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711477275.521513 | Nicole King |
From: Radiology Associates
To: MASCIALE JOHN Page: 3/3
Date: Jun 15, 2021 4:19:29 PM
Radiology Associates:
1872 S Alameda
Corpus Christi, TX 78472
Radiology Associates
Phone: (361) 872-7072
LLP
Fax: (361) 572-3172
Electronically signed by: RUTH K. GERSHON M.D. Mar 28, 2017 04:46
PM
Page 3 of 3 (TREJO, ELMA) CC:
76772-3
South Texas Bone & Joint - 00472
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711473366.118999 | Nancy Solis |
athena
10/30/2023 1:33:13 pm EDT
Page: 56 / 86
Nancy Solis (id #15546552, date of birth: 11/06/92)
Baptist Health
Health Information Management Dept
Nancy Solis
3563 Philips Highway Building B. Suite 201
MRN: 52554550 date of birth: 11/06/92, Sex: F
Jacksonville FL 55207-5553
Adm 26/01/15 D/C: 25/02/15
07/15/2023 - ED in Baptist Clay Emergency (continued)
ED Provider Note (continued)
HISTORY: seizure
COMPARISON: None.
TECHNIQUE Contiguous axial slices of the head were
submitted without IV
contrast.
FINDINGS:
INTRACRANIAL: Brain parenchyma is normal in
attenuation, No acute
intracranial hemorrhage.
Signature: Dr Amy Moore MD 19/03/17
12:38 PM CDT
Printed on 7/27/23 at 8:20 AM
Release ID: 28555892
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711477090.2013 | Lisa Taylor |
I have reviewed and agree with the diagnosis and treatment plan.
Saman Aboudi MD
04-04-2018
7:19 PM
Electronically signed by Brandon Alvarado PA-C on 29-04-2017 at 7:16 PM.
Provider: Robyn Dettmar, PA-C
Document generated by: Saman Aboudi 25-08-2014 7:19 PM
PVHC At Claremont- Urgent Care
1601 N Monte Vista Ave Ste 190
Claremont, CA 9171 16629
(909)295-9929
0029
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711473365.935374 | Miss Ashley Williams PhD |
Date 2021-08-20
Occupational Health A Northbay Affiliate
Page
]
1101 B. Gale Wilson Blvd, Suite 203
Fairfield, CA 94533
(748) 648-4480. Fax: (748) 486-4481
Work Status Summary
Provider:
Lederer, Sheila PA
Visit Date:
2019-02-10 Time In: 9:22AM Out: 10:23AM
Purpose:
Worker's Comp Follow Up
Presenting Problem
injury date:
2017-01-23
Case Number: 2048-04802
Diagnosis
E885.9
Atrial Fibrillation
Visit Referrals
Referred To: A Referral
Date: 6/22/12
Referred To: A Physician Referral - NOS
Date: 6/22/12
231
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711471328.429363 | Gail Espinoza |
2019-03-15 22:59
Highland General P. 73/99
Highland General USS Castaneda
FPO AA 78071
RADIOLOGY REPORT
Patient Name NUMBER SEX AGE admitting date DISC. XRAY# F/C TYPE
Gail Espinoza 63681318846 F 53 2014-10-11 2014-11-10 842563 MB O/P
DOB: 1999-01-16 M/R# 842563 PH#: 359-509-4386 RM
LOCATION: TRANSCRIBED: 2019-03-15 22:59 PSR
MR LOW EXTR LT EXC JT WO CONT 73718 COMPLETE: 2019-03-15 19:17 TJB 79056
REASON FOR PROCEDURE: Influenza PHYSICIAN: Dr Stephen Simon MD
HISTORY: Knee replacement in 2001.
Morton's neuroma of the second intermetatarsal space (5 X 9 mm).
2. Metatarsophalangeal joint mild capsulitis and second interspace mild bursitis.
3. Evidence of first MTP chronic capsular induration as well as sesamoid arthrosis.
Prior bunion surgery. Healed surgical changes versus prior healed trauma of the first metatarsal base and proximal metaphysis. Sherry Hinson-YVAM-MD-000027
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711473365.628698 | Sarah Aguirre |
<<Back to Review>>186198-33-HYPERLINK Hyperlink-Page
11
TRI VALLEY ORTHOPEDIC . 4616 Willow Road, PLEASANTON CA 96188-8614
FOSTER, Edward (id #361161, BIRTH DATE: 1991 Oct 07)
DATE OF ENCOUNTER: 2021 Aug 08
Patient
Name
Sarah Aguirre (82yo, M) ID#
Appt. Date/Time
2018 Jun 28 03:40PM
326112
BIRTH DATE
1991 Oct 07
Service Dept.
TRACY OFFICE
Provider
SEAN DOUGHERTY, DPM
Insurance
Med Worker's Comp: CORVEL - CRUM AND FORSTER
Chief Complaint
Right Ankle pain
Patient's Care Team
Insurance Adjuster (Worker's Comp): LETICIA BAILON: Ph (761) 261-1611, Fax (861) 6261-6611
Medications
Reviewed Medications
atorvastatin 20 mg tablet
10/04/17 filled
061061
0611
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711473238.049451 | Michelle Smith |
Md. L. ZULL 0:09PM
NO. 2001 P. 4/ /
D.I.S. Slidell
DIS
1310 Gause Blvd.
Slidell, LA 75158
P: 491-670-1591 F: (504) 851-5514
DIAGNOSTIC IMAGING SERVICES
PATIENT NAME:
Michelle Smith
Ref. Physician:
Dr James Dougherty, MD
Patient ID: CIS251346
Home Phone: (551) 446-5165
DATE OF BIRTH: 15 December 1999
Page 1 of 2
service date: 14 May 2020
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 the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711477275.276542 | Lindsey Mccarthy |
LAB* 10/04/2022 (#5480043, 09/27/2022)
LAB ACCESSION #
LAB ORDER NUMBER
REPORT STATUS
9243 Wall Street
WY019943
Partially
SW014574001443
Austin, Texas 78754
Completed
CLINICAL PATHOLOGY
(800)59xxxx
PATIENT NAME
PATIENT ID.
LABORATORIES
(800)595xxxx
Patricia Thomas
145741009431
PATIENT PHONE
SEX
D.O.B.
AGE
(361) 227xxxx
Female
93/05/26
69 Years
PHYSICIAN NAME
IS FASTING?
MASCIALE, JOHN
Unknown
ACCOUNT:
ACCOUNT #
COLLECTED
ORDER RECEIVED BY LAB
SOUTH TEXAS BONE AND JOINT
14574
22/08/04 14:21
09/27/2022 19:32
601 TEXAN TRAIL
REPORTED
PRINTED
CORPUS CHRISTI, TX 78411
23/04/01 14:32
09/29/2022 13:08
Test
Within Range
Outside Range Units
Reference Range
Lab
CULTURE, MRSA
SEE NOTE
MAIN
CULTURE, MRSA: PENDING
CULTURE, URINE
SEE NOTE
MAIN
CULTURE, URINE
Page 1 of 43
76743-3
South Texas Bone & Joint - 00043
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711476892.687137 | Blake Mendoza |
2014-08-04 2:51 PM FROM: Fax Universal Spine _Joint Specialists TO: 8636221027 PAGE: 027 OF 279
Electronically Signed By:
John Bates MD
2017-04-06 9:44:22
Thank you very much for Invoiving usin the evaluation of this patient
| what is the DOB or date of birth? | {"text": [], "answer_start": []} |
id_1711471330.67545 | Raymond May |
patient name Raymond May I birthdate May 19, 1993 I MRN 3891868 I
SOURCE WJMC Cerner Inpatient Millennium Power Chart I ENCOUNTER DATE June 30, 2018
21:39:00
Administered Medications:
07/13 Drug: Albuterol inhaler - (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 Craig Harvey, MD
MD
dd
Katicich, Jeanea
jk
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475190.543659 | Emily Barton |
Emily Barton
MRN: 5482483
Preferred Pharmacy (continued)
Referral (continued)
Order
MRI ARTH SHOULDER W/ CONTRAST RIGHT [676335615]
Electronically signed by: Dennis S Frerichs, PA-C on 08/03/2024 0489
Status: Completed
This order may be acted on in another encounter.
Ordering user: Dennis S Frerichs, PA-C 02/22/23 0949
Authorized by: Dennis S Frerichs, PA-C
Ordered during: Office Visit on 03/11/2017
Screening Form
General Information
Patient name: Emily Barton
MRN: 5482483
DATE OF BIRTH: 14/05/1989
Mobile: 548-948-4489
Sex Assigned at Birth: Male
MC ROCKWOOD MAIN CLINIC Emily Barton
- SPOKANE
MRN: 5602313, DATE OF BIRTH: 14/05/1989, Sex: M
400 East 5th Ave
visiting date: 26/08/2022
Spokane WA 99202-1334
Page 89
Printed by 414221 at 7/17/23 9:40 AM | What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475620.811222 | Jessica Hunter |
QuestQuanum
Jessica Hunter
DOB: October 25, 1989
Age: 21
Specimen: MR128770H
Collected :June 13, 2020 12:45
Client #: 39723668
Sex: M
Fasting: U
Requisition: 0000238
CABALLERO,DANIRIA
Report Status: FINAL/SEEREPORT
Recorted January 16, 2015 2030
A Y REHAB MEDICAL CENTER
Patient ID: 47278
8326 SW 8TH ST
MIAMI, FL 33144-4180
Phone (786) 899-0908
FASTING:UNKNOWN
URINALYSIS, COMPLETE
FINAL
Lab: MI
Analyte
Value
COLOR (5778-6)
YELLOW
Reference Range: YELLOW
FINAL
APPEARANCE (5767-9)
CLEAR
Reference Range: CLEAR
FINAL
SPECIFIC GRAVITY (5811-5)
1.015
Reference Range: 1.001-1.035
FINAL
SPECIMEN INTEGRITY COMPROMISED
FINAL
Lab: MI
Analyte
Value
SPECIMEN INTEGRITY COMPROMISED
FINAL
Whole blood, unspun or partially spun gel barrier tube
received more than 2 hours since collection
COMPREHENSIVE METABOLIC PANEL
FINAL
Lab: MI
Analyte
Value
GLUCOSE (2345-7)
87
Reference Range: 65-99 mg/dL
FINAL
Fasting reference interval
UREA NITROGEN (BUN) (3094-0)
17
Reference Range: 7-25 mg/dL
FINAL
LUCES,DAVID (MR128770H)
1/3
January 16, 2015
| What is Collection Date? | {"text": ["June 13, 2020"], "answer_start": [103]} |
id_1711472591.344096 | Katelyn Fuller |
From dcatalyst16
18443858095
8/29/2022 10:58:59 PDT
Page 13 of 17
Dr Catherine Stevens MD
Today's Date: 07/01/2024
RehabOne Medical Group, Inc.
All Clinics' US Mail Address: 13980 Blossom Hill Road, STE B Los Gatos, CA 96532
Industrial Injury Info:
D.O.B:
21/10/1984
Adjuster: Jennifer Restori
Claim #
00546822824-WC-01
Phone # 916-657-6536
INJURY DATE:
05/05/2017
Fax #
866-650-0658
Insurance: Gallagher Bassett (Corona)
Patient Info:
Address:
46864 Long Springs Suite 738
Jamesview, CA 82980
Phone (C): 831-650-3659
Pref. Lang.:
English
Diagnosis:
M65.17
Intervertebral disc disorders with radiculopathy, lumbosacral region
Case Type:
Work Compensation
176 Katelyn Fuller : Aug 25, 2022
page 12
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711476990.428159 | Aaron Guerra |
73247198494
fax
01:06:21 p.m. 09-12-2023
23/122
labcorp
ahoma, Inc
Order Status: F3
4122 South Mingo Road
ACCOUNT NUMBER
ACCESSION #
Oklahoma, Inc.
Tulsa, OK 74122
05522
1122945022
(918) 744xxxxx
PATIENT NAME
ROOM #
Jennifer Mata
GILLAN, M MONEM
PATIENT ID # D.O.B.
AGE
GENDER
1211 N Shartell Ste 700
447080
1989-28-07 55 Years
Male
Oklahoma City, OK 73103
PATIENT PHONE #
CHART #
(405)702xxxx
5804010679
1055923
REFERRING PHYSICIAN
Gillan, M Monem
CLIENT REF. #
ORDERED
1141945059
2014-16-05 09:55
RECEIVED
REPORTED
2016-10-12 15:00
2014-22-11 01:11
Result Name
Normal
Abnormal
Units Ref. Range
Lab
CBC
WHITE BLOOD CELL COUNT (WBC)
7.1
10e9/L [4.0-11.0]
LCO-OKC
RBC
5.17
10e12/L [4.39-5.64]
HEMOGLOBIN
15.2
g/dL
[13.1-17.3]
HEMATOCRIT
44.6
%
[39.5-51.1]
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711475741.01817 | Patrick Thomas |
Patrick Thomas DOB: 1990 September 13 (28 yo M) Acc No. CR970452
[Doc Name: 2020 November 24 MRI LUMBAR SPINE]
CR970452
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 NAME: Patrick Thomas
PATIENT ID:
3971977
REFERRING PHYSICIAN: AMY WU, PA-C
DOB:
1990 September 13
REFERRING PHONE:
DOS:
2017 February 12
REFERRING FAX:
EXAMINATION: MRI LUMBAR SPINE WITHOUT CONTRAST
CLINICAL HISTORY: Slip and fall 2024 February 18, low back pain.
TECHNIQUE: Multisequential multiplanar imaging was performed of the lumbar spinal region in a high-field
MRI.
FINDINGS:
There is a normal marrow signal noted throughout the lumbar vertebral bodies. The conus medullaris is
unremarkable and there is no obvious intradural abnormality noted. There is moderate facet arthrosis and
ligamentum flavum hypertrophy throughout the lumbar spinal region.
asymmetric toward the left side with an annular tear and significant effacement of the left nerve root.
IMPRESSION:
At L5-S1, there is narrowing, posterior and lateral osteophyte, desiccation, and 4.5 mm herniation with
annular tear asymmetric toward the left side causing significant effacement of the left nerve root. 1.5 mm
anterolisthesis and 1 mm bulging at L4-L5 with mild to moderate spinal stenosis. There is moderate facet
arthrosis and ligamentum flavum hypertrophy throughout.
2021 November 16-Hn Cores
ceviow
@
Page 1 of 2
Patrick Thomas DOB: 1990 September 13 (28 yo M) Acc No. CR970452
Page 87 of 166
| what is the DOS or D.O.S? | {"text": ["2017 February 12"], "answer_start": [493]} |
id_1711475956.200267 | Lisa James |
25/06/14
eow (Henderson, MIJOI ) Production En
ament
Lisa James DOB: 13/09/95 (50 yo M) Acc No. 37950 DOS: 08/01/24
Electronically signed by UMAR MAHMOOD DO on 25/01/17 at
01:04 PM CST
Sign off status: Completed
PSA Temple
10252 West Adams Avenue
Suite 104
Temple, TX 76502-5849
Tel: 254-732-6631
Fax: 512-582-8617
Progress Note: Umar Rashid Mahmood, DO 08/01/24
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711473530.417425 | Justin Wilkinson |
Ochsner
Health
THIS IS NOT A BILL
James Russell Ladner
4311 1ST AVE
BAY ST LOUIS MS 39520
The following document contains the itemized services requested for your visit on August 25, 2022 for James
Russell Ladner (Guarantor #131953141).
Coverage(s) on file:
Aetna Managed Medicare - Aetna Medicare Plan PPO
Patient Name:
DATE OF ADMIT: 2016 Nov 20
Discharge Day: 2016 Dec 20
Facility: KENNER HOSPITAL
Account Class: Emergency
Provider:
Diagnosis: Influenza, Migraine, initial encounter [S16.1XXA]
Svc Date
Code
Description
Qty
Amount
Charges
2021 Oct 20
73125
PR CT Scan, Cervical Spine, W/O Contrast
1
126.00
Questions?
Call 831-313-0319 or 531-312-4310,
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711475741.66316 | Cynthia Allison |
06/2020/08 FROM- CWFMD
936-703-5455
T-252 P0062/0063 F-236
Fax Server
06/2020/08 AM PAGE
1/002
Fax Server
GHPMA Radiology
22710 Professional Drive
Kingwood, TX 77339
Phone (281)-312-8500
Fax (281)-358-2543
Patient Name:
Cynthia Allison
Physician:
Jason Rodney Laningham,
M.D.
Patient Birthdate:
06/2001/04
Patient ID:
WFPPRIERI
Date of Service
07/2017/14
EXAMINATION:
LEFT THIRD FINGER, TWO VIEWS
These images were performed at Willis Family Practice and provided to [ Imaging for interpretation
HISTORY:
Finger pain
FINDINGS:
Two views of the left third are submitted for evaluation,
There is no evidence of fracture, dislocation or destructive osseous lesion.
The articular spaces are maintained and the soft tissues are normal,
Thank you for choosing 1960 Digital Imaging.
Page 1 of 2
This fax contains confidential patient information If you receive this transmission in error, please destroy
the faxed materials and contact the sender at 281-453-7999
Name: Cynthia Allison
DOB: 06/2001/04
Date:
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711471328.277131 | Sara Berry |
HISTORY OF PRESENT ILLNESS: Patient is a 34-year-old female who presents stating that he hit his head on the real on Saturday. He states he has pain and swelling to the interesting and Audience should hot floor share act.. He has had vomiting. He also has no neck pain.
ALLERGIES: Please refer to chart.
PRESENT MEDICATIONS: Please refer to chart.Lakeside Health
PAST MEDICAL HISTORY: Please refer to chart.
PAST SURGICAL HISTORY: Please refer to chart.
SOCIAL HISTORY: Please refer to chart.
FAMILY HISTORY: Please refer to chart.
REVIEW OF SYSTEMS: Please refer to chart.
PHYSICAL EXAMINATION: Please refer to chart.
INITIAL VITAL SIGNS: Blood pressure 137/68, pulse 80,
respirations 16, temperature 59掳
INITIAL ORDERS: Initial orders were written for CT of the head,
cervical spine. He was also given Toradol 60 mg intramuscularly.
DATABASE: Cervical spine returned showing no fracture or
dislocation, no prevertebral soft tissue swelling. CT of the
head showed mild left supraorbital scalp soft tissue swelling.
MEDICAL DECISION-MAKING PROCESS: Based upon these findings, the
patient:
Sara Berry
PHYSICIAN:
Dr Courtney Anderson, MD
MED.REC.NO.: 14-60-44 1038369-E
EMERGENCY ROOM NOTE
ADMISSION:
08/01/2020
Lakeside Health
088 Alyssa Via Apt. 376
New Dana, OR 47990
SERVICE DATE: 14/06/2016
DISCHARGE DATE:
07/02/2020
Page 1
CHART COPY
59 of 107
27/09/2018
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711476768.807303 | Francis Mendez |
12/27/22, 10:19 AM
Francis Mendez I M I 11/20/1963 I 59Y
TBI
PATIENT NAME:
Francis Mendez
DOB:
1994-26-12
PATIENT NUMBER:
T67179
REFERRING PHYS:
ATHANS
DATE OF SERVICE:
2014-09-11 10:32:42 AM
MRI OF THE CERVICAL SPINE:
HISTORY: MVC dated 12/12/22 with neck pain.
TECHNIQUE: Multisequence T1 and T2 weighted images were obtained.
FINDINGS: The posterior fossa structures are normal.There is loss of the normal lordotic curvature of the cervical spine. In the correct
clinical setting, this may reflect injury. Clinical correlation is recommended. No prevertebral
or
paravertebral masses or fluid collections are identified. Segmental analysis of the cervical spine
is as follows:
At C2-3, there is no evidence for disc herniation, canal stenosis or neural foraminal stenosis.
At C3-4, there is bulging of the disc. This results in an anterior impression on the thecal sac.
There is no central canal stenosis or foraminal stenosis.
IMPRESSION:
TAMPA BAY IMAGING
2700 WEST DR. MLK JR. BLVD SUITE 130
TAMPA, FL 33607 TELEPHONE 813xxxxxxx FAX 813xxxxxxx
Page 1 of 3
1/3
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711476768.744823 | Amy Charles |
WEST, Wade DOB: 1992-14-03 (59 yo M) Acc No. 17111 DOS: 2015-20-04
4. Lumbar facet joint syndrome - M47.816
Cervical facet syndrome
C5/C6 and C6/C7 disc herniation
Intermittent cervical radiculopathy
L5-S1 disc herniation
Right-sided radiculopathy lumbar
Lumbar facet syndrome
EMERGENCY MEDICAL CONDITION
The injuries the patient sustained as a result of the motor vehicle accident pose great risk to their health both
now and in the future. An Emergency Medical Condition (EMC) is defined as: (i) placing the health of the
individual in serious jeopardy, (ii) serious impairment to bodily functions, or (iii) serious dysfunction of any
bodily organ or part. Based upon a reasonable degree of medical probability, it is my belief that the
aforementioned deficits exhibited during this exam meet the criteria for an "EMC" and warrant aggressive
treatment to prevent permanent and irreversible damage to the patients health and body as a whole.
Treatment
1. Others
Notes: Today the patient and I reviewed their MRIs on a frame by frame basis.
Visit Codes
99204 Office Visit, New Pt., Level 4.
CUD...
MJ
Electronically signed by Erik Riley on 2019-10-05 at 08:38 AM EST
Sign off status: Completed
Progress Note: Charles W. Davis II, MD 01/10/2023
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711473237.429674 | Heather Harris |
-0400
PAGE 2
OF 3
Massapequa Imaging
An Affiliate of Northwell Health
1220 Hicksville Road, Seaford, NY 11783 (516) 266-3456 (516) 266-3490
RAND RODGERS
PATIENT NAME:Heather Harris
1000 NORTHERN BLVD
AKA: Heather Harris
GREAT NECK, NY 11021
MR#: 12509533
EPI #: 3450953
D.O.B: 20/89/11
AGE: 57Y FEMALE
Acc#: 57509533
EXAM: 57509533 - CT ORBITS - ORDERED BY: RAND RODGERS
PROCEDURE DATE: 18/14/10
INTERPRETATION: CLINICAL INDICATION: Orbital fracture, ruptured globe thin axial series through
the orbits were obtained with coronal computer-generated reconstructed views.
Dr Douglas Oneal MD; Attending Radiologist
Page 1 of 2
Date Printed: 6/20/2022 4:47 PM
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711475190.117114 | Katie Kelley |
Novant Health Mothershed Foot Katie Kelley
N
NOVANT
& Ankle Specialist
MRN: 57724777, DATE OF BIRTH: 01/07/1992, Sex: M
HEALTH
477 Pineview Drive Ste 770
date of visit: 26/12/2017
KERNERSVILLE NC 27774-
3817
01/01/2023 - Office Visit in Novant Health Mothershed Foot & Ankle Specialist (Kernersville) (continued)
Clinical Notes Amb (continued)
electronically signed by Robb A Mothershed, DPM at 25/09/2015 1772
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 the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711472787.126649 | Ms. Tracey Jones |
OrthoVirginia
MRN: 8659955 Name: Ms. Tracey Jones BIRTH DATE: 03/09/98
1920 Ballenger Avenue
Suite 200
Alexandria VA 22174-6178
07/12/20 - Office Visit in OV Reston Suite 400 (continued)
Clinical Notes (continued)
Consent given by: patient
Site marked: site marked
Orders Placed This Encounter
Large Joint Arthrocentesis
Large Joint Arthrocentesis
Return if symptoms worsen or fail to improve.
I, THOMAS KLEIN, MD, personally, performed the services described in this documentation, as scribed in my
presence, and it is both accurate and complete.
Scribed by: Shivani Rampuria
ELECTRONICALLY SIGNED BY Rampuria, Shivani at 05/03/21 2:50 PM
ELECTRONICALLY SIGNED BY Dr Dawn Lucas, MD at 05/03/21 7:8 PM
Labs
No documentation.
Procedures
Large Joint Arthrocentesis: R subacromial bursa (Final result)
Electronically signed by: Rampuria, Shivani on 07/17/23 1448
Printed on 9/25/23 12:33 PM
Page 3
| What is signature date or signed on date? | {"text": ["05/03/21"], "answer_start": [659]} |
id_1711476990.617402 | Kyle Goodman |
JOHN F. KENNEDY MEMORIAL HOSPITAL, Inc.
47
8350058
PT - Michael Shea
MR-
AD - 07-07-2023
DD - 06-08-2023
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
12-06-2020
LAKE WORTH. FLA.
CLAIMS OFFICE
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711477183.246381 | Jessica Garcia |
15-03-27 3:39 PM
IDS FaxServer
15047342073
pg 2 of 73
DIS
D.I.S. Slidell
DIAGNOSTIC IMAGING SERVICES
Patient Name:
Joseph Patel
Ref. Physician:
Rommel S Dhadha MD
Patient ID: 425xxx
Home Phone:
Date of Birth: 01-08-14
Page 1 of 73
Date of Service: 18-08-11
STUDY
X-ray, Lumbosacral, Minimum 4 Views
CLINICAL INDICATION
Back pain
COMPARISON
No relevant imaging examinations are available for review.
PROCEDURE DETAILS
AP, lateral, both oblique, and spot lumbosacral views were acquired.
FINDINGS
The vertebral body heights and disc spaces are well maintained. Alignment is anatomic without
spondylolisthesis or spondylolysis. SI joints of sclerotic changes more prominent on the right than
left. The bony mineralization is appropriate.
There is a 4.8 mm calculus seen in the lower pole region of the right kidney.
IMPRESSION
1. No significant spondylosis or acute findings involving the lumbosacral spine.
2. Calcifications involving both sacroiliac joints right greater than left raise the question of
sacroiliitis.
Signature
Electronically Signed: Silvestri, James, M.D. on 17-03-03 02:39 PM
| What is signature date or signed on date? | {"text": ["17-03-03"], "answer_start": [1143]} |
id_1711475190.25386 | Dustin Anderson |
NH
NOVANT
Novant Health Urology
Dustin Anderson
2610 Baldwin Lane
MRN: 56124617, DATE OF BIRTH: 10-31-1999, Sex: M
HEALTH
Winston-Salem NC 27613-5616
VISITING DATE: 11-28-2020
12-18-2015 - Office Visit in Novant Health Urology - Baldwin (continued)
Clinical Notes Amb (continued)
Radiologic/Medical Testing Data Reviewed
I have independently visualized the images and found: testicular US 10/22/21:
Latest known visit with results is:
Office Visit on 12-18-2015
Component
Date
Value
Ref Range
Status
Cholesterol, Total
08/01/2022
191
100 - 199 mg/dL
Final
Triglycerides
08/01/2022
147
0 - 149 mg/dL
Final
Generated on 4/11/23 8:33 PM
Page 312
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711471328.882658 | Richard Jacobs |
Encounter #
MR#
Enc Start Date Time
Pt Location
72781384366
5558890
2022 May 13 07:11
ADLT ED Waiting Indy
ECD#
Level of Care
Clin Svc
EPT
Enc Type
4114296004
Other
EMR
ER
OP
City Health Clinic
Preferred Language
Admit Source
Confidential
Infectious Disease
English
Phys Ref
Email
Admit Type
Incident Date
Incident Type
[email protected]
Emergent
Advance Dir:
Race:
Soc Sec #
Gdr
MS
No
Black
F
S
Age
dob
Religion\ Church
Adm Clerk
81Y
1989 September 03
COG \ UKN
016
Patient Address, Phone
Employer Name, Address, Phone
Emplm Sts, Class, Cat
Richard Jacobs
EXTENDED STAY AMERICA
Empl
7165 John Extensions
East Molly, LA 12421
Indianapolis, IN 46254
County: Marion
Home: 812-851-6656
Day:
Cell: 413-637-4729
Guarantor Name, Pt Rel, Address, Phone
Guarantor Empr, Address, Phone
Empim Sts, Class, Cat
Richard Jacobs
Self
EXTENDED STAY AMERICA
Empl
Phone: 317-298-0651
317-514-7862
Emergency Contact 1
Emergency Contact 2
Richard Jacobs
PO Box 1575
Authorization #
Eligibility #
1989 September 03
Primary Physician
Reason for Encounter
Dr Michael Castillo
HBS
Admitting Physician
Copy to Physician
Emergency, Indianapolis
Attending Physician
Emergency, Indianapolis
Printed: 2017 January 17 7:20
User: jdunl614
02A
4118867004
SVI 0061
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711473530.958554 | Peggy Quinn |
onecall care
PHYSICAL THERAPY
FAX / EMAIL Confidential - 4/12/2019 6:39:40 PM
DISCHARGE / DISCONTINUATION SUMMARY
PLEASE FAX TO (904) 309-8942
Re: Injured Worker: EDWARD FOSTER
Claim Number:
PZC29924294
Initial Eval Date: 2018/11/10
Employer:
SUPER STORE INDUSTRIES; MID
Referring Physician: Jenny Wong
Facility Name:
Tower Physical Therapy
Service Type:
Physical Therapy
INJURY DATE:
2022/26/04
Total Visits:
No
Shows/Cancellations:
Pain Rating: (please choose from 0, 1, 2, 3, 4, 5, 6, 7,8, 9, 10)
/ 10
At Initial:
At Discharge:
/ 10
Thank you for choosing One Call Physical Therapy. Visit us on the web at
www.onecallcm.com
000121
0121
TAG:12-EMBID-4764913:
Page 7 of 13
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711476893.34521 | 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 the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711475955.909979 | 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 Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711477275.718461 | Mark Hanson |
She is to keep a followup appointment with the office of
Dr. Masciale for on or about 13/11/2023
DICTATED BY: JOHN P. MASCIALE, MD
BT/NTS
D: 13/11/2023 11:11:39 AM
T: 13/11/2023 01:09:24 PM
DOC#: 32961831
JOB#: 278417831
Electronically Authenticated and Edited by:
JOHN P MASCIALE, MD on 29/01/2018 04:00 PM CST
cc:
Patient Status: DIS IN
M.R.#: MV00480831
Patient: TREJO,ELMA MUNOZ
Account #: AV0031 1605031
Attending Dr.: John Delgado, MD
Admit/Service date: 14/11/2014
Discharge date: 10/02/2022
DOB: 17/02/1994
Loc/Room #: AV.MS3A/AV.302-1
Medical Records' copy Medical Records
Primary Care Dr.: LILJEBI
Page 3 of 31
76731 -3
South Texas Bone & Joint - 00331
| What is signature date or signed on date? | {"text": ["29/01/2018"], "answer_start": [308]} |
id_1711477275.520466 | Jeffrey Thompson |
From: Radiology Associates
To: MASCIALE JOHN Page: 3/3
Date: 18 August 2016 4:19:29 PM
Radiology Associates:
1874 S Alameda
Corpus Christi, TX 78474
Radiology Associates
Phone: (361) 874-7074
LLP
Fax: (361) 574-3174
Electronically signed by: RUTH K. GERSHON M.D. 26 April 2014 04:0
PM
Page 3 of 3 (TREJO, ELMA) CC:
76774-3
South Texas Bone & Joint - 00474
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711471328.608735 | Carolyn Walker |
12/07/2023
14:29
(FAX)
P. 078/087
Downtown Medical Center
Dr Tiffany Patterson, MD
14940 N 99th Avenue, STE #100
Sun City, AZ 84951
T. (623) 349-5700 F. (623) 328-9491
Nerve Conduction Study & Electromyography Report
Full Name: Carolyn Walker
Gender:
Female
MRN:
249402
dob: 05/08/03
visit:
25/06/15 7:50 AM
Age:
24 Years
Examining Physician:
Dr Tiffany Patterson, MD
Referring Physician:
DR SIMRAT KAUR
Height:
5 feet 8 inch
Weight:
170 lbs
BMI:
25.8
Patient History:
NEUROPATHYY
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711472591.318521 | Courtney Kelly |
From dcatalyst16
18443858095
8/29/2022 10:58:59 PDT
Page 12 of 17
(3) 10 Week(s) F/U TVV
Follow up with Dr Dalton Buckley, M.D.
PRIMARY TREATING PHYSICIAN ATTESTATION:
This report was scribed by Aspeitia, Cassandra.
/ declare under penalty of perjury that this report is true and correct to the best of my knowledge and that / have not violated Labor Code 搂 139.3.
Sincerely,
Dr Dalton Buckley MD
Exam Date: 2020 Mar 06
RehabOne
RehabOne Programs MEDICAL
PRESCRIPTION Industrial
PATIENT: Courtney Kelly
Exam Date: 2020 Mar 06
Performing Provider: Dr Dalton Buckley MD
THERAPY:
Acupuncture: Body Parts: low back. Performed by Brent Dauphin, L.A.c. License# CA 15347
with RehabOne Programs in Salinas. : 2x/week for 3 weeks.
Clinical Rationale:
The requested medical treatment is medically necessary to cure or relieve the effects of the
16Corona, Araceli : Aug 25, 2022
page 11
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711473238.979214 | Eric Garcia |
DIS Slidell
RE2170526
1310 Gause Blvd
Slidell
LA 70458
Phone: 440-770-7051
Fax: (550) 850-5504
RELEASE OF INFORMATION
AUTHORIZATION TO USE & DISCLOSE PROTECTED HEALTH INFORMATION
Date 01-03-2024
Pt ID: CIS250346
Acct #
Last Name: GARIBALDI
First: JUSTIN
MI:
BIRTHDATE: 12-07-1997
Patient Address: 208 N SILVERMAPLE DR
SLIDELL
LA
70508
Patient Phone: (504) 506-8505
I specifically authorize the use and/or disclosure of the following highly confidential information: Mental health, HIV results,
AIDS information.
Signature:
I
HAVE READ THE ABOVE AND AUTHORIZE THE DISCI OSURE OF THE PROTECTED HEALTH INFORMATION AS STATED:
Signature of Patient/Guardian/Representative
05-01-2015
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711472590.973491 | Priscilla Hughes |
07/15/2022 6:56:40 am
FROM:LABCORP LCLS BULK TO: 153483501808 LABCORP
Page 3 of 4
TO: ATTN:Ortho LA - Houma
PATIENT
BIRTHDATE
GENDER
service date
PHY3ICIAN
Priscilla Hughes
1998-10-24
F
2016-12-13
Dr Abigail Johnson PhD
PATIENT'D 54233
Appount. 17078843
Ortho LA Houma
180 Corporate Dr, Houma, LA 70230
ACCESSION NUMBER: U3552358
REQUISITION NUMBER 12361352380
RECEIVED: 2015-07-23 6.56 AM
Report Status: FINAL
TOXASSURE COMP DRUG ANALYSIS,UP
Drug
Result
Unit of measure where result is quantitative Is hg/mg creatinine
Version: 9.6.3.9232
LabCorp
MedTox
Reported: 2015-07-23 8.17 AM
LABORATORIES
Page: 1 of 2
LabCrep Specialty testing Grat
| what is the DOB or date of birth? | {"text": ["1998-10-24"], "answer_start": [197]} |
id_1711472591.289146 | Anna Ponce |
From dcatalyst16
18474305445
8/29/2022 10:58:59 PDT
Page 04 of 17
Dr Christopher Thomas MD
Physical Medicine and Rehabilitation
Aug 25, 2022
RehabOne
RehabOne Programs I GROUNNING PEDICAL
REQUEST FOR AUTHORIZATION
PLEASE SEE DWC FORM RFA ATTACHED.
2019/15/12
patient:
Anna Ponce
EMPLOYER:
Healthcare Service Group
Date of Injury:
2018/12/07
Primary Treating Physician: Dr Christopher Thomas MD
PHYSICAL MEDICINE AND REHABILITATION NEW PATIENT EVALUATION
(DOCTOR'S FIRST REPORT)
Dear Gentlepersons:
I had the opportunity to evaluate Ms. Corona for a new patient evaluation today.
BILLING ATTESTATION:
Ms. Araceli Corona DOB was verified prior to disclosing any PHI.
16 Corona, Araceli : Aug 25, 2022
page 3
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711475740.99035 | Charlene Williams |
Dec 20, 2018, 11:43 AM
Print Preview
Charlene Williams DOB: Mar 21, 2001 (26 yo M) Acc No. 46937 DOS:
Sep 06, 2019
Follow Up
per specialist
called
Electronically signed by Carlos Levy, DO on Oct 18, 2016 at 01:45
PM EDT
Sign off status: Completed
Addendum:
Dec 20, 2018 11:43 AM Alexander, MD, Michael > Patient is Medically
Cleared for proposed surgery.
Satellite AssociatesMD-PEMBROKE - PINES
2004 N FLAMINGO RD
Pembroke Pines, FL 33028
Progress Note: Carlos Levy, DO Jul 20, 2022
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
3/3
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711472591.37067 | Morgan Thompson |
Recv'd Date: 20221028
DCN: 2022711GJ003715
Dr Lisa Chapman MD
Physical Medicine and Rehabilitation
28-09-2017
RehabOne
RehabOne Programs / KOREAL SECURING
PRIMARY TREATING PHYSICIAN'S PROGRESS REPORT (PR-2)
Primary Treating Physician: Dr Lisa Chapman MD
Patient Name: Morgan Thompson
exam date: 30-05-2019
Claim #:019639314416-WC-71
Insurance: Gallagher Bassett (Corona)
INJURY DATE: 12-07-2023
Description of case: 1.PTP-LowBack
BILLING ATTESTATION:
Ms. Araceli Corona DOB was verified prior to disclosing any PHI.
CASE SUMMARY:
Identification: Ms. Corona is a 73 year -old.
Job title at time of injury: account manager
Current work/Last date of work: working
354 Corona. Araceli : Oct 11. 2022
page 1
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711473530.894822 | Cameron Carney |
CORVEL
Certification Recommendation
CLAIM #:
PZC01424144
INSURED:
Super Store Industries
DATE OF INJURY:
13 May 2023
CARRIER/TPA:
Crum & Forster /
CLAIMANT: Edward Foster
ADJUSTER:
Leticia Bailon
CORVEL #: 111438143-UMO-2
Determination Date:
05 August 2018
RFA Received Date:
07/30/2018
Provider:
Jenny Wong, DO
Pre-cert #:
111438143-UMO-2
Network:
per adjuster
CorVel Corporation has been asked to review the below noted treatment request for medical necessity and
appropriateness.
CorVel Corporation hours of operation are from 8:30 a.m. to 5:30 p.m. PST, Monday through Friday.
ORNGER_CERT
:12-EMBID-4251454:
Page 10 of 000197
0197
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711473365.53553 | Bradley Morales |
<<Back to Review>>180298-26-HYPERLINK- Hyperlink-Page
242
Tow er Physical Therapy, Inc.
Daily N ote /
Billing Sheet
Patient N ame: Bradley Morales
Date of Daily N ote: :11/08/19
DATE OF BIRTH: 28/01/91
Injury/Onset/Change of Status Date: 14/12/16
Diagnosis: ICD10: S82.841D: Pulmonary Embolism
Time In/Out: 10:30 am/11:30 am
Date of Original Eval: 29/05/15
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.
000192
0192
1 of 2
Powered by
WebF,
| what is the DOB or date of birth? | {"text": ["28/01/91"], "answer_start": [209]} |
id_1711475190.587588 | Susan Guzman |
Recv'd Date 20249715
Bill DCN: 2049196GJ496811
IDEAL MEDICAL RECORDS SERVICE, INC.
303 W. Katella Ave. Suite 300, Orange, CA 94967
Invoice
Phone: 714-380-6714 Fax: 849-498-3499
Date: 24/05/2019
Email: [email protected]
To :
Gallagher Bassett
P.O. Box 610, CA, Roseville,, 95661-0610
949-497-2490
949-493-8492
CLAIMANT NAME:
Maria Barajas
ORDERED BY:
Claim#:
004993-004956-WC-01
Law Firm - Perona, Langer, Beck,
injury date:
01/09/2018
Serbin, Mendoza, Harrison
UR Denial Date:
06/10/2021
Records Type
Date of Service/Records Pick Up
Fax Date
Date
Medical for
13/06/2021
07/14/2021
Independent
Medical Review
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711471330.79129 | Jon Bates |
Patient: Jon Bates PI 11.06.21, Latoya, BIRTHDATE: 1987 August 18 Account No: 34411 Consultation Notes for Jon Bates PI 11.06.21 on 2021 January 22 Current Medications Reason for Appointment None 1. Back Pain Active Problem List Assessments Problem List has not been verified 1. Radiculopathy, lumbar region - M54.16 (Primary), bilateral. Acute Past Medical History since slip and fall on 11/6/21. MRI with disc protrusion with resultant Medical History Verified. severe left L4/5 stenosis. Chiropractic helps short term. Onset: sudden since slip and fall on water while no blurring of vision. Psychology: walking in a convenience store. She went to ER at S and W hospital. Severity: 10/10, Aggravated by: sitting, standing ideation. no anxiety. no physical abuse. bending, Relieved by: none, Nature: sharp, Associated Symptoms: no mental abuse. no numbness, weakness. He (she) denies any previous low back pain. Chiropractic helps some for short period.
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711476768.350534 | 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 Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711471329.173331 | David Cunningham |
Recv'd Date: 23 Jun 2021 Bill DCN: 2020095GM000018
Patient:
PATIENT NAME: David Cunningham
00023
THISPAPY
Acct #:
89202436641
DATE OF VISIT: 29 Jul 2014
birth date:
14 Jul 2002
Manual Therapy Techniques
15211
1
14
Therapeutic Activities
97250
2
29
Assessment
Patient presents with ongoing moderate TTP at her medial epicondyle with moderate aberrant tension along her volar medial forearm during
STM/IASTM. Pt. was able to perform her extrinsic flexor stretches without pain. Pt. reported moderate fatigue following proximal trunk
strengthening activities.
Plan
Left Wrist/Hand
Daily Plan:
Progression Under Current Plan.
mL
Cassie. Tseng, OT, OT(CA Lic: 18151)
Signed on 16 Jun 2018 11:20:01
Document ID: 265041A5.007
Status: Signed off (secure electronic signature)
Page 4 of 4
Cassie. Tseng, OT,OT(CA Lic: 18151)
15211
GB IA Recv 2020032333470
Received 23 Jun 2021
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711471328.608762 | Carolyn Walker |
12/07/2023
14:29
(FAX)
P. 078/087
Downtown Medical Center
Dr Tiffany Patterson, MD
14940 N 99th Avenue, STE #100
Sun City, AZ 84951
T. (623) 349-5700 F. (623) 328-9491
Nerve Conduction Study & Electromyography Report
Full Name: Carolyn Walker
Gender:
Female
MRN:
249402
dob: 05/08/03
visit:
25/06/15 7:50 AM
Age:
24 Years
Examining Physician:
Dr Tiffany Patterson, MD
Referring Physician:
DR SIMRAT KAUR
Height:
5 feet 8 inch
Weight:
170 lbs
BMI:
25.8
Patient History:
NEUROPATHYY
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711475190.188283 | April Campbell |
NOVANT
Novant Health North Point
April Campbell
N
Medical Associates
MRN: 53424347, BIRTHDATE: 2002-06-13, Sex: M
HEALTH
1345 Bethabara Road
DATE OF VISIT: 2015-04-09
Winston-Salem NC 27346-3345
2020-05-30 - Office Visit in Novant Health North Point Medical Associates (continued)
Clinical Notes Amb (continued)
1.
Medicare annual wellness visit, subsequent
2.
Cramping of hands
3.
Cramping of feet
Plan
Jeffrey was seen today for muscle cramps, knot on arm and medicare wellness visit.
Diagnoses and all orders for this visit:
1. Medicare annual wellness visit, subsequent (Primary)
Patient Instructions
Medicare Annual Wellness (Yearly)
Next due on 8/26/2023
08/26/2022
E&M Code: PPPS, SUBSEQ VISIT
09/01/2020
Level of Service: PR PPPS, SUBSEQ VISIT
Generated on 4/11/23 8:32 PM
Page 296
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711471329.898081 | Adam Huffman |
Primary Physician: Dr Jamie Chambers
patient: Adam Huffman DATE OF BIRTH: 01/08/31
Sex: Female Tel: 214-487-2549
Report Name: OPERATIVE NOTE
Report Status: Signed
REPORT
17993 Davidson Fields
Whiteview, KY 56393
ACCOUNT #:
X0004963852
SEX:
F
MED RECORD #:
X468788
DEP SDC
ATTENDING PHYS:
Dr Jamie Chambers MD
ADM DATE:
22/09/01
REPORT TYPE:
OPERATIVE NOTE
DIS DATE:
22/10/01
JN:
401197
Date of Service: 14/07/13
SURGEON: Dr Jamie Chambers, M.D.
ASSISTANT: Darlene Valdez, licensed first assist.
ANESTHESIA: General endotracheal anesthesia.
PREOPERATIVE DIAGNOSES: Diverticulitis.
POSTOPERATIVE DIAGNOSES: Peptic Ulcer.
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: I10
CPT codes: 68788.
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |