id
stringlengths 16
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|---|---|---|---|---|
id_1711471328.608725 | 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 visit date or date of visit? | {"text": ["25/06/15"], "answer_start": [328]} |
id_1711476578.280963 | Melissa White |
Patient: OWENS, Shannon DOB:Oct 26, 2000
OWENS, Shannon DOB: Oct 26, 2000 (46 yo F) Acc No. 758856
Nov 26, 2015, 3:51 PM
Owens, Shannon (MR#21770222) Printed by SOUTO ALMENTEROS
UNIVERSITY OF MIAMI
JHealth
MILLER SCHOOL
UNIVERSITY OF MIAMI HEALTH SYSTEM
of MEDICINE
MRI CERVICAL SPINE CONTRAST
Owens, Shannon
MRN: 21770222, Sex Assigned at Birth: Female, Oct 26, 2000 yrs)
Accession #: UR3111390
Final Result
Appointment Info
Exam Date
MRI of the Cervical Spine without contrast
Feb 24, 2017
HISTORY and INDICATION: 45 years old Female, Spondylosis of
cervical joint; Neck pain
Department
ICD-10:
UHealth Tower: Magnetic Resonance
Comparison: None
Imaging (MRI)University of Miami Hospital
and Clinics
TECHNIQUE:
B 305-243-5522
MR images of the cervical spine were acquired without intravenous
FINDINGS:
Diagnoses
Regarding alignment, there is a mild anterolisthesis C4-5. Regarding
vertebral marrow signal, there is no abnormality on STIR imaging.
Spondylosis of cervical joint
IMPRESSION:
1. Degenerative changes right occipital-C1 articulation, right C4-5 and
Coral Gables FL 33146-2522
left C5-6.
2. No abnormal signal within the cervical spinal cord.
Signed by Dagher, Azar Peter, MD on Oct 23, 2023 4:42 PM
Owens, Shannon MRN: 21770222 ACC: UR3111390 MRI Cervical
Spine W/O Contrast
Document: Nov 26, 2015-Records
Printed: Apr 29, 2016 12:22:11
Page 122 of 228
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711473366.058662 | James Schultz |
athena
10/30/2023 1:33:13 pm EDT
Page: 48/86
James Schultz (id #15146512, Date of Birth: 06/01/1985)
Encounter Summary for James Schultz
Encounter Details
Date
Type
Department
Care Team
Description
06/11/2019 Emergency
Discharge Disposition: 01
4:55 AM
Baptist Clay Emergency
DISCHARGED TO HOME
EDT -
OR SELF CARE
06/11/2019
1771 Baptist Clay Drive
3:44 PM
EDT
FLEMING ISLAND, FL
32513-8511
Demographics
Sex:
Female
Ethnicity:
Not Hispanic or Latino
Date of Birth:
06/01/1985
Race:
White
Preferred
Information not available
Marital status:
Married | What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711476990.458555 | Alexandria Walker |
2016-05-07 10:13:54
Oklahoma Spine 4058789650
4/64
Summit Medical Center
1864 Renaissance Blvd
Edmond OK 730133023
Phone: 405xxxxx Fax: 405xxxxx
Visit Note - Procedure
Provider: Taylor Griffin, MD
Encounter Date: 2024-02-26
Patient: Alexandria Walker (6475)
Sex: Male
DOB: 1997-07-06 Age: 55 Year
Race: Unreported/Refused to Report
Address: 171 Catfish Dr, Ponca City OK 89650 Pref. Phone(H): 918xxxxx
Insurance:
UMR (PP)
Insurance ID: 14089650
Description: General
Current Medication:
Other MD:
1 Atorvastatin 20 Mg Tablet SIG: Take 1 daily
2 Hydrocodonc-acetaminophen 5-325 Mg Tablet SIG: Take 1 every 6 hours as needed for pain
This visit note has been electronically signed off by Khalid Khan, MD on 2020-01-16 at 03:27
PM.
Patient: Alexandria Walker
DOB: 1997-07-06 Visit: 2017-08-24
Page:
64
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711473531.041636 | Angela Frost |
From: Stephanie Gonzales Fax: 19494649849
To:
Fax: (449) 498-5495
Page: 7 of 20
03/15/2022 8:55 PM
Dr Danielle Gardner, M.D.
Adjunct Assistant Professor, Pain Management
(949) 491-2490
Fax (849) 949-9495
DATE OF REPORT:
04 May 2018
Patient name:
Angela Frost
Date of Birth:
25 Sep 1986
SS#
549-25-0493
EMPLOYER:
Superstores Industries
CLAIM #
SIF11449649
Injury Date:
11 Jun 2017
Department of Industrial Relations/Subsequent Injury Benefits Trust Fund, 1750 Howe
Ave, Ste 370, Sacramento, CA 95825-3367 (916) 928-4601 Fax: (916) 928-4705
SUBSEQUENT INJURY BENEFITS TRUST FUND SUPPLEMENTAL REPORT
Mr. Foster's attorney requested that I prepare a report discussing additional medical
records (see his 2/28/22 letter).
Emanuel Medical 1021 pages
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711476892.744003 | Christopher Miller |
25-04-2014 02:58 PM
TO:1674 3548974
FROM: 83374 74974
Page: 74
Proc ID: 12706
Page 9 of 74
FAPA
PostOP
Patient: Lisa Rose
DOB: 28-07-1997
FEINERMAN ANESTHESIA
MRN: C11974
Acct: C11974
DOS: 22-10-2017
Diagnosis: Other cervical disc displacement, high cervical region (M50.21), Spinal stenosis, cervical region (M48.02). Cervicalgia (M54.2),
Radiculopathy, cervical region (M54.12)
Procedure(s): Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of
herniated intervertebral disc; 1 interspace, cervical (63020), Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance
(fluoroscopy or CT); cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure) (64634), Destruction by
neurolytic agent, paravertebral facet joint nerve(s).
Patient is stable and can be discharged from the Post Anesthesia Care Unit
Signature
Signed by Andrew Duren (Anesthesiologist) 08-08-2018 11:18
PostOp Done Time: 04/06/2023 11:20
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711476893.105532 | Tanner Holland |
131 9904384
Reset Form
Print Form is
STATE OF CALIFORNIA
Division of Workers' Compensation
Disability Evaluation Unit
EMPLOYEE'S DISABILITY QUESTIONNAIRE
DEU Use Only
This form will aid the doctor in determining your permanent impairment or disability. Please compl猫te this form and
give it to the physician who will be performing the evaluation. The doctor will include this form with his or her report
and submit it to the Disability Evaluation Unit, with a copy to you and your claims administrator.
Employee
Florentino
First Name
MI
Mejia
Last Name
SSN (Numbers Only)
1624 Travion Court #1, Fairfield, CA 9904384
Street Address 1/PO Box (Please leave blank spaces between numbers, names or words)
International Address (Please leave blank spaces between numbers, names or words)
Fairfield
CA
94533
City
State
Zip Code
Date of Birth
85/06/16
MM/DD/YYYY
Date of Injury
14/05/11
MM/DD/YYYY
Chevy's
Employer
Restaurant
Nature of Employers Business
Claim Number 1
0024060013b6wc01
DWC-AD form100 (DEU) Page 1 (REV. 11/20418)
376
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711475620.598777 | Kyle Jackson |
Kyle Jackson DOB: 01/12/02 (51 yo M) Acc No. 95842 Doc Name: 22/04/21 Inj
LA Health Solutions
3001 Division Street, Suite 104, Metairie, LA 70002
606 Colonial Drive, Suite A, Baton Rouge, LA 70806
T: (504) 262-8889 F: 504-603-2826
POST PROCEDURE PAIN ASSESSMENT
USE THE LETTERS BELOW TO INDICATE THE TYPE & LOCATION OF YOUR SENSATIONS RIGHT NOW
A - ACHE
B - - BURNING
N - NUMBNESS
S - STABBING
T - TINGLING
P - PINS & NEEDLES
Post Procedure Pain
x
Patient Signature: Jostfullt
Witness:
Date: 18/05/16
Kyle Jackson DOB: 01/12/02 (51 yo M) Acc No. 95842 Doc Name: 22/04/21 Inj
Page 69 of 134
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711475190.29112 | Daniel Alvarado |
<<Back to Review>>194126-2 HYPERLINK- Hyperlink-Page
306
KAISER PERMANENTE庐
Daniel Alvarado
MRN: 110624062862, dob: 1993/25/11, Sex:
F
SSN: xxx-xx-3624
Date of Visit: 2022/10/03
2015/04/01 - 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
ENCOUNTER DATE: 2021/07/01
Creation Time: 1/3/2008 9:52 AM
Status: Signed
Editor: Lattupally, Shirisha (P.T.) (THERAPIST, PHYSICAL)
PT visits: 7/8.
DATE OF INJURY: 2022/03/05
Left knee contusion.
Generated on 4/12/22 10:33 AM
000306
0305
| what is the DOB or date of birth? | {"text": ["1993/25/11"], "answer_start": [125]} |
id_1711472285.268725 | Tiffany Brown |
7609521074
16:08:03
11-09-2017
4/6
STATE OF CALIFORNIA
DOCTOR'S FIRST REPORT OF OCCUPATIONAL INJURY OR ILLNESS
PATIENT NAME (first name, middle initial, last name)
Sex
57. Date of
Mo. Day
Yr.
Age
Tiffany Brown
Birth 25
Address:
8549 No. and Street SUC Box City Vidoroille Zip CA 92345
19. Telephone number
10. Occupation (Specific job title)
Social Security Number
Diseuse
Teacher guiste
526-23-7241
13 Date and hour of injury
MaDal
05/17/07
4. Date last worked
Mo. Day Yr.
Occupation
or onset of illness
a.m.
p.m.
Oct, 13, 2017
15. Date and hour of first
Mo. Day Yr.
Hour
Return Date/Code
examination or treatment
24/14/10 if Others
a.m.
p.m.
treated patient?
Doctor's Signature
/ JV Jonethan Luna, PA
CA License Number A044696 / PA17660
Doctor Name and Degree (please type) Roger A. Moushabek, M.D.
IRS Number 10/16/17
Address 12408 Hesperia Road
Suite # 25
Victorville
CA
92395
Telephone Number 760-952-1222
01/09/2018
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711476766.193832 | Eric Cook |
Bethesda Hospital West
2815 S. Seacrest Blvd
9655 Boynton Beach Blvd
Boynton Beach, FL 33xxx
Boynton Beach, FL 33xxx
Patient Name: Brandon Adams
MR#: 111786856
DOB: Dec 24, 1989
Account#: 2521037564
Date of Admission: Apr 29, 2020
Sex: F
Attending Physician: 79356
Facility: BMH
Ordering Physician: 79356
Collection Date and Time: Feb 23, 2018 12:05
Service Date: Jan 30, 2022 12:05
eBlood Bank
TEST NAME
RESULT
UNITS
RANGES
ABN FL ST
ANTIBODY SCREEN
NEG
F
NEG
Page 1 of 1
| what is the admit date or admission date? | {"text": ["Apr 29, 2020"], "answer_start": [240]} |
id_1711475190.356416 | Cory Ball |
<<Back to Review>>194126-3-HYPERLINK- - Hyperlink-Page
187
Cory Ball
KAISER PERMANENTE庐
MRN: 110594059859, Date of Birth: 31/08/96, Sex:
F
SSN: xxx-xx-3594
Visit: 08/05/14
15/05/19 - Scheduled Telephone Encounter in CCM-DIABETES (continued)
Clinical Notes (continued)
3) Further blood sugars needed to assess effect of insulin
next visit evaluate changing INSULIN REGIMEN SQ
P
LIFESTYLE/EDUCATION :
Reviewed rule of 15 for treatment of low blood sugar.
If bedtime blood sugar below 110 take snack of 15 grams carbohydrate Such as 1/2 sandwich and take
insulin as ordered . Call Mary Hallum if occurring 2 or more times in 2 weeks .
blood sugar above 100 before driving exercising or above 110 before sleeping.
ELECTRONICALLY SIGNED BY Hallum, Mary C. (R.N.) at 12/04/17 10:11 PM
Generated on 4/6/22 11:06 AM
000187
0186
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475741.015675 | Edward Long |
Edward Long DOB: 08 Mar 1992 (30 yo M) Acc No. CR201012
[Doc Name: 12 Feb 2023 MRI LUMBAR SPINE]
CR201012
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: Edward Long
PATIENT ID:
3110776
REFERRING PHYSICIAN: AMY WU, PA-C
DOB:
08 Mar 1992
REFERRING PHONE:
DOS:
26 Sep 2018
REFERRING FAX:
EXAMINATION: MRI LUMBAR SPINE WITHOUT CONTRAST
CLINICAL HISTORY: Slip and fall 15 Sep 2022, 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.
28 May 2018-Hn Cores
ceviow
@
Page 1 of 2
Edward Long DOB: 08 Mar 1992 (30 yo M) Acc No. CR201012
Page 87 of 166
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711471328.661066 | Donna Davis | Fax Server
20/23/05 9:51:00 AM PAGE 9/010 Fax Server
General Medical Center
Date: 20/23/05
Dr Brian Reid, MD
4827 Pierce River
North Amanda, OR 26214
Beneficiary Name: Donna Davis
dob: 24/03/05
Beneficiary Phone Number: 576-859-7058
Sponsor Name: Beth Davis
Sponsor SSN: xxx-xx-1512
Plan Type: Prime Eligible
Reference Number: 92060510067
Requesting Provider: Dr Brian Reid, MD
Requesting Provider NPI: 1343192490
Dear Dr Brian Reid, MD:
General Medical Center is the Managed Care Support Contractor (MCSC) for the
Department of Defense's health care program, General Medical Center, in your region. We thank you for your
continued service to our General Medical Center beneficiaries.
We received your request for service(s) for the above General Medical Center beneficiary.
Reason for Request: Outpatient Authorization Request
Servicing Provider Name: Dr Brian Reid, MD
Specialty Type: Urology
Servicing Provider Address: 4827 Pierce River
North Amanda, OR 26214
Servicing Provider Phone: 357-436-7268
Service Type
Frequency
Surgical Care
57288* - 57288 10/19/04 - 12/14/2010 1 Visit or Unit(s)
Donna Davis-KPJayaraman-00009
| what is the DOB or date of birth? | {"text": ["24/03/05"], "answer_start": [197]} |
id_1711471330.675456 | 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 Procedure Date? | {"text": [], "answer_start": []} |
id_1711473530.853094 | John Morgan |
<<Back to Review>>180298-26-HYPERLINK-Hyperlink-Page
213
Work Wellness
16/12/2016
1801 Colorado Ave Ste 130 Turlock, CA 95382
Page 6
(209) 216-3333 Fax: (209) 216-3330
Office Visit
Edward Foster
Home: (209) 499-3172
Male DATE OF BIRTH: 21/01/1990
28790
ELECTRONICALLY SIGNED BY Jennifer S Wong DO on 08/12/2021 at 10:37 AM
000213
0213
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711475190.322313 | Samantha Vasquez |
KAISER PERMANENTE庐
Samantha Vasquez
MRN: 110384038838, BIRTH DATE: 1989-07-20, Sex:
F
SSN: xxx-xx-3384
date of visit: 2016-02-22
2023-12-15 - Telephone in ADULT AND FAMILY MEDICINE (continued)
Clinical Notes (continued)
Status: Signed
Editor: Clark, Juliana Elizabeth (M.A.) (MEDICAL ASSISTANT)
signature Clark, Juliana Elizabeth (M.A.) at 2015-10-14 9:44 AM
Telephone Encounter by Clark, Juliana Elizabeth (M.A.) at 1/13/2011 0944
Version 1 of 1
Author: Clark, Juliana Elizabeth (M.A.)
Service: -
Author Type: MEDICAL ASSISTANT
Filed: 1/13/2011 9:44 AM
encounter date: 2022-02-13
Creation Time: 1/13/2011 9:44 AM
Status: Signed
Editor: Clark, Juliana Elizabeth (M.A.) (MEDICAL ASSISTANT)
Generated on 4/12/22 10:33 AM
000564
0563
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475955.667073 | Curtis Santos |
Cause No. 80033214857
Curtis Santos
搂
IN THE DISTRICT COURT OF
搂
搂
vs.
搂
TARRANT COUNTY, TEXAS
DOLLAR GENERAL CORPORATION,
DOLGENCORP OF TEXAS, INC.
搂
352ND JUDICIAL DISTRICT
AFFIDAVIT
RECORDS PERTAINING TO: Curtis Santos
DATE OF SERVICE: 2019 May 20 to present
BEFORE
ME,
the
undersigned
authority
personally
appeared
Spencer Derrick
who, being by me duly sworn, deposed as follows:
the record was made at or near the time of the act, event or condition recorded or reasonably soon thereafter.
1. Total amount of medical or health care expenses from your office billed for CLEMIS J. JAMISON
for 2019 May 20 to present $ 8,260.00
2. Total amount of medical or health care expenses that Curtis Santos has actually paid for
2019 May 20 to present which equals $
0
The records attached copies of the microfiche on which
the image of the original documents have been transferred and nothing has been removed from the original file before
making these copies.
THE RECORDS ATTACHED HERETO ARE TRUE, CORRECT AND COMPLETE. FURTHER AFFIANT
SAITH NOT
Spencer arrick
Sherrie L. Galvan
SIGNATURE OF NOTARY PUBLIC IN AND FOR THE STATE OF TX
My Commission expires
2022 February 12
Order No. 98863.44
FLAUG
Sherrie L Galvan
My Commission Expires
9/28/2028
Notary ID
140828189
| what is the DOB or date of birth? | {"text": [], "answer_start": []} |
id_1711475190.116215 | James Lara |
Novant Health Mothershed Foot James Lara
N
NOVANT
& Ankle Specialist
MRN: 52924297, DOB: 1987 Apr 27, Sex: M
HEALTH
429 Pineview Drive Ste 290
visiting date: 2016 Jan 20
KERNERSVILLE NC 27294-
3817
2023 Nov 18 - Office Visit in Novant Health Mothershed Foot & Ankle Specialist (Kernersville) (continued)
Clinical Notes Amb (continued)
Electronically Signed by Robb A Mothershed, DPM at 2016 May 09 1292
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 operation? | {"text": [], "answer_start": []} |
id_1711476990.556123 | 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 Date of Discharge? | {"text": [], "answer_start": []} |
id_1711476766.895326 | Mrs. Sandra Terry |
Johnson, Karen Female 09-23-1962
LONJETH
INTERVENTIONAL PAIN CENTERS
Clayton Adams, MD, APMC
4226 Teuton St, Metairie LA 70026
Tel: 504xxxx Fax: 504xxxxx
PROGRESS NOTE
Patient First Name:
Patient Last Name:
Date of Birth:
Sex:
Karen
Johnson
1993-28-11
Female
Attending Provider:
Referring Provider:
Visit Date:
Chart No.:
Eric Lonseth MD
Nicolas Pappas
2019-22-06
SCL 11344
Reason For Visit: NPE
Chief Complaint: Neck Pain
History of Present Illness
Neck Pain In addition, Ms. Johnson has right shoulder pain and low back pain.
Denies fever or malaise.
Denies Covid-19.
Onset of symptoms following a motor vehicle accident on 5/4/2022. Johnson underwent one CESI with reduction in neck pain by 50% for one month. She underwent disectomy
and anterior cervical fusion C4-7 with Dr. Jeffrey Pinto on 12/29/2022. Ms. Johnson reports moderate reduction
in neck pain following the ACDF and continued symptoms of right cervical radiculopathy.
Ms. Johnson denies prior history of neck pain. She was involved in one fender bender a number of years ago
for which she denies neck pain.
Primary pain is that of a constant stabbing, aching neck pain that radiates into the right shoulder and down the
right arm and into the hand and all 5 fingers of the right hand.
She has frontal headaches since the 5/4/2022 MVA which she did not experience previously.
(Page 1)
| what is the visit date or date of visit? | {"text": ["2019-22-06"], "answer_start": [400]} |
id_1711471330.821117 | Melissa Alvarez |
PATIENT Melissa Alvarez Rm/Bed MR 66806662405 Pt # 120506373
Attending Adm Date BIRTHDATE 12 January 2002 Sex F
Consult Note 03 November 2017 17:39
Dictated By: Dr David Decker, MD
date of admit: 09 October 2014
Discharge Day: 08 November 2014
Sunnydale General
PATIENT: Melissa Alvarez BIRTHDATE: 12 January 2002
MRN: 1266127 ACCTN: 122708799
ADM DATE: 09 October 2014 SEX: F
ROOM: 8437 01
Consultation Date: 03 November 2017
REASON FOR CONSULTATION: Dr Carl Hughes Scott asked me to see the patient
because of unexplained acute renal failure.
HISTORY OF PRESENT ILLNESS: Ms. Hinson is a 50-year-old female who was admitted to the Northern Surry Hospital
on 3/16/2010 with a creatinine of 2.2.
She was diagnosed with diabetes about 2 years ago.
She said her hemoglobin A1c had been 6 prior to her presentation.
PAST MEDICAL HISTORY:
1. Diabetes mellitus for 2 years.
2. History of hypertension.
Facility SYSA, Prod - Forsyth Med Ctr Page 1 of 3 out COPY Mid 90's Sherry Hinson-NeA-MD-000003
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711473366.06221 | Brian Richardson |
athena
10/30/2023 1:33:13 pm EDT
Page: 48/86
Brian Richardson (id #13446342, DOB: 30 May 2001)
Encounter Summary for Brian Richardson
Encounter Details
Date
Type
Department
Care Team
Description
29 June 2021 Emergency
Discharge Disposition: 01
10:35 AM
Baptist Clay Emergency
DISCHARGED TO HOME
EDT -
OR SELF CARE
29 June 2021
1771 Baptist Clay Drive
3:44 PM
EDT
FLEMING ISLAND, FL
32343-8341
Demographics
Sex:
Female
Ethnicity:
Not Hispanic or Latino
DOB:
30 May 2001
Race:
White
Preferred
Information not available
Marital status:
Married | what is the DOB or date of birth? | {"text": ["30 May 2001"], "answer_start": [92]} |
id_1711476767.586301 | Patrick Mccormick |
21/03/14 08:36
1
12
unknown
P 8/38
Kathy Cook
Coastal Neurology
Page:
7
610 Trenia Ann I
725 W Granada Blvd. Ste 22
Date: 21/03/14
Orange City
FL
32763
Time:
Ormond Beach, FI 32174
7:50 AM
Patient: Patient ID is equal to 23638
Date: Service date of the Charge:
14/06/23
CPT:
Description:
Charge
Primary
Primary
Secndry
Non Primary
Pt
Account
Amount
Pmnt
Adj
Pmnt
Adj
Pmnt
Balance
20551
Injection(s); single tendon
$350.00
$0.00
$0.00
$0.00
$0.00
$0.00
$350.00
20553
Injection(s): single or multiple
$380.00
$0.00
$0.00
$0.00
$0.00
$0.00
$380.00
Total Outstanding Balance for Date of Service:
$1,270.00
Date: Service date of the Charge:
17/10/03
CPT:
Description:
Charge
Primary
Primary
Secndry
Non Primary
Pt
Account
Amount
Pmnt
Adj
Pmnt
Adj
Pmnt
Balance
20553
Injection(s): single or multiple
$380.00
$0.00
$0.00
$0.00
$0.00
$0.00
$380.00
Total Outstanding Balance for Date of Service:
$920.00
Date: Service date of the Charge:
10/24/2023
CPT:
Description:
Charge
Primary
Primary
Secndry
Non Primary
Pt
Account
Amount
Pmnt
Adj
Pmnt
Adj
Pmnt
Balance
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711471330.704641 | Nicholas Pena |
Maple Grove Clinic
830 Shane Mall Suite 056
Port George, SC 26470
Phone: 959-532-9824 Fax: 288-943-2118
Transcription
PATIENT:
Nicholas Pena
Service ID #: 59536353054
Referral Q ID:
DATE OF BIRTH:
03/05/1987 Age: 55
date of injury: 11/11/2018
Service Date: 24/09/2017
Dictated By: Dr Mr. Kyle Montgomery, MD
Diagnosis: Hemorrhoids
Notes:
PHYSICIAN PROGRESS REPORT
EMPLOYER: Joseph J Albanese Inc
date of injury: 11/11/2018
Dear Claims Examiner:
I personally reviewed the patient's Past Medical, Family, and Social
History as reported on the initial visit, and it remains unchanged other
than the exceptions otherwise noted.
OBJECTIVE FINDINGS:
General Appearance: The patient is examined, in no apparent distress. He
is alert and oriented x3. He is well-developed and well-nourished male
appearing his stated age.
Examination of the Lumbosacral Spine:
Dictated By: Dr Mr. Kyle Montgomery, MD
Dictated On: 7/23/2020 3:36 PM
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711476990.556129 | 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 Collection Date? | {"text": [], "answer_start": []} |
id_1711476578.310547 | Laura Reynolds |
UNIVERSITY OF MIAMI
UMHC
Owens, Shannon
HEALTH
HOSPITAL AND CLINICS
1475 NW 12th Avenue Suite
MRN: 50770250, DOB: 1997 Oct 01, Sex: F
3050
Enc. Date: 2023 Oct 10
Miami FL 50136-1050
05/05/2023 - Office Visit in UHealth at UMHC Sylvester Spine Institute (continued)
Clinical Notes (continued)
Miami, FL 33136
Fax: 305-250-6505
Electronically signed by Dr Chase Armstrong, MD at 2014 Oct 27 12:51 PM
Eismont, Frank J., MD at 5/5/2023 1530
Author: Eismont, Frank J., MD
Service: -
Author Type: Physician
Filed: 5/5/2023 5:43 PM
Encounter Date: 2023 Oct 10
Creation Time: 5/5/2023 4:40 PM
Status: Signed
Editor: Dr Chase Armstrong, MD (Physician)
Electronically signed by Dr Chase Armstrong, MD at 5:43 PM
USER, SCANNING at 5/9/2023 0301
Author: USER, SCANNING
Service:
Author Type: Resource
Filed 5/8/2023 11:01 PM
Encounter Date: 2023 Oct 10
Creation Time 2021 Aug 14 11:01 PM
Status: Signed
Editor: Onbase, Scanning
Generated on 2021 Aug 14 4:18 PM
Page 50
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711476766.896265 | Emily Arias |
Johnson, Karen Female 09-23-1962
LONJETH
INTERVENTIONAL PAIN CENTERS
Michael Mccullough, MD, APMC
4277 Teuton St, Metairie LA 70077
Tel: 504xxxx Fax: 504xxxxx
PROGRESS NOTE
Patient First Name:
Patient Last Name:
Date of Birth:
Sex:
Karen
Johnson
95/10/02
Female
Attending Provider:
Referring Provider:
Visit Date:
Chart No.:
Eric Lonseth MD
Nicolas Pappas
18/04/12
SCL 11344
Reason For Visit: NPE
Chief Complaint: Neck Pain
History of Present Illness
Neck Pain In addition, Ms. Johnson has right shoulder pain and low back pain.
Denies fever or malaise.
Denies Covid-19.
Onset of symptoms following a motor vehicle accident on 5/4/2022. Johnson underwent one CESI with reduction in neck pain by 50% for one month. She underwent disectomy
and anterior cervical fusion C4-7 with Dr. Jeffrey Pinto on 12/29/2022. Ms. Johnson reports moderate reduction
in neck pain following the ACDF and continued symptoms of right cervical radiculopathy.
Ms. Johnson denies prior history of neck pain. She was involved in one fender bender a number of years ago
for which she denies neck pain.
Primary pain is that of a constant stabbing, aching neck pain that radiates into the right shoulder and down the
right arm and into the hand and all 5 fingers of the right hand.
She has frontal headaches since the 5/4/2022 MVA which she did not experience previously.
(Page 1)
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711475444.262057 | David Morris |
17/04/28 FROM- CWFMD
936-703-5455
IMPORTANT: PLEASE PRESENT THIS SLIP AT YOUR APPOINTMENT
Women's Imaging Center
CONROE REGIONAL MEDICAL CENTER
Patient:
Erica Pirie
D.O.B.: 93/07/13
& SCREENING BILATERAL MAMMOGRAM (Asymptomatic Patient with or without implants)
Diagnostic Bilateral Mammogram (Symptomatic, Olinical Findings with or without Implants)
Spot Compression
Stateotacitio Core Bx
*Galactogram
Ultrasound of the Breast(a)
Patient Diagnosis:
CHANGE
maxine
and Discretion
design
CONROE
13057
QUEST
Signature
REGIONAL MEDICAL CENTER
May 100
Yesya
GIN
ST
508 Medical Ctr Slvd. (2nd 1001 behind elevators)
Conton, Texas 77304
TOTAL
It 17318
(336) 589-7522 to schadule an appointment
1-882-MED-CNTR 1-382-693-2847METRO # 21-564-7000 ext 7100 (030) 530-7100. Fax (938) 839-7622
us May
BCDG-12 NEV. 08/07)
This term must be dated and will be valid for six (6) months.
June family no
from HI
Physician Signatura:
Date: 22/05/13
condide
ACCOUNT INFOICAL CENTER
Love
promit
0102-11-90
LOOS BEL
JASON LANINGHAM, M.D.
804 West Montgomery
Name: David Morris
DOB: 93/07/13
| what is the DOB or date of birth? | {"text": ["93/07/13"], "answer_start": [192]} |
id_1711471329.712764 | Ryan Young |
Page: 2 Surgical Case Record
PATIENT NAME: BP00046620 Ryan Young
birthdate: 21-09-2001
Account No: BP33768395003
Age: 50
Physician: Dr Sophia Williams MD
Evaluation Date:29-06-2017
Sex: F
Specialty: ORS-Orthopaedic Surgery Room-Bed/T.Loc:
O.R.: POR04-OPERATING ROOM #4
Date of Operation, Operation Date, Oper Date: 01-04-2014
Maplewood Medical Center
Primary Procedure: LEFT KNEE MANIPULATION
Case Close/ Run Date: 13-07-2019
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
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: Ryan Young MRN:BP00043554 Encounter:BP0001107108 Page 2 of 29 73797-42 Maplewood Medical Center -00046
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711477182.964645 | Regina Yates |
LOUISIANA PAIN
SPECIALISTS
PAIN DIAGNOSIS & INTISIVENTIONSXPE)
Kenner 231 West Esplanade Avenue, Suite B, Kenner, LA 70038
LABORATORY RESULT
PATIENT DEMOGRAPHICS
GUARANTOR & INSURANCE INFORMATION
Patient: Catherine English
Insurance:VA CCN OPTUM
DOB: 30-07-1992 Age: 38 year Sex: Male
Guarantor: Catherine English
Address: 4191 1ST AVE Bay Saint Louis MS 39538
Phone:
LAB VENDOR DETAILS
ORDERING DETAILS
Lab Name: LPS Lab
Ordering Physician Name: Suneil Jolly MD
Address: 3434 Houma Blvd Suite 301 Metairie LA 70386 -
Order#: LAB003992 Order Date: 01-03-2016
0000
Result Date: 25-06-2021
Sr.No.
Test Name
Result
Unit
Min-Max
Abn-Type
Urine Drug Screen
1
Panel
2
Methamphetamine
neg
| What is Ordered Date? | {"text": ["01-03-2016"], "answer_start": [588]} |
id_1711477090.41772 | Kenneth Turner |
CASA COLINA HOSPITAL AND CENTERS FOR HEALTHCARE . USE OF ELECTRONICS AND SYSTEM AGREEMENT
As an authorized user with access to Case Colina Hospital and Centers for Healthcare's (hereafter referred to as CCH) electronic equipment, including
but not limited to PCs, laptops, te ephones and tablets, your use of an assigned user name and password is the legal equivalent to your signature. The
equipment, software and data are the property of CCH and are only to be used for tasks directly associated with your job. Any use of CCH computers or
computer systems (hereafter referred to es computers) represents your signed authorization and acknowledgement of the conditions set forth below:
Use of CCH computers may, based on your job duties and responsibilities, allow access to confidential information concerning to patients, residents,
their families or significant others, and CCH business.
Your obligation to maintain onfidentiality under this Agreement continues after your employment/relationship with CCH ends.
Keep all food, liquids and magnets away from electronic equipment; avoid extreme heat or moisture.
For Users of the Electronic Health Record (EHR):
This badge is required to your job and it is your responsibility to bring it with you each day.
Repeated instances of a lost, forgotten or missing badge will be subject to disciplinary action.
Never allow another person to use your badge and/or bar code.
Never attempt to use another person's badge and/or bar code.
The placement of pens, stickers, etc., on your badge that cover up your face, name or bar code is prohibited.
Always log off when leaving your work area. The EHR-MAK system records activity based on your user login. Logging off or
locking the computer will help avoid the possibility of other people gaining access to the EHR and recording information under
your user login.
E.J. Initials
I
have read, understand and agree to abide by the above statements:
Steven Buck
Sex:
Male / Female (please circle)
Name (print):
Signature:
Elm
Date:
13/05/17
Department
Ext:
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711477090.557131 | Patricia Anderson |
newhope
chiropracltic
Acknowledgement of receipt of notice of privacy practices, consent for purposes of treatment,
payment and healthcare operations
I
acknowledge that I was provided a copy of the notice of privacy practices and that I have read them, or
declined the opportunity to read them, and understand that notice of privacy practices. I understand that this
form will be placed in my patient chart and maintained for six years
Patent records: Patient records, including X-rays, are the property of New Hope Chiropractic. These records are
only released with your written permission or as required legally. Some forms may have a fee. We request a
minimum of 24 hours notice for forms and letter to be completed by the provider.
Financial matters: Payment is due at the time services are provided unless prior arrangements have been made.
All charges will be explained to you prior to any service being performed.
Medicare: The office will accept assignment for Medicare. Patients are responsible for their copayment and
payment for any services not covered by Medicare.
Personal Injury: In most cases, this office will accept assignment for payment. If the office accepts assignment
for payment the patient is still legally responsible for their account balance. Patients will be required to sign a
lien in the case of personal injuries
Workers' Compensation: Work-related injury cases are accepted on assignments with permission of the
employer and prior authorization from the employer's compensation insurance carrier.
Massage Cancellations: In an effort to accommodate all patients, we ask that all patients keep their scheduled
appointments or proceed us with 24 hours notice (1 business day). Our office has a $25 administrative fee for
those who miss their massage appointments without advance notice. This policy helps to ensure that we can
accommodate you when in medical need.
I have read the above statements and accept these conditions.
Print name: James Powell
Signature:
Gerorth
Date:
2017-26-08
Dr Anne Moore Chiropractic Physician
Address. 4775 S. Florida Ave. Lakeland, FI 33875 Phone. 863.752.1750
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475741.1041 | Rachel Howard |
Rachel Howard DOB: 89/11/11 (18 yo M) Acc No. CR644538
[Doc Name: Medical Records-Cora Health-18/11/30-7195407
24/03/24 a.m. 16/09/09
CoraPhysicalTherapy
General Evaluation
CORA Physical Therapy - Regency
CORA
9527 Regency Square Blvd., Unit 105
Jacksonville, FL 18983741044
Name: Rachel Howard
FOR WORK COMP ONLY
SYS6445323
DOB: 89/11/11
Case Manager:
Onset Date: 19/06/07
Surgery Date:
Eval Date: 15/02/12
Occupation:
Employer:
Ref Provider: Amy Wu APRN
Sex: M
Medical Dx: M79672 - Pain in left foot, M7542 - Impingement syndrome of left
Status:
shoulder, M5126 - Other intervertebral disc displacement, lumbar region
Last Day:
Treatment Dx:
Cur PDC:
JobReq PDC:
SUBJECTIVE
History/Symptoms: Patient is a 51 y/o. L hand dominant, male, who
PMH/Meds: Patient reports other health problems as BMI over 30.
OBJECTIVE
Patient has not had therapy for the same condition.
Pain Rating: Current- 6/10 Worst- 8/10
Dominant Arm:
Left
Function
AROM
PROM
Strength
indicates with pain)
(* indicates with pain)
Cervical flex
46 deg*
Cervical ext
60 deg*
23 deg*
Ankle DF
20 deg
-8 deg**
Rachel Howard DOB: 89/11/11 (18 yo M) Acc No. CR644538
Page 110 of 166
| what is the DOB or date of birth? | {"text": ["89/11/11"], "answer_start": [23]} |
id_1711476892.866387 | Jo Colon |
l'have not violated Labor Code 13. s and the contents of the report and bill are true and correct to the best of my
knowledge. Signed this date, Solano County, California.
11.00
DATE:
T 97.1 P 72 R 12 B/P 165/78
CURRENT MEDS:
See lied list
1/:10 in WT162 HT 56 Last Tetanus:
ALLERGIES/ADVERSE REACTIONS
Patient Instruction:
Acceptable level:
Pain: Yes pain No Ley 18
MEDICATIONS: NEDA
Learner:
Patient:
Pain is the primary reason for this visit
LATEX: to
Family:
26 yo Male c/o fugist area pair at
Teaching Method:
Verbal Presentation:
R) Leg Injured by slipping happened
Demonstration:
Written Materials:
is days ago u. Day puts)
Medication:
-
Medications dispensed:
2130pm RDJUOQ 60ms PM toradol MSaympe
OCCUPATIONAL HEALTH
Provider: Dr.kitchens
Date of Service:
2021 Aug 17
Time: 10:11
1101 B Gale Wilson Blvd. Suite 203, Fairfield, CA 94533 (707) 646-4600
Patient:
DOB: 2001 Aug 28
Initial Visit
Employed
DOI: 2017 Aug 25
165
2022 Jun 30
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711473237.37272 | Amy Sims |
39
FAX
MRN: 1940366H
Amy Sims
Nassau Unly. Medical
Gender: Female
Center
Age: 49y (02-12-1995)
Current Location:
Surg-Pediatric Eye Clinic
AMB OPHTH New Patient Ophthalmology Visit [Charted Location: Surg-Pediatric Eye
Clinic [DATE OF SERVICE: 03-25-2016 8:20, Authored: 07-Apr-22 10:53]- for Visit:
7742879X4204042031,
Notice of Status and Rights Involuntary Admission:
Patient's Name: Amy Sims
MRN: 1942742H
Sex: Female
BIRTH DATE: 02-12-1995
Facility Name: Nassau University Medical Center
Date of Admit: 04-16-2018 10:31
Date & Time: 10-08-2018 11:01
Allergies:
Allergy, Intolerance, Adverse Event:
Allergies:
No Known Allergies: Active
HPI:
Ophthalmology HPI:
Chief Complaint
Left ruptured globe
Page 1 of 6
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711471329.335953 | Kent Smith |
62442406851
23:25:38 a.m.
04-13-202
3/3
Rosewood General
2018 Jun 11
9424 Samantha Flat
Davidmouth, AL 88368
Page 3
358-810-3115 Fax: 489-914-6770
Office Visit
Kent Smith
Work: (870) 972-8931
Female DOB: 1995 Sep 19
150364
Ins: Blue Advantage Grp: 62442406851
:
ASSESSMENT: Right trimalleolar ankle fracture.
PLAN: The risks versus benefits of operative versus non-operative treatment were discussed with the
patient and her husband, They agree to proceed with surgery.
ABB/bcc
0829
signature
Dr Ariel May MD on
2016 Jul 08 at 1220
PARHAM-0127
000039
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711475741.279162 | Melvin Martin |
The Gables Surgical Center
Melvin Martin
DOS: 2018 Apr 28 7:00:00 AM
ID /Visit: 117744/
PATIENT INFO:
SEX: M
DOB: 1996 Jul 21
AGE: 29
SSN: xxx-xx-xxxx
DRIVERS LICENSE:
OCCUPATION:
PH:
RESPONSIBLE PARTY:
Melvin Martin
19254 NW 67 Place Miami Lakes, FL 33015
RSP SSN: xxx-xx-xxxx
RSP OCC:
PRIMARY INSURANCE:
SECONDARY INSURANCE:
Edersy Suarez Law Office LOP Melvin Martin
14160 Palmetto Frontage Road. Suite #21
HIALEAH, FL 33016
POLICY: 42484446680
GROUP: Atty: Edersy Suarez
I
CERTIFY THAT I HAVE READ THE FOREGOING AND THAT I AM THE PATIENT, PARENT, LEGAL GUARDIAN OR AM DULY AUTHORIZED BY THE
PATIENT AS THE PATIENT'S GENERAL AGENT TO EXECUTE THE ABOVE AND ACCEPT ITS TERMS.
I
UNDERSTAND AND AGREE THAT, AT THE TIME THE PATIENT HAS MET THE GABLES SURGICAL CENTER'S MEDICAL CRITERIA TO LEAVE THE
FACILITY,
1
WILL HAVE A RESPONSIBLE ADULT PRESENT TO TAKE ME/PATIENT HOME. I RELEASE THE GABLES SURGICAL CENTER FROM ANY
RESPONSIBINITY EVENTS IN VIOLATION OF THIS AGREEMENT
June
2018 Apr 21
06:21
Signed
Witness
Date
Time
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711475741.208208 | Alexander Smith |
Alexander Smith DOB: 09/1987/05 (42 yo M) Acc No. CR152660
[Doc Name: Ortho One Recs - DOS 08/2018/10-323054]
Alexander Smith
Visit Note - 08/2022/06
PMS ID:
Sex:
DOB:
Phone:
MRN:
52660PAT32345077146 Male 09/1987/05 (xxx) xxx-xxxx MM0000007835
Musculoskeletal, and Neurological
presentation and mechanism of injury. Contusions can be expected to remain the same in some cases, but
and was notable for joint pains, joint
enlargement in the setting of symptoms such as progressive neurologic dysfunction is an indication for urgent
stiffness, and unsteady gait.
Loss, And No Redness.
Contact office if: the patient experiences increasing pain or swelling, numbness or tingling in the affected
extremity, or an enlarging mass.
Patient to cont. PT
I discussed the following medical options with the patient:
Acetaminophen : Acetaminophen is a drug that is commonly used as a pain reliever. The maximum daily dose is
4 grams.
After counseling, we decided on the following plan: Conservative Management, Observation, and Physical
Therapy
Follow up in 4 weeks. Other Instructions: follow up
Staff:
Fady Bahri (Primary Provider) (Bill Under)
Electronically Signed By: Fady Bahri, 06/2019/11 03:20 PM EDT
Fady Bahri (Primary Provider) (Bill Under)
Southside
Page 2
(904) 619-3048 Work
6100 Kennerly Road Suite 202
Jacksonville, FL 32216-4979
Alexander Smith DOB: 09/1987/05 (42 yo M) Acc No. CR152660
Page 166 of 166
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711476893.231098 | Ashley Tran |
Pacific
Pain Management Compliance Testing
Toxicology
Laboratories
actox
Laboratory Report
Donald Simpson MD. PhD . Medical Director
9348 De Soto Avenue Chatsworth.
California DPH CLF4442
31560
Patient Name: Alejandra Pittman
Patient ID: 643-75-8032
INTEGRATED PAIN CARE-RICHMOND
Age, DOB: 27,23 November 1999
LAB ID: B2069649
ATTN: Raymond Jackson
Sex: M
Collected: 10 September 2022
3160 GARRITY WAY
Other ID:
Received: 11 April 2017
RICHMOND, CA 94806
Requesting Physician: Dr Angela Taylor
Reported: 11 April 2017
Requisition#: 7352932
Drug(s) Screened For: PACPAIN PANEL #9621832
Medication(s) Prescribed: TRAMADOL,CYCLOBENZAPRINE
Normalized
Drug
Test Result
Value
Result
Comment
TRAMADOL
NOT DETECTED
Test result is not expected with prescribed medications.
Specimen Validity Testing
Normal Range
Result
Comment
CREATININE URINE
>19 mg/dL
186.2
Normal
SPECIFIC GRAVITY, URINE
>1 0030
1.0279
Normal
NITRITES. URINE
<200 ug/mL
26
Normal
pH. URINE
4.5-9 0
5.5
Normal
632
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711476990.03481 | Taylor Hobbs |
Pacific Pain
Institute
Visit Note - Follow-up Visit
Provider:
Supervising: Ryan Andrews, M.D.
Performing: Dylan Hanson, PA-C
Encounter Date: 2016-30-01
Patient: Mejia, Florentino (PT00001958)
Gender: Male DOB: 2003-23-01 Age: 28 year 2 month
Race: Other
Address: 1678 Travion #t #1, Fairfield CA 94533
Injury Date: 2015-27-12
Employer: Chevys Fresh Mex
Case Insurance: Gallagher Bassett 14278
Complaint:
Mr. Florentino is a 28 year old male here today for a follow up visit. He sustained injury at work
on Dec. 6, 2011. He is having pain in back and right leg pain. His current pain level is a 8 on the
1-10 pain scale. His pain is constant and he describes it to be a aching, dull, sharp and shooting
pain. His pain radiates up his neck and down his right leg. He is also experiencing numbness,
pins/needles in right leg and weakness in right leg due to the pain. Any prolong sitting, walking
and bending worsens his pain. To relieve the pain he takes medication and uses ice packs.
Patient reports some nausea and dizziness to his medications. Patient states his current pain level
is without any medications.
Current Medication:
1 Cyclobenzaprine 7.5 Mg Tablet SIG: Take 1 tab at bedtime
2 Medrox SIG: Apply to affected area 2-3 everyday
3 Pantoprazole 20 Mg Tablet Dr SIG: Take 1 tab daily everyday
ROS:
Neurologic: (+) numbness, (+) tingling.(+) right lower extremity weakness.
Examination:
Patient: Taylor Hobbs DOB: 2003-23-01 Visit: 2020-06-03 Page: 78
678
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711477090.749401 | Francisco Walker |
Perception
no hallucinations or delusions during interview
Orientation
oriented
Memory / Concentration
short term intact,long term intact
Insight / Judgement
good
Diagnosis
Diagnosis
WHODAS /
Diagnosis
Reviewed
Inactive
Resolved
Code
Description
Type
Primary
GAF / CGAF Status
Date
Date
Date
Date
F31.81
Bipolar II Disorder
Active
03 Mar 2017
JabaraMayer
Service Date: 07 Dec 2020 12:00:00 PM
Released:
03 Mar 2017 9:28:06 PM
This document was printed from PIMSY EMR System It contains protected health information (PHI).
DOS: 12 Apr 2016 12:00:00 PM
Shauna Becker (B-C-14860)
B-C-14860-60557
03 Mar 2017
Date Of Birth
25 Oct 2003
Gender:
Female
CLIENTNUMBER B-C-14849
Page 3 of 49
| what is the DOB or date of birth? | {"text": ["25 Oct 2003"], "answer_start": [699]} |
id_1711473239.031302 | Paul Lynch |
RE2132527
MRI Patient History and Questionnaire
Patient Name JUSTIN GARIBALDI
CIS323332
D.O.B 02-05-1993
Patient 256
The following list consists of items that can interfere with MR Imaging, or if present, can be hazardous to
your safety.
Pacemaker/ Defibrillator
Yes
No
Cardiac Stent
Yes
No
Brand and ID#
List ALL Surgeries
0
Please remove all jewelry and hairpins prior to going into MRI suite for exam
I have completed this questionnaire and answered all questions to the best of my knowledge.
01-11-2023
Patient Signature
Date
Patient% Representative
Date
Kelly
Signature Babing
01-11-2023
Technologist's
Date | What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711471330.591061 | Chase Ramirez |
Prairie Hill Hospital
Chase Ramirez
MRN: 33773659, BIRTH DATE: September 29, 1984, Sex: M
713 Alicia Overpass
Lake Maryhaven, PR 37172
Visit Day: August 04, 2021
Result Summary (continued)
Documents - Encounter Level on August 30, 2020: (continued)
Dr Edwin White, MD
Phone: 666-989-8406
713 Alicia Overpass
Lake Maryhaven, PR 37172
Please sign and return this page only by fax or mail.
Plan of Care Approval for Chase Ramirez
Thank you for this referral.
Dean Harm is a good candidate for continued physical therapy services. Patient has been compliant to
home exercise program.
Respectfully yours,
Therapist Signature:
Jesus Gordon, PT, DPT PT60388818
April 22, 2022 9:13 pm
Plan of Care Approval
Total Visit Count: 5
Approval of the plan of care as documented
Changes to Plan of Care:
Hold therapy service until patient follows up at physician office.
Physician Signature:
Dr Edwin White, MD
Approval Date:
January 10, 2019
Progress Evaluation for Chase Ramirez
Page 6
BIRTH DATE: September 29, 1984
| what is the visit date or date of visit? | {"text": ["August 04, 2021"], "answer_start": [154]} |
id_1711475955.798269 | Jessica Hansen |
08-11-2020 14:58 FROM- CWFMD
T-274 P0002/0013 F-256
02-11-2018
Jessica Hansen
COMPANION DX REFERENCE LAB-HAWAII, LLC
CompanionD,
THE QUEEN'S MEDICAL CENTER
FAX 808,691,5017
1301 PUNCHBOWL ST.
CLIA ID # 12D2066057
KINAU 405
HONOLULU, HI 96813
GENERAL MEDICINE PERSONAL PHARMACOGENOMICS EVALUATION TEST REPORT
Created On: Thursday, 02-11-2018
PATIENT AND ORDER INFORMATION
PATIENT
Jessica Hansen
ORDER 10
DATE OF BIRTH
01-16-1999
SAMPLE TYPE
Buccal Swab
AGE
42
COLLECTION DATE
02-17-2022
GENDER
Female
RECEIVED DATE
02-11-2018
STATED ETHNICITY
Caucasian
PRACTICE
GHPMA-PLL-WILLIS
PATIENT to
10000004410
PHYSICIAN
CONSIDER MONITORING FOR MALAISE, ORAL CANDIDIASIS,
ARTHRALGIA, SINUSITIS/SINUS INFECTION; MINOR DOSE
ADJUSTMENT (DECREASE) MAY BE NECESSARY
FLEXERIL
DDI
RISK OF INCREASED LEVELS AND CLINICAL EFFECTS FROM
2/11
Name: Jessica Hansen
DOB: 01-16-1999
Date:
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711471330.675475 | 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 Collection Date? | {"text": [], "answer_start": []} |
id_1711475741.072657 | 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 the DOB or date of birth? | {"text": ["February 16, 1997"], "answer_start": [25]} |
id_1711472787.23977 | Jessica Montgomery |
visit: 10 Sep 2022
Page 2 of 3
Name:Jessica Montgomery
date of birth:01 Feb 1997
Vitals - PULM
Recorded: 22 Sep 2017
1:50PM
Systolic
111
Physical Exam
Constitutional: no acute distress
Cardiac: normal s1, s2
Procedure
EXAM: 79238383 - CT CHEST - ORDERED BY: DENA M DAGLIAN
date of procedure 01 Aug 2015
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.
380 Community Drive " Manhasset, NY, 13801Tel (386) 385-5383 Fax (538) 385-5383
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711473366.091279 | Lisa Williams |
athena
10/30/2023 1:33:13 pm EDT
Page: 55/86
Lisa Williams (id #16346392, dob: 06/2001/18)
Baptist Health
Health Information Management Dept
Lisa Williams
3563 Philips Highway Building B. Suite 201
MRN: 56354630 dob: 06/2001/18, Sex: F
Jacksonville FL 32207-5663
Acct #: 24001074438
Adm: 03/2021/08 D/C: 04/2021/07
07/15/2023 - ED in Baptist Clay Emergency (continued)
Medical Decision Making:
75-year-old female with seizure today.
EKG:
DATE OF ENCOUNTER: 12/2020/15
Confirmed by Arcement, Adam (912) on
Radiology:
head we IV contrast.
Final Result
CT HEAD WITHOUT IV CONTRAST
Date of Exam: 05/2015/23 6:3 AM CD
Printed on 7/27/23 at 8:20 AM
Release ID: 28635632
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475190.54192 | Mr. Kyle Grant |
Mr. Kyle Grant
MRN: 5512513
Preferred Pharmacy (continued)
Referral (continued)
Order
MRI ARTH SHOULDER W/ CONTRAST RIGHT [676335615]
electronically signed by: Dennis S Frerichs, PA-C on 2020-06-13 0519
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 2019-11-12
Screening Form
General Information
patient name: Mr. Kyle Grant
MRN: 5512513
DOB: 1997-03-16
Mobile: 551-951-4519
Sex Assigned at Birth: Male
MC ROCKWOOD MAIN CLINIC Mr. Kyle Grant
- SPOKANE
MRN: 5602313, DOB: 1997-03-16, Sex: M
400 East 5th Ave
visiting date: 2016-11-02
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_1711477275.309991 | David Mcgee |
C-REACTIVE PROTEIN 09/22/2022
(#5428529, Final, 09/21/2022 3:19pm)
Ordering Provider
JOHN MASCIALE, MD
Performing
CLINICAL PATHOLOGY LABORATORIES - MAIN LAB (BLOOD NOT DRAWN AT THIS LOCATION)
Lab
VISIT CPLLABS.COM FOR LOCATION NEAREST YOU
AUSTIN TX 787xx
Specimen/Accession
WH830980
Specimen
ID
Source
Specimen Coll. Date
29 April 2014 15:51
Result
Final
Status
Specimen Rec. Date
14 June 2015 19:46
Report
Status
Specimen Reported
09 November 2021 04:47
Date
SEDIMENTATION RATE 09/22/2022 (#5428529, Final, 09/21/2022 3:19pm)
Ordering Provider
JOHN MASCIALE MD
Performing
Lab
CLINICAL PATHOLOGY LABORATORIES - MAIN LAB
AUSTIN TX 787xx
Specimen/Accession
WH8309xx
Specimen
ID
Source
Specimen Coll. Date
29 April 2014 15:51
Result
Final
Status
Specimen Rec. Date
09 November 2021 19:46
Report
Status
Specimen Reported
09 November 2021 04:03
Date
Report
76729-3
South Texas Bone & Joint - 00029
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475189.907263 | Johnny Williams |
PATIENT: Johnny Williams
Medical Record Number:
713-83-13; PNS-11342138
dob: 2001-11-01 AGE: 68 years
SEX: Male
Financial Number: 51371134
Problem List
Problem Name: BMI 33.0-33.9,adult
Life Cycle Date: 8/7/2020
Life Cycle Status: Active
Last Updated: 8/7/2020
Classification: Medical; Code: 253848011; Confirmation: Confirmed; Onset Date: : Course: ; Persistence: : Prognosis:
General Diagnostic
Accession
Exam Date/Time
Procedure
Ordering Provider
Status
DX-13-0132135
2019-07-25 1:10 CST Thoracic Spine
Wells PA, Brandon
Auth (Verified)
AP/Lat
12/1/2022 10:43 CST
by: Tellez . Stephanie
Rawlins 013613
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711476990.782974 | David Stewart |
Tampa Bay
Pulmonary
Medicine, P.A.
Ashley Flores, M.D., F.A.C.P., F.C.C.P
Felicia Reed, M.D., F.C.C.P.
402 Noland Drive
Brandon, FL 33511xxxxx
Ph: 813-xxxxxxx Fax: xxxxxxx
SWANN, USA
DOB: 1989/25/04
DOS: 2014/15/09
SPIROMETRY TEST RESULTS:
Spirometry reveals a reduction in FVC at 59% or 1.85L and FEV1 at 63% or 1.55L No bronchodilator
response is noted.
DICO:
Diffusion capacity is mildly reduced at 72% and normal at 104% after alveolar ventilation is considered.
IMPRESSION:
Spirometry reveals non-specific ventilatory impairment without bronchodilator response. Flow volume
loop suggests a restrictive impairment. DLCO is normal after correction for alveolar volume.
Thank you for allowing me to assist with the care of this patient.
Sincerely yours,
Dr Angela Garcia M.D., F.A.C.P., F.C.C.P.
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711477183.354673 | Andrea Whitaker |
SCIF RECD DTE 16-04-15 VLSCAN 56 21-07-21 11:15 AM 332040 13 040
Pain & Rehabilitative
CONSULTANTS MEDICAL GROUP
NEW PATIENT EVALUATION
BABAK J JAMASBI, MD, FACPM
Board Certified Pain Medicine& Anesthesiology
RE: Anthony Dozier
CL#: 40655040
BRENDAN MORLEY, MD, FACPM
Board Certified Pain Medicine& Anesthesiology,
DOI: 19-04-24
EMPLOYER: Cal Fire
TIMOTHY LO, MD, MPH
Board Certified in Neurology, Pain Medicine, Medical
INSURANCE: State Compensation Insurance Fund
Acupuncture, QME, Electrodiagnostic Medicine
DATE OF SERVICE: 15-03-01
ARZHANG ZERESHKI, MD
Board Certified in Pain Medicine, Physical Medicine &
Rehabilitation, QME
HISTORY OF INJURY
NEIL KAMDAR, MD
Board Certified Pain Medicine& Anesthesiology
This patient reports that he was a fire captain/paramedic for Cal
Fire. His primary job is as a paramedic, it sounds as though
FILIP CHENG, DO
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711477090.174017 | William Skinner |
PVHC at Pomona - Primary Care
1770 North Orange Grove Avenue, Suite 101
Pomona, CA 91761-
Patient:
William Skinner
MRN:
000267361
Date of Service: 2020 August 12
FIN:
561854761
Provider:
Dr. Jasmine Morse, Mohamed Yehia
DOB/Age/Gender: 1999 May 25 42 years
Female
Abdelwahed
Women's Health.
Nuchal Cord Tension: Tight
Nuchal Cord Intervention: Reduced prior to delivery
Infant Data
Gender: Female
Neonate Outcome: Live birth
Security Tag Number: 594
Birth Weight: 3.591 kg
Apgar Score 1 Minute: 7
Apgar Score 5 Minute: 9
Pediatrician: Tommy Suarez
Note: Items documented with :- had no clinical data which qualified at time of report creation
END OF REPORT
Clinics - Offsite
***
Clinical Documentation Content on Following Page
***
Report Request ID: 61364061
Page 28 of 161
Print Date/Time: 2023 April 06 10:12 PDT
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711473530.751782 | Jordan Singh |
TOWER PHYSICAL THERAPY, INC.
Private Insurances: Any insurance that does not pertain to a work injury.
Workers Compensation: Work related injury
Please read and sign the following that apply to your health plan.
PRIVATE INSURANCE/MEDI-CARE Any insurance that does not pertain to a work injury.
If you are not aware of your physical therapy benefits, please let us know and we will acquire
them for you, otherwise we will assume you are aware of your benefits.
Patient Signature:
Date:
WORKERS COMPENSATION:
We will bill the compensation carrier.
Patient
Signature: Ed Foster
Date: 2021-16-03
000083
0083
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711476578.450683 | Eric Taylor |
BRAVE HEALTH INC . 1952 NW 7th Avenue, Suite 300, MIAMI FL 35236-1152
OWENS, Shannon (id #92952, dob: 22/10/86)
Return to Office
Patient will return to the office as needed.
Encounter Sign-Off
Encounter signed-off by Courtney Hale, Anthony Reeves, 08/05/19
Encounter performed and documented by Courtney Hale, Anthony Reeves
Encounter reviewed & signed by Courtney Hale, Anthony Reeves on 08/05/19 at 7:7pm
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711475190.360804 | Ashley Flores |
<<Back to Review>>194126-3-HYPERLINK- - Hyperlink-Page
187
Ashley Flores
KAISER PERMANENTE庐
MRN: 110554055855, BIRTHDATE: 1995 July 03, Sex:
F
SSN: xxx-xx-3554
Visit Day: 2020 April 03
2017 October 25 - Scheduled Telephone Encounter in CCM-DIABETES (continued)
Clinical Notes (continued)
3) Further blood sugars needed to assess effect of insulin
next visit evaluate changing INSULIN REGIMEN SQ
P
LIFESTYLE/EDUCATION :
Reviewed rule of 15 for treatment of low blood sugar.
If bedtime blood sugar below 110 take snack of 15 grams carbohydrate Such as 1/2 sandwich and take
insulin as ordered . Call Mary Hallum if occurring 2 or more times in 2 weeks .
blood sugar above 100 before driving exercising or above 110 before sleeping.
electronically signed by Hallum, Mary C. (R.N.) at 2022 January 01 9:41 PM
Generated on 4/6/22 11:06 AM
000187
0186
| what is the visit date or date of visit? | {"text": ["2020 April 03"], "answer_start": [188]} |
id_1711477090.840864 | Kayla Williams |
2020 March 20 19:59:15 EDT
To: 19537226837
Page: 05/637
From: Lauris Rigdon
Fax: 3374937237
Signatures
Treating Provider Signature
Initiated by Maria Stalder, PT, DPT on 2015 March 08 14:56 EDT. License #: 049147
Electronically co-signed by Mary Smith, PT on 2017 July 23 16:01 EDT. License #: 024378
Patient Shauna Becker (DOB: 1999 May 29)
Treated by Maria Stalder, PT, DPT (License #379137)
DOS: 2024 March 06
Page 4 of 37 of Plan of Care
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711473237.455906 | Brandy Young |
NORTHWELL HEALTH
LONG ISLAND JEWISH MEDICAL CENTER
256-05 56th AVENUE, NEW HYDE PARK, NEW YORK, 11560 (556) 456-7560
patient name: Brandy Young
DATE OF OPERATION, OPERATION DATE, OPER DATE: July 27, 2019
MEDICAL RECORD #: 000020679641
ENCOUNTER #: 184900201001
SURGEON: I. RAND RODGERS LJ056127
Date of Birth: December 14, 1984
OPERATIVE REPORT
PREOPERATIVE DIAGNOSIS: Blind phthisical left globe following trauma.
OPERATIONS: Left globe enucleation with insertion of 20 mm Medpor spherical implant
and left lateral tarsorrhaphy.
POSTOPERATIVE DIAGNOSIS: Blind phthisical left globe following trauma.
ANESTHESIA: General endotracheal, local 1% Xylocaine with epinephrine mixed 1:1 with
0.5% Marcaine with epinephrine.
INDICATIONS: This patient sustained significant left ocular trauma as one of many injuries
she recently sustained.
PROCEDURE: With the patient supine on the operating table, the appropriate monitoring
devices applied and intravenous line started, antibiotics administered, and a general
endotracheal anesthetic satisfactorily administered.
Page 1 of 2
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711475190.115279 | Gerald Hubbard |
Novant Health Mothershed Foot Gerald Hubbard
N
NOVANT
& Ankle Specialist
MRN: 52424247, DOB: 1996 Jan 05, Sex: M
HEALTH
424 Pineview Drive Ste 240
Visiting Date: 2020 Apr 15
KERNERSVILLE NC 27244-
3817
2015 Oct 06 - Office Visit in Novant Health Mothershed Foot & Ankle Specialist (Kernersville) (continued)
Clinical Notes Amb (continued)
signature Robb A Mothershed, DPM at 2019 Sep 21 1242
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 signature date or signed on date? | {"text": ["2019 Sep 21"], "answer_start": [400]} |
id_1711475444.319943 | Richard Wagner |
2020 Sep 01 FROM- CWFMD
936-703-5455
T-256 P0034/0111 F-240
TOPICAL PAIN FOCUSED
Richie's
Toll Free Phone
SPECIALTY PHARMACY
Toll Free Fax
Patient's Name:
Richard Wagner
Prescriber's Name:
JOSHUA DUBOSE
Street Address:
14570 TRERO LANE
Street Address:
804 W MONTGOMERY
City, State ZIP:
WILLIS TX 77378
City, State ZIP:
WILLIS TX 77378
BIRTHDATE:
2003 Nov 20
Office #:
936.890.8000
Phone #:
xxx.yyy.zzzz
Fax #: zzz.zzz.zzzz
Additional Contact #:
Patient Allergies:
PRESCRIBER'S SIGNATURE: X
DATE:
2014 Jun 19
Commonly Requested Medications: (CMRD references a Medication Compounded by Pharmacy, TC
references a Topical Cream, CA references a Commercially Available Medication)
1.
CMPD Diclofenac Sodium 0.15% Lid贸caine 2.25% Prilocaine 2.25%TC (1740)
Directions: (Directions selected below apply to all medications indicated above - please check desired dosing)
Apply 4 grams three to four times daily for treatment of pain - DISPENSE #480 (FOUR-HUNDRED-
EIGHTY) GRAMS FOR 30 DAY SUPPLY (PAINNORM)
OTHER
I authorize pharmacy to dispense any of the checked medications below. In fleu of medication checked above, If
desired by the patient for any reason
CMPD Flurbiprofen 10%, Cyclobenzaprine 1% in LAM* (1667) DISPENSE #120 GRAMS - Apply 2 to 4
grams three to four times daily for treatment of pain (PAINDLP)
Refills: (Number of refills indicated here refers to all medications prescribed above and below)
1 Year
5
3
1
Zero
Name: Richard Wagner
DOB: 2003 Nov 20
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711472590.888992 | Jerome Willis |
Dr Lori Warner, MD
Thibadaux - 726 North Acadia Road
orthoLA
Laplace - 465 Belle Terre Boulevard
Raceland - 141 Twin Oaks Drive
Houma - 180 Corporate Drive
Orthopaedic Sports Medicine,
Joint and Hand Specialists
CONSENT FOR
THERAPY CARE AND TREATMENT
I, the undersigned, do herby agree and give my consent for ortho LA to provide physical
therapy and or occupational therapy care and treatment considered necessary in treating
my physical condition.
Patient
Printed Name: Jerome Willis
Nadine Buggage
30 April 2014
Signature of Patient/Guardiah
Date
CONSENT FOR TREATMENT OF A MINOR: As a parent and/or legal guardian, I
authorize Ortho-LA to treat the minor patient named in the attached forms.
Signature of Patient/Guardian
Date
Post Office Box 28 Thibodaux LA 70302//Tel:858-397-9775//Fax:543-237-4655//www.ortho-la.com
| What is signature date or signed on date? | {"text": ["30 April 2014"], "answer_start": [537]} |
id_1711476578.569045 | Laurie Gilmore |
INBOUND NOTIFICATION FAX RECEIVED SUCCESSFULLY
TIME RECEIVED
REMOTE CSID
DURATION
PAGES
STATUS
08/17/09 at 3:41:29 PM EDT
SVMC
Received
SVMC
25/16/05 12:37:28 PM
PAGE
6/006
Fax Server
Corona, Araceli
558 Abbott St Ste A
MRN: 311xxx, DOB: 29/01/08, Sex: F
DOCTORS
Visit date: 14/18/02
ON DUTY
Phone: 831xxx
MONTH
HIM ROI Letters Report
Psychiatric:
Mood and Affect: Mood normal.
Behavior: Behavior normal.
Assessment/Plan
Acute medial meniscal tear, left, subsequent encounter
Ambulatory referral to Orthopaedic Surgery; Future
Cyst of medial meniscus, left
Ambulatory referral to Orthopaedic Surgery; Future
Left knee pain, unspecified chronicity
Primary Treating Physician: Dr Sharon Walsh,Latoya Jones, MD
Date of Exam: 31/17/07
CA License :
53592xxxxxx
Specialty:
Urgent Care/Occ Med
Address:
17xx NORTH MAIN ST
Telephone:
Phone: 831xxxxxx
SALINAS CA 9390xxxx
Dept: 831xxxx
Dept Fax: 831xxxx
Signature: Electronically signed by Latoya Jones, MD
Date: 14/24/03
END OF REPORT
Generated on 25/16/05 12:34 PM
Page 15
115
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711476766.367607 | Michele Dean |
Bethesda Pathology Report
Bethesda
Hospital East
Pathology
Name:
Michael Santana
Specimen #: SE-5803-36
Age:
45 Y
Medical Record 136786836
# :
DOB:
12/01/1998
Patient # :
2523637736
Sex:
F
Specimen
09/11/2015
Received:
Locat AMBULATORY CARE
Report Date:
11/06/2014
ion:
Procedure 07/08/2020
Signed
KENNETH
Date:
Out By:
BENGTSON, M.D.
Physician (s) : Sarah Davis, MD
FINAL REPORT
History/Diagnosis: HYPERTROPHY OF NASAL TURBINATES, DEVIATED
NASAL SEPTUM
Operation Performed: SEPTOPLASTY, SUBMUCOSAL, RESECTION OF THE
INFERIOR TURBINATE
Specimen:
1. CARTILAGE, NASAL SEPTUM
KLB/SGJ 09/11/2015
Microscopic Description :
Microscopic slides examined on all non gross only specimens.
DIAGNOSIS:
NASAL SEPTUM CARTILAGE:
-FRAGMENTS OF BENIGN BONE
CHANGES
<Sign Out Dr. Signature>
KENNETH BENGTSON, M.D.
05/11/2018 at 13:12
**End of Report
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711475190.387036 | Stacy Anderson |
NOVANT
Novant Health Urology
Stacy Anderson
N
2100 Baldwin Lane
MRN: 51024107, Date of Birth: 07-08-1995, Sex: M
HEALTH
Winston-Salem NC 21003-5106
date of visit: 12-02-2021
09-11-2021 - Office Visit in Novant Health Urology - Baldwin (continued)
Clinical Notes Amb (continued)
or family expresses understanding and all questions and concerns were answered. The patient is in agreement with
the plan as stated above.
signature Victor M Pereira, PA-C at 21-10-2021 0104
Labs
Urinalysis
Resulted: 02/23/23 0107, Result status: Final result
Order status: Completed
Filed by: Lainey Younts 02/23/23 0837
Collected by: 18-11-2022 0102
Resulting lab: NH UROLOGY - BALDWIN
Acknowledged by: Victor M Pereira, PA-C on 02/23/23 1233
Testing Performed By
All Reviewers List
Victor M Pereira, PA-C on 2/23/2023 12:33 PM
Generated on 4/11/23 8:32 PM
Page 46
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711475190.38876 | Brian Figueroa |
NOVANT
Novant Health Urology
Brian Figueroa
N
2610 Baldwin Lane
MRN: 56124617, D.O.B: 22/03/95, Sex: M
HEALTH
Winston-Salem NC 26103-5616
Visit: 20/01/20
29/03/18 - Office Visit in Novant Health Urology - Baldwin (continued)
Clinical Notes Amb (continued)
or family expresses understanding and all questions and concerns were answered. The patient is in agreement with
the plan as stated above.
ELECTRONICALLY SIGNED BY Victor M Pereira, PA-C at 27/08/18 0614
Labs
Urinalysis
Resulted: 02/23/23 0617, Result status: Final result
Order status: Completed
Filed by: Lainey Younts 02/23/23 0837
Collected by: 09/03/21 0612
Resulting lab: NH UROLOGY - BALDWIN
Acknowledged by: Victor M Pereira, PA-C on 02/23/23 1233
Testing Performed By
All Reviewers List
Victor M Pereira, PA-C on 2/23/2023 12:33 PM
Generated on 4/11/23 8:32 PM
Page 46
| what is the DOB or date of birth? | {"text": ["22/03/95"], "answer_start": [99]} |
id_1711473365.430264 | Todd Bowman |
X-RAY BREAK DOWN FORM
Modesto Radiology Imaging
1524 McHenry Ave, Suite 100
Modesto, CA 95350
Phone: 472-790-1095
Fax: 366-714-4982
ATTENTION:
Firm:
EQUICOPY
Telephone: 858-358-5850
Patient: EDWARD FOSTER
Order Number: 185898-37
Date: 10-26-22
Jacket/Medical Record #: 76-58-02/325825
PLEASE NOTE!!!
service date
Exam
Number of Films
Aug 20, 2014
CT RT ANKLE
7-16
Films: $15.00 per sheet
Cds: $25.00 per CD (can copy multiple exams on CD)
0002
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711477090.586716 | Michael Olson |
17-08-24 04:45 PM TO:16103548946 FROM:8333674959
Page: 59
36
ORTHO AND SPINE
PRE- & POST-OPERATIVE INSTRUCTIONS
PREPARED FOR: Norma Marquez MD
Pre-Op Appointment: 3/22/2023
Surgery Date/Time: 00 18-02-17 t 4/24/2023
Incision Check: NA
JIAM
2-Week Post Op: 4-21-23 t 5-5-2023 9AM
8-Week Post Op: 6-14-2023 9AM
OFFICE - 360 ORTHO AND SPINE
11809 N DALE MABRY HWY, TAMPA, FL 33618
SURGERY CENTER - CENTER FOR ADVANCED SURGICAL SPECIALISTS (CASS)
11XXX N. DALE MABRY HWY, TAMPA, FL 336XX
Please call (833) 367XXXXX
with any questions
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711475956.022324 | Brandon Martin |
2023-10-09 10:15AM
No. 0020 P. 23.
From +1.843.839.3608
Mon 28 Feb 2022 03:42:27 PM EST
Page 1 of 2
OrthoSO
235 Singleton Rigde Road
Conway, SC 29572
OrthoSC
Phone: (843)234-2094
Fax: (843)347-4375
Patient Name:
Brandon Martin
Accession Number:
G220228121501003
Patient ID:
43351800A
Location:
COA-CO
Gender:
Female
Referring Physician:
ALCI, ERKAN
Date of Birth:
1984-06-03
Date of Service:
2015-01-08 12:02
Procedure Description:
MRI CERVICAL SPINE WITHOUT
Home Phone:
CONTRAST
Report Status:
Final
Professionally Interpreted by Carolina Radiology
Reporting MD: DERRICK, RUSSELL
Dictation Time: February 28,2022 15:34
EXAM:
MAIL CERVICAL SPINE WITHOUT CONTRAST
CLINICAL DATA:
PT C/O CERVICAL PAIN WITH BILATERAL UPPER EXTREMITY NUMBNESS,
TINGLING, AND WEAKNESS. PT STS NO KNOWN INJURY.
Carolina Radiology
Report exported on Mon, 2023-10-09 15:41:04 -0500 - Page 1 of 2
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711475189.937746 | Christopher Jordan |
NOVANT
Novant Health North Point
Christopher Jordan
N
Medical Associates
MRN: 52924297, BIRTH DATE: 84/11/18, Sex: M
HEALTH
1295 Bethabara Road
visiting date: 19/12/18
Winston-Salem NC 27296-3295
23/12/20 - Office Visit in Novant Health North Point Medical Associates (continued)
Clinical Notes Amb
Progress Notes
Dr Andrew Kim, MD at 4/7/2023 1934
Author: Dr Andrew Kim, MD
Service:
Author Type: Physician
Filed: 04/07/23 1954
DATE OF ENCOUNTER: 17/01/21
Status: Signed
Editor: Dr Andrew Kim, MD (Physician)
PLAN:
Patient Instructions
Apply ice as needed over the swollen tender area.
Follow up if symptoms worsen or fail to improve.
Generated on 4/11/23 8:32 PM
Page 4
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711476578.512372 | Colton Odonnell |
Patient: Amanda Schultz DOB:1986-02-11
Amanda Schultz DOB: 1986-02-11 (46 yo F) Acc No. 7588xx
YM
AKUMIN
Akumin Pembroke Pines
Phone: (954) 566xxx
10950 Pines Blvd
Fax: (954) 430xxx
Pembroke Pines, FL 330xx
Website: akumin.com
Thank you for referring your patient to Akumin Pembroke Pines
Dr Dominique Robinson, M.D
Electronically Signed: 2020-02-16
Exam requested by: JAIME ARANGO CIFUENTES MD
BIRADS: BI-RADS 2
The information contained in this facsimile message is privileged and confidential information intended only for the use of the individual or entity named as recipient. If
the reader is not the intended recipient, be hereby notified that any dissemination, distribution or copy of this communication is strictly prohibited.
Thank you!
Printed 2014-08-04 310 PM
Amanda Schultz (Exam: 2015-12-20 1:15 PM)
Page 69 of 69
Amanda Schultz DOB: Nov 17, 1976 (46 yo F) Acc No. 7588xx
Page 169 of 169
Document: 2014-08-04 Records
Printed: 2014-08-04 12:22:11
Page 169 of 169
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711477183.515858 | Andrea Elliott |
Quantum Pain and Orthopedics
Tel:
Fax:
QUANTUM
Email: Info@QuantumPainOrtho.com
PAIN AND ORTHOPEDICS
www.QuantumPainOrtho.com
SymptomDescription.
1.
Where is your pain?
5
Is your pain:
Sharp
Dull
Burning
Pulling
Shooting
Aching
Throbbing
Stabbing
Do you have associated symptoms of:
Numbness
Tingling
Cramping
Decreased sensation
Weakness or clumsiness
Other Type of Pain (Describe):
13. Using the pain scale (0-10), best describe the level of your pain at its worst:
5
14. Using the pain scale (0-10), best describe the level of your pain at its least:
FRONT
BACK
Use the diagram to show where you have your pain. Mark the area with
an (X) that best describes your pain location:
14/41
R
L
R
Ariel Wells
Ariel Wells
28/09/2019
Patient/Guardian'Signature
Print Name
Date
from
QPO20180530
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711473530.780202 | Rachel Perkins |
<<Back to Review>>180298-33-HYPERLINK Hyperlink-Page
23
TRI VALLEY ORTHOPEDIC . 4626 Willow Road, PLEASANTON CA 94458-8454
Rachel Perkins (id #345145, birth date: 10/2000/14)
List each specific requested medical services, good, or items in the below space or indicate the specific page numper(s)
of the attached medical report on which the requested treatment can be found. Up to five (5) procedures may be entered:
Diagnosis (Required)
ICD-Code (Required)
1. Closed bimalleolar fracture - Right
S82.841P: Displaced bimalleolar fracture of right lower leg, subsequent
encounter for closed fracture with malunion
Service/Good Requested (required)
Right ankle ultra guidance cortisone injection
Requesting Physician Signature:signature: SEAN DOUGHERTY, DPM
Date:04/2017/20
Sean Dougherty DPM
000023
0023
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711476892.862748 | Erica Erickson |
l'have not violated Labor Code 13. s and the contents of the report and bill are true and correct to the best of my
knowledge. Signed this date, Solano County, California.
11.00
DATE:
T 97.1 P 72 R 12 B/P 135/78
CURRENT MEDS:
See lied list
1/:52 in WT162 HT 56 Last Tetanus:
ALLERGIES/ADVERSE REACTIONS
Patient Instruction:
Acceptable level:
Pain: Yes pain No Ley 18
MEDICATIONS: NEDA
Learner:
Patient:
Pain is the primary reason for this visit
LATEX: to
Family:
26 yo Male c/o fugist area pair at
Teaching Method:
Verbal Presentation:
R) Leg Injured by slipping happened
Demonstration:
Written Materials:
is days ago u. Day puts)
Medication:
-
Medications dispensed:
2130pm RDJUOQ 60ms PM toradol MSaympe
OCCUPATIONAL HEALTH
Provider: Dr.kitchens
Date of Service:
19 Oct 2023
Time: 10:11
1101 B Gale Wilson Blvd. Suite 203, Fairfield, CA 94533 (707) 646-4600
Patient:
DOB: 16 Jan 1999
Initial Visit
Employed
DOI: 17 Mar 2016
135
31 Aug 2017
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711477275.579145 | James Reed |
CT, LUMBAR SPINE, W/ CONTRAST (#54463xx, 11/15/04 12:00am)
Patient Portfolio
Page 1 of 2
MCKESSON
Patient Name: Paige Jacobs
DOB: 07/97/02
Empowering Healthcare
ID: MV00480852
Study Date: 25-Sept-2022 14:50
Final Report
CT SPINE LUMBAR W CONT
CHRISTUS Health System
SST - SPOHN HOSPITAL SOUTH
5950 Saratoga Blvd.
Corpus Christi, Tx 78414
RADIOLOGY REPORT
Signed
Patient: Paige Jacobs
DOB: 07/97/02 F 69
Account #: AV0001604xxx
Med Rec #: MV00480xxx
Patient Location: AV.ED/
Procedure: SPINE LUMBAR DE CONT CPT:721xx
Requisition #: 22-0238552
REPORT #: 0925-0652
Date of Exam: 12/15/03
Time of Exam: 1353
HISTORY: post op wound to lumbar, pain, discharge
COMPARISON None.
TECHNIQUE: CT lumbar spine with intravenous contrast. A CT
dosimetry report is saved to PACS. CT scanner utilized a dose
reduction technique.
FINDINGS:
Electronically signed by: Ryan Hanisch MD 19/23/02 3:53 PM CDT
Workstation: RPCCWRS130P6
Dictated By: HANISCH, RYAN J MD
Date Dictated: 19/23/02 1553
Signed By: HANISCH, RYAN J MD
Date Signed: 19/23/02 1542
CC: LILJEBI ; MARIA L AYARZAGOITIA, FNP
Admitting MD:
76729-3
South Texas Bone & Joint - 00452 | What is the Date of Exam or Examination date? | {"text": ["12/15/03"], "answer_start": [628]} |
id_1711476766.897386 | Patricia Pacheco |
Johnson, Karen Female 09-23-1962
LONJETH
INTERVENTIONAL PAIN CENTERS
Andrea Williams, MD, APMC
4278 Teuton St, Metairie LA 70078
Tel: 504xxxx Fax: 504xxxxx
PROGRESS NOTE
Patient First Name:
Patient Last Name:
Date of Birth:
Sex:
Karen
Johnson
1995-05-06
Female
Attending Provider:
Referring Provider:
Visit Date:
Chart No.:
Eric Lonseth MD
Nicolas Pappas
2022-02-09
SCL 11344
Reason For Visit: NPE
Chief Complaint: Neck Pain
History of Present Illness
Neck Pain In addition, Ms. Johnson has right shoulder pain and low back pain.
Denies fever or malaise.
Denies Covid-19.
Onset of symptoms following a motor vehicle accident on 5/4/2022. Johnson underwent one CESI with reduction in neck pain by 50% for one month. She underwent disectomy
and anterior cervical fusion C4-7 with Dr. Jeffrey Pinto on 12/29/2022. Ms. Johnson reports moderate reduction
in neck pain following the ACDF and continued symptoms of right cervical radiculopathy.
Ms. Johnson denies prior history of neck pain. She was involved in one fender bender a number of years ago
for which she denies neck pain.
Primary pain is that of a constant stabbing, aching neck pain that radiates into the right shoulder and down the
right arm and into the hand and all 5 fingers of the right hand.
She has frontal headaches since the 5/4/2022 MVA which she did not experience previously.
(Page 1)
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711475741.240208 | Mrs. Sylvia Wong |
7
Nombre de La Entidad: The Gables Surgical Center (ENTIDAD)
RECONOCIMIENTO DE RECIBO DEL AVISO DE PRIVACIDAD
Yo reconozco que he recibido el documento adjunto Aviso de Privacidad.
07/12/2023
Paciente lo Representante Personal
Fecha
Firma
ID / Visit: 117744 /4 DOS: 28/03/2022
Mrs. Sylvia Wong
Sex: M
DOB: 25/11/1988
Age: 46
Phys: Jacobson, Robert
Nombre de Paciente
Si la firma del representante personal aparece arriba, por favor describa la relaci贸n del
representante personal del paciente:
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711472786.617077 | Timothy Howard |
LFIM
LAUGHLIN, FALBO
Anaheim
LEVY
& MORESI
714 385 6400
LLP
Concord
925 464 4649
Fresno
San Bernardino Office
564 464 4640
Mailing Address
One Capitol Mall, Suite 400
Los Angeles
864 664 8640
October 9, 2023
Facsimile: 964 864 2364
www.lflm.com
DEFENDANT'S ADVOCACY
Redding
564 264 6468
PANEL QUALIFIED MEDICAL EXAMINATION LETTER
Sacramento
964 464 6645
San Diego
664 233 9648
Dr Nathan Salas PhD, M.D.
Re:
Elizabeth Jarero V. Casa Colina Hospital and Centers for Healthcare and Beta Healthcare
Group
WCAB Case No.: ADJ18297326
LFLM No: 864-264449
Date of exam: 21/04/19 @ 11:30 a.m. (telehealth)
Dear Dr. Cervantes:
You have been selected as a Qualified Medical Evaluator in psychiatry.
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711477275.547641 | Susan Cervantes |
Patient Portfolio
Page 2 of 64
Ordering Dr: Jill Fritz
Patient Status: REG ER
Attending Dr:
Admit Service Date: Mar 23, 2018
Signed by: Hanisch, Ryan J Signed on: Aug 03, 2017 15:58
http://spohnpacshrsd.christushealth.org/WPP/ShowReport.asp
Jan 13, 2015
76764-3
South Texas Bone & Joint - 00464
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711476990.169397 | Lisa French |
08/30/2014 1:01:14 PM -0400 COVENTRY HEALTH CARE
COVENTRY
PO Box 580
Workers COUR
Hazelwood, MO 63080
MD Rezi, Toufan
San Leandro, CA 94577xxxxx
06/19/08
MD Timothy Ellis
2480 Merced Street
San Leandro, CA 94877xxxx
Patient: Florentino Majia
Date of Injury: 21/22/09
Claim Number: 002408-001868-WC-80
Request for Authorization Received Date . 14/18/02
Date Lack of Information Letter sent
Reference Number. 10771080
NOTIFICATION OF AUTHORIZATION
Outcome of Requested Treatment:
Requested Service
Functional Restoration Program,BOhoure,Inillal
Description
Trial,97789x60
Approved Service
Functional Restoration Program,80hours,infliat
Description
Trial,97788x80
Approved Quantity
1-Physical Therapy
Decision Date
06/27/2014
Date of Service
11/21/02-11/21/02
on rbehal/-ofGALLAGHER-BASSETT) the requested treatment referenced above has been reviewed by Coventry Workers' Comp
Services, and has been determined to be medically necessary.
If you have any questions about payment, please contact the claim administrator,Jose Villasenorat(800)297-0886
If you have any questions about this review, please contact Cheisea Ambray at Coventry Workers' Comp Services, at (866) 264-
4113 ext.
Sincerely,
Cheisea Ambray
Utilization Review Nurse
00:
Florenlino Mejia
Law Offices of Hodsin & Mullin
Jose Villasenor
1154
| what is the DOB or date of birth? | {"text": [], "answer_start": []} |
id_1711473238.015099 | James Fisher |
<<Back To Review>>180298-16-HYPER LINK - Page
178
Legal Copy
SGMF-PRIMARY CARE
James Fisher
Sutter Health
95355-4276
MRN: 53484928, BIRTHDATE: 2002-08-24, Sex: M
Single Notes
DATE OF VISIT: 2016-12-14
Notes (continued)
Patient Instructions by Dr Brittany Stephenson MD at 12/30/16 1528
Author: Dr Brittany Stephenson MD
Service: -
Author Type: Physician
Filed: 12/30/16 1528
encounter date: 2019-05-12
Status: Signed
Editor: Dr Brittany Stephenson MD (Physician)
Electronically signed by Dr Brittany Stephenson MD at 2019-02-20 1528
Notes
Progress Notes by Kobrine, Steven E, MD at 2023-04-11 1523
Printed by [S275222] at 10/28/21 11:27 AM
00178
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711472591.028685 | Edwin Ali |
Gulf Coast Surgical Center LLC
Edwin Ali
DOS: 2016/22/05 2:30:00 PM
ID / Visit: 48390 / 1
PATIENT INFO:
SEX: F
dob: 1989/09/07
AGE: 50
MAIN PHONE: 751-561-7710
ADDRESS: 123 Cody Fall
Ginabury, CT 52072
RESPONSIBLE PARTY:
BUGGAGE,
NADINE
A
123 Cody Fall
Ginabury, CT 52072
RSP SSN:
RSP OCC: TRMC
RSP PH: 608-872-7889
I
UNDERSTAND AND AGREE THAT, AT THE TIME THE PATIENT HAS MET GULF COAST SURGICAL CENTER LLC's MEDICAL CRITERIA TO
LEAVE THE FACILITY, I WILL HAVE A RESPONSIBLE ADULT PRESENT TO TAKE ME/PATIENT HOME. I RELEASE GULF COAST SURGICAL
CENTER LLC FROM ANY RESPONSIBILITY FOR EVENTS IN VIOLATION OF THIS AGREEMENT.
Nadine Buggage Miniton
2016/20/01
1393
Witness
Date
Time
Signed
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711476893.291773 | Joann Morales |
20-03-04 9:22 29 AM NorthBay Health System 707-646-5000 Page 3 of 3
1101 B Gale Wilson Blvd. State 100 Faufield. CA 91533 071646-4646
Magnerl
Pesonanco
Exam Date/Time:
Exam:
Accession Number:
Ordering Physician:
24-02-06 09:26:31
MR MRI Lumbar Spine
MR-12-0002095
Kitchens, Charles. M.D.
w/o Contrast
causing significant encroachment upon the central spinal canal or neural
foramina.
IMPRESSION:
1. Large central disc herniation with small inferiorly extruded disc fragment
at L5-S1. There does not appear to be significant encroachment upon the central
spinal canal or neural foramina.
2. Very small central disc herniation at L4-L5 without significant
encroachment upon the central spinal canal or neural foramina.
DT: 6/21/2012 (1226 hours)
Final Report
Dictated by: Gonser. William N.. M.D.
Signed by: Gonser. William N., M.D.
Transcriptionist: McGraw. Tena
06/21/2012 12:01
Parent NameJoann Morales
Medical Record No 6048648
Financial No 8010198
DOB 01-03-28 Age 26 years
Gender Male
PI
Diagnostic Imaging
Type
Outpatient
Admit Date 21-09-01
Ordering Physician Kitchens Charles MD
Solano Imaging Medical Associates
Brian Middleton. MD
Katherine Guerrero. MD
William N Gonser. MD
Properto 25 2012
Page 2 of 48
248
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711473365.827168 | Sara Wolf |
Electronic Physician Orders
Order: Activated Partial Thromboplastin Time (APTT)
Order Date/Lime 03-11-2016 09:56 EST
Order Status: Completed
Activity Type: General Lab
End-state Date/Time 12/4/2021 3:25 EST
Electronically Signed by: FERNANDEZ OLIVERO SR MD,
Consulting Physician:
GERARDO ANDRES
Entered By: Contributor system.FLHO MISYS on 12/4/2021 09:56 EST
Order Details: Routine collect, 06-10-2022 9:55:00 AM EST, Lab Collect
Order Comment:
patient:
Sara Wolf
MRN: 73026305
FIN#: 93010305
Printed On:
10/30/2023 05:11 EDT
Page 128 of 516
Report Request ID#: 330333098
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711475190.354601 | Melissa Myers |
<<Back to Review>>194126-3-HYPERLINK- - Hyperlink-Page
187
Melissa Myers
KAISER PERMANENTE庐
MRN: 110224022822, birthdate: 1990-02-15, Sex:
F
SSN: xxx-xx-3224
Visit: 2020-12-19
2023-08-05 - Scheduled Telephone Encounter in CCM-DIABETES (continued)
Clinical Notes (continued)
3) Further blood sugars needed to assess effect of insulin
next visit evaluate changing INSULIN REGIMEN SQ
P
LIFESTYLE/EDUCATION :
Reviewed rule of 15 for treatment of low blood sugar.
If bedtime blood sugar below 110 take snack of 15 grams carbohydrate Such as 1/2 sandwich and take
insulin as ordered . Call Mary Hallum if occurring 2 or more times in 2 weeks .
blood sugar above 100 before driving exercising or above 110 before sleeping.
Electronically signed by Hallum, Mary C. (R.N.) at 2022-07-12 6:4 PM
Generated on 4/6/22 11:06 AM
000187
0186
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711472286.52533 | Justin Hicks |
Justin Hicks
MRN: 5605213
06/05/2023 - Telephone in MultiCare Rockwood Orthopedics & Sports Medicine
MultiCare Health System
Patient name: Justin Hicks
MRN: 5605213
CSN: 296528619
Account Information
Admit Date
HAR#
Pt Class
Hospital Svc
Bed
23-04-2023
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
birthdate:
02-03-1988 (18 yrs)
United Parcel Service
Sex:
male
Marital Status:
Significant Other
RIVER VIEW CORPORATE
Justin Hicks
CENTER
MRN: 5652313, birthdate: 02-03-1988, Sex: M
16201 East Indiana Ave
date of visit: 12-05-2018
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_1711475444.848312 | Lauren Williams |
Lauren Williams DOB: 1998 Apr 03 (20 yo M) Acc No. 38248 Doc Name: 2015 Mar 02 DMA Jones
DMA Authorization for Release of Health Information for Billing and Payment
Patient Name: Lauren Williams
Patient Address: 208 N Silver MAPLE Dr. Slid211 LA. 70458
Patient Social Security #: xxx.yy.zzzz
Phone # (111) 111-1111
Date of Birth: 1998 Apr 03
1. The patient's health information may be disclosed to Diagnostic Management Affiliates, L.L.C.
("DMA") or Diagnostic Management Affiliates - Preferred Provider Organization. L.L.C. ("DMA-
PPO"). (hereafter referred to as DMA) and to the attorneys for the patient who have been identified
by the patient as his/her attorney or who have a written engagement agreement to provide legal
services to the patient in connection with a personal injury claim of the patient. The information
disclosed may include the patient's health information and may include but is not limited to
medical records. billing records, reports, opinions. X-ryys. abstracts or excepts or any records, lab
reports. discharge summaries. history and physicals, consults, out patient reports, pathology reports.
physical therapy information and reports and emergency records and reports. The information
released may include information related to alcohol and drug abuse psychiatric, HIV and/or genetic
information.
I understand that a revocation is not effective to the extent that DMA has relied on the use or
disclosure of the protected health information. I understand that information used or disclosed
pursuant to this authorization may be subject to re-disclosure by the recipient and may no longer
be protected by federal or state law.
My signature is an acknowledgement that I have received a copy of this authorization.
Date: 2017 Mar 21
Signature of Patient or Legal Representative
Page 4
Rev. 2023 Mar 25
File: DAIA Testing & Surgery Forms
Lauren Williams DOB: 1998 Apr 03 (28 yo M) Acc No. 38248 Doc Name: 2015 Mar 02 DMA Jones
Page 98 of 123
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711471330.54001 | Rebecca Myers |
Pineview General Hospital
Patient name:
Rebecca Myers
MRN:
05357130
admitting date: 03/08/2016
FIN:
92898665936
Disch: 02/09/2016
BIRTHDATE/Age/Sex: 05/11/1989
62 years
Female
Admitting:
Dr Kenneth Chaney.MD
Location:
E4M4 E440-E447; E442; 1
Attending: Dr Kenneth Chaney.MD
Copy to: Li,Ed
Discharge Documentation
Document Type:
ED Clinical Summary
Service Date/Time:
12/04/2017 01:35 PDT
Result Status:
Auth (Verified)
Perform Information:
Inez,Darlene M RN (04/07/2019 01:35 PDT)
Sign Information:
Inez,Darlene M RN (04/07/2019 01:35 PDT)
ED Clinical Summary
Pineview General Hospital
5429 Mills Causeway
North Kimberly, OK 07887
Visit Information
Patient name: Rebecca Myers
FIN:
BIRTHDATE: 05/11/1989 12:00 AM
Arrival Date/Time: 8/27/2019 6:31 PM
Current Date/Time: 08/28/19 01:35:40
Primary Care Provider: UNK, Provider
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711476766.990969 | Anthony Moran |
MPT I McLaughlin Physical Therapy
3120 20th St
Physical Therapy
Metairie, LA 70002xxxx
Initial
Phone: xxxxxxxxxxx
Fax: xxxxxxxxxxx
Examination
Patient Name: Alicia Moreno
Date of Initial Examination: 04/12/2019
Date of Birth: 17/08/1995
Injury/Onset/Change of Status Date: 11/11/2021
Referring Physician(s): Pappas, Nick MD
Diagnosis: ICD10: M25.511: Pain in right shoulder
Surgery: (Date/Type) 05/10/2017 C Spine Fusion
Treatment Diagnosis: ICD10: M25.511: Pain in right
shoulder, M75.111 Incomplete rotator cuff tear or rupture of
right shoulder, not specified as traumatic
Subjective
Treatment Side: Right
History of Present Condition/Mechanism of Injury: Pt is a 61 year old female who presents to PT complaining of neck and
(R) shoulder pain 2 partial RC tear / bursitis with history of multi level C spine fusion.
Objective
Outcome Measurement Tools
Upper Extremity
Upper Extremity Quick DASH
65.91/100
Observation
Standing Posture Rounded Shoulders
Range of Motion
1 of 25
Powered by
WebPT
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711476892.715753 | Gina Knapp |
Jan 07, 2017 02:58 PM
0:16103548976 FROM: 8333674976
Page: 76
Proc ID: 12766
Page 6 of 76
FAPA
Anesthesia Record
Patient: Cassandra Frazier
DOB: Jan 22, 1995
FEINERMAN ANESTHESIA PA
MRN: C11976
Acct: C11976
DOS: Dec 01, 2021
Height: 185.4 cm Weight: 147.4kg
PS: ASA 3
OR: OR 1
Encounter Type:
Surgeon:
Diagnosis: Other cervical disc displacement, high cervical region (M50.21), Spinal stenosis, cervical region (M48.02), Cervicalgia (M54.2), Radiculopathy, cervical region
(M54.12)
Procedure(s): Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral
disc; 1 interspace, cervical (63020), Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each
additional facet joint (List separately in addition to code for primary procedure) (64634).
Airway Management Notes
Glidescope
Anesthesiologist present and or immediately available for:
Providers
Start End
Michael Richardson (Anesthesiologist)
Signed at: Dec 20, 2021
Medical Direction
KC Kang Compton (CRNA)
Signed at: 04/06/2023 0
| what is the DOB or date of birth? | {"text": ["Jan 22, 1995"], "answer_start": [164]} |
id_1711475189.968601 | Dawn Phillips |
NOVANT
Novant Health North Point
Dawn Phillips
N
Medical Associates
MRN: 54824487, BIRTHDATE: 15/10/92, Sex: M
HEALTH
1485 Bethabara Road
Visiting Date: 11/06/19
Winston-Salem NC 27486-3485
17/01/23 - 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.
electronically signed by Dr Joshua Rogers, MD at 28/12/19 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 visit date or date of visit? | {"text": ["11/06/19"], "answer_start": [173]} |
id_1711475741.483404 | Elizabeth Phillips |
Elizabeth Phillips DOB: 11/1998/21 (72 yo M) Acc No. CR586457
10/2019/28, 9:09 AM
JAX SPINE & PAIN CENTERS
Courtney Delaparte, APRN
5191 FIRST COAST TECH PKWY THIRD FLOOR
Nurse Practitioner
JACKSONVILLE, FL 32224-0609
Tel: 904-223-3321 Fax:
Patient:
Elizabeth Phillips
10/2019/28
DOB:
11/1998/21, Sex: Male
Address:
1329 SOARING FLIGHT WAY, JACKSONVILLE, FL 32225-6828
Phone:
904-887-5708
Ordered Date:
05/2022/18
Assessments:
Lab:
OTHER
Fasting:
No
Specimen:
Clinical Info:
Name
Value
Reference Range
Carisoprodol
Cotinine
EtG
Gabapentin
Result:
Received Date:
Notes:
Patient Name: Elizabeth Phillips , DOB: 11/1998/21
file:///C:/Users/Emilym/AppData/Local/Temp/eCW.qini20at.emp/8f6cfce6-7098-4914-b013-deb0b635698c.htm
1/1
Elizabeth Phillips DOB: 11/1998/21 (72 yo M) Acc No. CR586457
Page 43 of 166
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711473530.494449 | Bryan Chen |
KNMH CT SCAN
Bryan Chen
180 W Esplanade Ave
MRN: 8348348, birthdate: 11/1985/17, Sex: M
Kenner LA 73465
Acct #: 83403346341
Enc. Date 01/2018/15
08/25/2022 - Appointment in Kenner - Diagnostic Ctr (continued)
Outpatient Medications at Start of Encounter as of 8/25/2022
Disp
Refills
Start
End
gabapentin (NEURONTIN) 300 MG capsule
Sig - Route: Take 900 mg by mouth 3 (three) times daily. - Oral
Class: Historical Med
Lab and Imaging Orders
CT Cervical Spine Without Contrast
Electronically signed by: Dayna G. Toscano, NP on 04/2018/25 1009
Status: Completed
Ordering user: Dayna G. Toscano, NP 08/25/22 1009
Ordering provider: Dayna G. Toscano, NP
Authorized by: Dayna G. Toscano, NP
Ordering mode: Standard
Ordered during: ED on 02/2024/24
Indications of use: Neck trauma (Age >= 65y)
Result
CT Cervical Spine Without Contrast (Order
434903430)
Generated on 10/3/22 11:37 AM
Page 2
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711472286.578329 | Michael Davis |
Michael Davis
MRN: 5602413
04/04/2023 - External Document in MULTICARE HEALTH INFORMATION (continued)
Injury Date:
Place of Injury:
2020-21-01 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
800-324-9919
253-424-4948
Tacoma WA 98245-3799
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: 5602413 , birth date: 1988-15-07, Sex: M
TACOMA WA 98424-0299
Date of Visit: 2019-05-01
Page 54
Printed by 414221 at 7/17/23 9:40 AM
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711476578.186753 | Emma Parker |
BAYLOR SCOTT & WHITE
Williams, Charles Eugene
BaylorScott&White
HEART AND VASCULAR
MRN: 9211620, DOB: 17 May 1997, Sex: M
HEALTH
HOSPITAL - DALLAS
Date of Service 19 Mar 2022
621 N HALL ST
DALLAS TX 75206-1320
09 Jul 2020 - Procedure Pass in Hospital
Visit Information
Admission Information
Arrival Date/Time:
Admit Date/Time:
16 Mar 2017
IP Adm. Date/Time:
Admission Type:
Point of Origin:
Admit Category:
Means of Arrival:
Primary Service:
Secondary Service: N/A
Transfer Source:
Service Area:
Unit:
Admit Provider:
Attending Provider:
Referring Provider:
09 Jul 2020 - Procedure Pass in Baylor Scott & White Heart and Vascular Hospital - Dallas
Facesheet
Patient Information
Patient Name
Legal Sex
DOB
Williams, Charles Eugene (2011620)
Male
17 May 1997
Basic Information
Date Of Birth
Legal Sex
Race
Ethnic Group
Preferred Language
Language for Written
17 May 1997
Male
Black or African
Not Hispanic or
English
Material
American
Latino
English
Printed on 17 May 1997 10:22 AM
Page 120
7520 8-20
Baylor Scott & White Heart & Vascular Hospital - 00120
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711471328.610123 | Morgan Smith |
12/07/2023
14:29
(FAX)
P. 078/087
Prairie Hill Hospital
Dr Alice Taylor, MD
18740 N 99th Avenue, STE #100
Sun City, AZ 88751
T. (623) 387-5700 F. (623) 328-9871
Nerve Conduction Study & Electromyography Report
Full Name: Morgan Smith
Gender:
Female
MRN:
287402
birthdate: 05/98/06
date of visit:
19/15/04 7:50 AM
Age:
40 Years
Examining Physician:
Dr Alice Taylor, 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 Discharge? | {"text": [], "answer_start": []} |
id_1711476766.193841 | Eric Cook |
Bethesda Hospital West
2815 S. Seacrest Blvd
9655 Boynton Beach Blvd
Boynton Beach, FL 33xxx
Boynton Beach, FL 33xxx
Patient Name: Brandon Adams
MR#: 111786856
DOB: Dec 24, 1989
Account#: 2521037564
Date of Admission: Apr 29, 2020
Sex: F
Attending Physician: 79356
Facility: BMH
Ordering Physician: 79356
Collection Date and Time: Feb 23, 2018 12:05
Service Date: Jan 30, 2022 12:05
eBlood Bank
TEST NAME
RESULT
UNITS
RANGES
ABN FL ST
ANTIBODY SCREEN
NEG
F
NEG
Page 1 of 1
| what is the DOB or date of birth? | {"text": ["Dec 24, 1989"], "answer_start": [183]} |
id_1711471329.741836 | Michael Butler |
12-21-2019 7:43 TEXAS_MRI (FAX)46637839438 P.000/003
Oak Grove Hospital
patient: Michael Butler exm date: 08-20-2018 12:15 PM
BIRTH DATE: 03-08-1996 Age 30 Physician: Dr Katelyn Steele
date of evaluation:12-17-2022
MRN: TXCS28049 Exam: LUMBAR SPINE wo
MRI LUMBAR SPINE WITHOUT CONTRAST
INDICATION: MVA. Low back pain.
COMPARISON: None.
TECHNIQUE: Multiplanar multisequence images were obtained through the lumbar spine without administration of Intravenous contrast.
FINDINGS:
SPINAL CORD: The conus medullaris and nerve roots are normal with conus terminating at the T12-L1 level.
IMPRESSION:
1. L4-L5 posterior left subarticular/foraminal 3.8 mm disc protrusion-subligamentous disc / herniation Impinges on the descending left L5 nerve root in the lateral recess.
Associated severe left neural foraminal stenosis.
2. Severe foraminal stenosis with left L4 nerve root impingement In the foraminal space.
page of 2 73797-11 BCS Medical - 00057
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711477090.840877 | Kayla Williams |
2020 March 20 19:59:15 EDT
To: 19537226837
Page: 05/637
From: Lauris Rigdon
Fax: 3374937237
Signatures
Treating Provider Signature
Initiated by Maria Stalder, PT, DPT on 2015 March 08 14:56 EDT. License #: 049147
Electronically co-signed by Mary Smith, PT on 2017 July 23 16:01 EDT. License #: 024378
Patient Shauna Becker (DOB: 1999 May 29)
Treated by Maria Stalder, PT, DPT (License #379137)
DOS: 2024 March 06
Page 4 of 37 of Plan of Care
| what is the DOB or date of birth? | {"text": ["1999 May 29"], "answer_start": [351]} |