id
stringlengths 16
20
| title
stringlengths 7
24
| context
stringlengths 157
2.2k
| question
stringclasses 16
values | answers
stringlengths 32
56
|
|---|---|---|---|---|
id_1711475444.347391 | Cynthia Velasquez |
03/06/14 FROM- CWFMD
936-703-5455
T-242 P0006/0075 F-228
alternate
ALTERNATE HEALTH LABORATORY
Report Status: Final
1051 E NAKOMA DRIVE
HEALTH
SAN ANTONIO, TX 78216
Specimen Information
Patient Information
Ordering Physician
E Order
1804240004
Cynthia Velasquez
JOSHUA DUBOSE PA-C
Collected:
06/03/17
DOB:
10/09/98
Client Information
Printed:
03/06/14
Age:
46
Conroe Willis Family Med 2
Amended:
Gender:
Female
804 WEST MONTGOMERY
ID:
ELP100741
WILLIS, TX 77378
Laboratory Test
Critical
Abnormal
Normal
Optimal Range
Previous Results
Wheat IgE
0.48
<0.1 KU/L
White Bean IgE
<0.10
<0.1 KUIL
INHALANT ALLERGEN
C. Albicans IgE
<0.10
*01 KUL
A. Atternata IgE
<0.10
<0.1 sun.
Hickory/Pecan (gE
0.23
0.0 KD/L
Name: Price, Erica
DOB: 10/09/98
Date:
| What is Collection Date? | {"text": ["06/03/17"], "answer_start": [330]} |
id_1711475620.568523 | Kara Andrews |
Kara Andrews DOB: 08/11/02 (49 yo M) Acc No. 65716 Doc Name: 13/06/18 Inj
3
Room: 7
Pain:
Ht 518
CONSENT TO MEDICAL OR SURGICAL
LA HEALTH SOLUTIONS (504)262-8889
Wt: 248
3001 DIVISION STREET, STE104
606COLONAL DR,STE A
PROCEDURES, OPERATIONS, &
METAIRE, LA 70002
BATONROUGE LA70806
RONALD SEGURA M.D.
RICHARD ROBERTSON, M.D.
MEDICAL SERVICES
hereby authorize and direct Dr. Ronald Segura, and/or.Dr. Richard Robertson, with associates and
assistants of his choice, to perform upon:
Kara Andrews
08/11/02, 38175, male
Cervical tacet
he following medical diagnostic and /or therapeutic procedure or surgical operation:
Right C5l6 C6/7 C7/T,
hereby certify that I understand this consent and that all questions about the procedure /
procedures have been answered in a satisfactory manner and that all blanks were filled in prior to
my signature.
Date: 11/06/17 20
Time: 7:15
a.m / p.m.
Signature of Patient:
Signature of Relative
Witness: I
| cerify that all blanks in this form were filled in prior to signature and that I expl ained them to the
patient or patient representative before requesting the signature.
I
RS
Ronald Segura, M.D.
Richard Robertson, M.D.
Kara Andrews DOB: 08/11/02 (49 yo M) Acc No. 65716 Doc Name: 13/06/18 Inj
Page 66 of 134
| what is the DOB or date of birth? | {"text": ["08/11/02"], "answer_start": [22]} |
id_1711475741.243868 | Sean Hampton |
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.
July 15, 2014
Paciente lo Representante Personal
Fecha
Firma
ID / Visit: 117744 /4 DOS: July 26, 2018
Sean Hampton
Sex: M
DOB: June 18, 1995
Age: 70
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 the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711477183.325286 | Donna Martinez |
2019/29/08 9 33 24 AM PST (GMT-8) FROM 9856749749-TO 15048424047
Page of 2
MRO
2019/29/08
Initials:
DISCON LAW FIRM, L.L.C.
424 N. Causeway Blvd., Suite A
Mandeville, LA 70474
Thomas M. Discon
September 18, 2022
Via Facsimile: 504.842.4047
Ochsner Medical Center
Ochsner Health Services
Medical Records Department
1514 Jefferson Highway
New Orleans, LA 70121
Re:
Our Client:
Jennifer Guerra
DOB:
1988/07/02
DOI:
2020/18/06
Dear Sir or Madam:
Our firm has been retained by Mr. James Ladner for injuries sustained in an accident
on 2020/18/06. Enclosed please find a medical authorization executed by Mr. Ladner
authorizing your office to release directly to our firm a certified copy of his entire medical
file, including an itemized statement for services rendered, from January 1, 2022, to present.
Further please consider this correspondence a reminder that your treatment of Mr.
With kindest regards, I remain
Very truly yours,
s/Thomas M. Discon
THOMAS M. DISCON
TMD/djl
Enclosure
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711472285.656159 | Betty Miller |
Dec 04 18, 05:47p
ANNELIE PURDY PhD
8053490576
p.3
Page 1
PSYCHOLOGICAL TREATMENT REPORT AND RAF 12/4/18
NAME
Betty Miller
DATE OF BIRTH
1985-01-20
SSN
577-23-7771
EMPLOYER
Apple Valley Unified School District
injury date
2022-12-16; Claim 520870
Last Day of Work
2016-10-22
DOE
2020-10-24; 8/24/18.
TREATMENT
9/18/18; 10/02/18; 10/16/18; 10/26/18;11/13/18; 11/2718;
REASON FOR SEEKING PSYCHOLOGICAL EVALUATION/TREATMENT
Injured Worker, Diane Wieczorek, comes referred to me for consultation and treatment for the
emotional effects of her industrial psychological injury, injury date 2022-12-16, while employed as a
teacher at Apple Valley Unified School District.
DIAGNOSIS
F41.1 General Anxiety Disorder, Situational, and Industrially produced, but also further
aggravated by injury-related financial concerns
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711477183.42455 | Stephen Burgess |
Page 14 of 225
LADNER, James DOB: 26 Mar 1999 (72 yo M) Acc No. 204963 DOS: 19 Dec 2019
Current Medications
Taking
ibuprofen 1 tab Oral
Tylenol 1 tab Oral
Gabapentin 300 MG Capsule 1 capsule Orally Once a day
metFORMIN HCI 500 MG Tablet 1 tablet with a meal Orally Once a day
Past Medical History
Diabetes
Surgical History
Unremarkable
Family History
Father: deceased
Mother: deceased
3 daughter(s)
Social History
Tobacco Use:
Tobacco Use/Smoking
Are you a nonsmoker
Drugs/Alcohol:
OPIOID Risk Tool (2018 Edition)
Family Hx Alcohol? Yes
Family Hx Illegal Drugs? No
Family Hx Rx Drugs? No
Personal Hx Alcohol? No
Personal Hx Illegal Drugs? No
Personal Hx Rx Drugs? No
Age between 16-45 years? No
ADD, OCD, Bipolar, Schizophrenia? No
Depression? No
TOTAL SCORE 3
Risk Level for Opioid Use low
Miscellaneous:
Occupation: Retired.
Progress Note: Donald D Dietze, Jr MD 19 Mar 2016
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
hhttps://ladlssapp.ecwcloud.com/mobiledoc/jsp/catalog/xml/printMultipleChartOptions.jsp?e. 19 Mar 2016
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711473530.582855 | Darryl Taylor |
KNMH EMERGENCY DEPARTMENT
Darryl Taylor
137 W Esplanade Ave
MRN: 8378378, BIRTHDATE: 84-08-23, Sex: M
Kenner LA 73765
Acct #: 83703783761
Adm: 22-03-01
08/25/2022 - ED in Kenner - Emergency Dept (continued)
ED Provider Note (continued)
ED Notes
08/25/2022
ED Triage Notes by Devin F. Kelt, RN at 8/25/2022 1373
Author: Devin F. Kelt, RN
Service: Emergency Medicine
Author Type: Registered Nurse
Filed: 8/25/2022 10:24 AM
SERVICE DATE: 22-09-21 10:23 AM
Status: Signed
Editor: Devin F. Kelt, RN (Registered Nurse)
signature Devin F. Kelt, RN at 17-01-19 10:24 AM
Imaging
X-Ray Shoulder Trauma Left [370376837] (Final result)
signature: Dayna G. Toscano, NP on 17-01-19 1370
Generated on 10/3/22 11:37 AM
Page 21
| what is the admit date or admission date? | {"text": ["22-03-01"], "answer_start": [159]} |
id_1711475741.421979 | Amy Martin |
Amy Martin DOB: 1984 April 05 (38 yo M) Acc No. CR771752
[Doc Name: SAVANI 2019 November 20 BCBS]
Transaction ID: 18346724796 Transaction Date: 2023 January 12 10:26 am Customer ID: 8215896
Amy Martin Subscriber
MEMBER ID BZZ10821589601
Other Blue Plans
DOB 1984 April 05
GENDER Male
PLAN / COVERAGE DATE 2014 August 26 - 2021 August 04
DATE OF SERVICE 2023 December 14
Either the patient's ID, name, date of birth, or address in the response does not match the information sent in the request. The
response reflects the correct information. To avoid future errors in submission, please update this information in your computer system
Subscriber Information
221 James L Taylor Rd
PLAN NUMBER Facets
PRIOR ID NUMBER BZZ103459047
Plan / Product Information
ACTIVE COVERAGE
INDIVIDUAL
INSURANCE TYPE Preferred Provider Organization (PPO)
PLAN / PRODUCT
Blue Options
Members 18 and over with A1c between 5.7 and 6.1 without Type 2 Diabetes diagnosis are eligible for Virta Diabetes Prevention.
Members 18 and older with Type 2 Diabetes are eligible for Virta Diabetes Reversal
Service Types
Health Benefit Plan Coverage
ACTIVE COVERAGE
Infertility
ACTIVE COVERAGE
Preventive Drugs
Service Types
Pharmacy
ACTIVE COVERAGE
INDIVIDUAL
ACTIVE COVERAGE
Smoking Cessation 180 Day Supply Limit
ACTIVE COVERAGE
Service Types
Pharmacy
Amy Martin DOB: 1984 April 05 (38 yo M) Acc No. CR771752
Page 101 of 166
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475190.151025 | Randy Morrow |
NOVANT
NOVANT HEALTH MEDICAL
Randy Morrow
N
PARK HOSPITAL
MRN: 53624367, dob: 14/98/12, Sex: M
HEALTH
1950 South Hawthorne Road
Adm: 04/22/05, D/C: 03/22/06
Winston-Salem NC 27363-3362
23/17/06 - Admission (Discharged) in NHMPH Surgical Services (continued)
Clinical Notes Acute (continued)
Drains:
None
Specimens:
ID
Type
Source
Tests
Collected by
Time
1 right
Tissue
Spermatocele
PATHOLOGY
Brandon L
27/18/02 1618
TISSUE
Craven, MD
REQUEST
Implants: No implants in log
Procedure Detail
Findings:
Right spermatocele x2
Complications: None.
Electronically signed:
Dr Jennifer Myers, MD
30/14/03 / 4:39 PM
Electronically signed by Brandon L Craven, MD at 30/14/03 1641
Generated on 4/11/23 8:32 PM
Page 255
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711476578.148953 | Joanna Taylor |
BAYLOR SCOTT & WHITE
Williams, Charles Eugene
BaylorScott&White
HEART AND VASCULAR
MRN: 9211671, DOB: 01-09-10, Sex: M
HEALTH
HOSPITAL - DALLAS
Acct #: 33000308871
621 N HALL ST
Admitted 14-09-25. D/C 14-10-25
DALLAS TX 75226-1371
18-12-28- Admission (Discharged) in Baylor Scott & White Heart and Vascular Hospital - Dallas (continued)
Case 3450807 (A FLUTTER RF ABLATION WITH RHYTHMIA) (continued)
PONV
Nausea: absent
Emesis: No
Electronically signed by Pohar, Selvi, MD at 15-10-26 7:47 PM
Anesthesia Preprocedure Evaluation
Pohar, Selvi, MD at 2/8/2023 1106
Author: Pohar, Selvi, MD
Service:
Author Type: Physician
Filed 17-12-29 1:08 AM
Date of Service: 14-11-01 11:06 AM
Status: Signed
Editor: Pohar, Selvi, MD (Physician)
Anesthesia Review of Systems and Medical History:
Pulmonary System
Cardiovascular System
Atrial flutter
+ Tobacco use/dependence
+ hypertension
+ chest pain
+ dysrhythmias
Neurological/Musculoskeletal System
Gastrointestinal System
Printed on 18-12-28 10:22 AM
Page 71
771 08-71
Baylor Scott & White Heart & Vascular Hospital - 00071
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711477090.20342 | Jason Gregory |
I have reviewed and agree with the diagnosis and treatment plan.
Saman Aboudi MD
20-06-07
7:19 PM
Electronically signed by Debra Bass PA-C on 22-10-15 at 7:16 PM.
Provider: Robyn Dettmar, PA-C
Document generated by: Saman Aboudi 22-10-10 7:19 PM
PVHC At Claremont- Urgent Care
1601 N Monte Vista Ave Ste 190
Claremont, CA 9171 16642
(909)425-9942
0042
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475620.50752 | Sharon Wright |
Sharon Wright DOB: 1989 May 25 (74 yo M) Acc No. 96251 I Doc Name:2020 September 04.28 (EGG/F/U) Emailed to attr
Order Form
LAHS-Neurology
Req/Ctrl# (CD-): 1503887
3001 DIVISION ST, STE 100
Jonathan K. Jones, MD
METAIRIE, LA, 70002-5855
NPI: 1518385137
Neurology
Sharon Wright, Male, 1989 May 25
ID: 96251
Today: 2021 May 23 10:47 AM
208 N SILVER MAPLE DR, SLIDELL, LA 70458-5483
Order Date: 2022 July 06 03:00 PM
Primary Insurance Name: Eric Wright, Esq.
Insurance Address: 201 ST CHARLES AVE Ste 3206 . NEW ORLEANS 1 LA, 70170-1000
Subscriber Number: MVC 2021.03.18
Insured Name: Garibaldi, Justin
Address: 208 N SILVER MAPLE DR, SLIDELL, LA 70458-5483
Priority
Diagnostic Name
Assessment(s)
Instructions
Routine
EEG/ERP
- S06.9X9D, Traumatic brain injury
with loss of consciousness,
subsequent encounter
Electronically Signed By: Jonathan K. Jones, MD
Signature of Patient/Guardian
Order generated by eClinicalWorks (www.eclinicalworks.com)
Sharon Wright, M, 1989 May 25
https://lalahsapp.ecwcloud.com/mobiledoc/jsp/webemr/index.jsp#/mobiledoc/jsp/webemr/progressnotes/physiciansdashboard/dashboard.jsp/bwJDcD...
1/1
Sharon Wright DOB: 1989 May 25 (74 yo M) Acc No. 96251 I Doc Name:2020 September 04.28 (EGG/F/U) Emailed to attr
Page 68 of 123
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711475190.319664 | Bethany Jacobson |
KAISER PERMANENTE庐
Bethany Jacobson
MRN: 110794079879, dob: May 28, 1997, Sex:
F
SSN: xxx-xx-3794
VISITING DATE: Nov 27, 2016
Oct 03, 2020 - Telephone in ADULT AND FAMILY MEDICINE (continued)
Clinical Notes (continued)
Status: Signed
Editor: Clark, Juliana Elizabeth (M.A.) (MEDICAL ASSISTANT)
Electronically signed by Clark, Juliana Elizabeth (M.A.) at Dec 06, 2022 9:44 AM
Telephone Encounter by Clark, Juliana Elizabeth (M.A.) at 1/13/2011 0944
Version 1 of 1
Author: Clark, Juliana Elizabeth (M.A.)
Service: -
Author Type: MEDICAL ASSISTANT
Filed: 1/13/2011 9:44 AM
Date of Encounter: Oct 06, 2014
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 DOB or date of birth? | {"text": ["May 28, 1997"], "answer_start": [65]} |
id_1711473365.564422 | Jason Flowers |
<<Back to Review>>180298-26-HYPERLINK- Hyperlink-Page
243
Tow er Physical Therapy, Inc.
Patient N ame:Jason Flowers
1691 Colorado Ave, Suite 690
Patient # :369805
Turlock, CA 69382-6900
Phone: (269)696-6960
Daily N ote /
DOB: 1995/26/03
Document Date: 2022/05/10
Fax: (269)269-3695
Billing Sheet
Plan
Instructions: Progressing Patient Next Visit
Mar
Chris Stempson, MPT, CSCS
PT25198 for State of CA
E lectronically Signed b y Chris Stempson, MP,TCSCS on 2017/07/12 at 9:31 am
006943
0693
2 of 2
Powered by
WebF,
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711471329.740928 | Renee Riddle |
Jan 29, 2017 9:38 TEXAS_MRI (FAX)19077342530 P.001/003
Maple Grove Clinic
PATIENT NAME: Renee Riddle exam date: Feb 10, 2019 12:15 PM
BIRTHDATE: Jan 29, 1996 Age 42 Physician: Dr Erik Chapman
date of evaluation:Mar 06, 2018
MRN: TXCS34299 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 - 00011
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711473365.591 | Kristin Simon |
Tow er Physical Therapy, Inc.
TOWER
1801 Colorado Ave, Suite 26 0
Turlock, CA 95532-0530
Phone: (253)216 -353 0
F ax: (209)253 -353 5
Discharge Note
patient name: Kristin Simon (36 7 805)
Date of Discharge Note: Jul 30, 2017
dob: Sep 08, 1989
Injury/Onset Date: Jan 23, 2023
Physician Name: R. DE BOS, PA
Diagnosis: ICD10: S82.841D: Hemorrhoids
Date of Last Eval: 05/09/2017
Visit No.: 11
Treatment Diagnosis: ICD10: S82.841D: Displaced
bimalleolar fracture of right lower leg, subsequent encounter for
closed fracture with routine healing
FOSTER, EDWARD has been discharged from our care for the following reasons:
Visits complete, D/C.
Chris Stempson, MPT, CSCS
License #25198
Document created on May 13, 2018 2:33 pm
000534
0534
1 of 1
Powered by
WebF,
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711471328.432428 | Larry Riley |
2015-04-28 8:44
Pineview General Hospital P. 50/99
Pineview General Hospital PSC 6434, Box 5253
APO AA 02264
RADIOLOGY REPORT
patient name NUMBER SEX AGE DATE OF ADMIT DISC. XRAY# F/C TYPE
Larry Riley 23308836616 F 66 2016-01-27 2016-02-26 172697 MB O/P
D.O.B: 1998-02-06 M/R# 172697 PH#: 738-559-9370 RM
LOCATION: TRANSCRIBED: 2015-04-28 8:44 PSR
MR LOW EXTR LT EXC JT WO CONT 73718 COMPLETE: 2015-04-28 19:17 TJB 79056
REASON FOR PROCEDURE: Thyroid Disorder PHYSICIAN: Dr Angel Small MD
HISTORY: Appendectomy in 2005.
Morton's neuroma of the second intermetatarsal space (5 X 9 mm).
2. Metatarsophalangeal joint mild capsulitis and second interspace mild bursitis.
3. Evidence of first MTP chronic capsular induration as well as sesamoid arthrosis.
Prior bunion surgery. Healed surgical changes versus prior healed trauma of the first metatarsal base and proximal metaphysis. Sherry Hinson-YVAM-MD-000027
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711477090.6097 | Teresa Turner |
24/06/2020 04:45 PM
TO:74103548974 FROM: 8374674974
Page: 80
360
PRE-SURGERY INSTRUCTIONS
ORTHO AND SPINE
COVID symptoms. If you arrive to the surgery center with symptoms
and do not have proof of a NEGATIVE (-) test result, your surgery will be
cancelled.
Initial
Prior to your surgery, please be sure to complete the following:
CASS Pre-Procedure Medical History and Medication Reconciliation Forms
Current Medications/Vitamins: Review list provided on Pages 2 & 3 and follow all guidelines.
Bloodwork must be completed within 30 days of your surgery.
These include: Complete Blood Count (CBC), Basic Metabolic Panel (BMP) and
Prothrombin Time (PT/INR) which will measure how long it takes your blood to clot.
We will provide you with the order for the bloodwork at your Pre-Operative Appointment.
DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT ON THE NIGHT
BEFORE YOUR SURGERY
AND
PLEASE ARRIVE ON TIME TO THE SURGERY CENTER.
My signature is proof that I have read and understand that failing to follow the above guidelines will cause
a delay in my treatment due to surgery cancellation.
PATIENT/GUARDIAN SIGNATURE Chil E
DATE. 14/05/2020
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711475955.937269 | Dennis Copeland |
2015-04-05 16:50 FROM- CWFMD
936-703-5455
T-252 P0060/0063 F-236
From KISLINQ 1.205./18.7603 2023-02-10 08:46:27 CST Page 1 of 1
A
SPIRE
Huntsville
Conroe
5401-45 South. Suite C, Huntsville, TX 77340
1501 Riverpointe Dr, Suite 180, Consoe, TX 77304
Phone (936) 755-3650 Fax (936) 755-3652
Pirone (936) 1441-7227 Fax (936) 756-9729
Patient Name:
ERICA PRICE
Referring Physician: Rodney Jason Laningham
DOB:
1994-23-04
Location:
804 West Montgomery
MRN:
34518
Referring Fax:
(936) 890-9000
DOS:
2020-14-08
Conroe Diagnostic Imaging
RIGHT KNEE RADIOGRAPHS 3 VIEWS:
01/13/2017
PROVIDED CLINICAL HISTORY:
Right knee pain.
FINDINGS:
No evidence for fracture or other acute osseous abnormality . Alignment appears otherwise
anatomic. Joint spaces appear preserved. No lytic or blastic lesions are seen.
IMPRESSION:
Unremarkable right knee radiographs.
Thank you for choosing Aspire Hospital for your imaging needs.
Dictated By: Justin Trant, MD
Electronically signed: 2022-03-02 8:40:24 AM
1-13-17
V
Name: Dennis Copeland
DOB: 1994-23-04
Date:
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711475444.87462 | Jonathan Young |
Jonathan Young DOB: Mar 08, 1997 (63 yo M) Acc No. 43709
Jonathan Young DOB: Mar 08, 1997 (63 yo M) Acc No. 43709 DOS Jan 05, 2020
Jonathan Young
63 Y old Male, DOB: Mar 08, 1997
Account Number: 43709
208 N SILVER MAPLE DR, SLIDELL, LA-70458-5483
LA Health Solutions
Guarantor: Wright and Gray, PLC, Insurance: Eric Wright, Esq.
Payer ID: atty
Appointment Facility: LAHS-SLIDELL
Patient's Default Facility: LAHS-SLIDELL
Oct 12, 2023
MD follow up evaluation: KATE MCDONALD, MD
Reason for Appointment
Current Medications
1. This patient complains of right and left leg pain, right and left knee pain,
Taking
right jaw, left arm pain, right and left hip pain, right and left elbow, sacrum
Cyclobenzaprine HCI 5 MG Tablet 1
mid and upper back pain.
tablet at bedtime Orally Once a day
Advil
Disintegrating 1 tablet on the tongue and
Joint Stiffness Present
allow to dissolve Orally Once a day
Meclizine HCI 25 MG Tablet Chewable
Radiating Pain Present
1 tablet as needed Orally Once a day
the right
*Social History:
Marital Status: Married.
Rotation (Normal 80) 80 Slight pressure bilateral
Cigarettes, packs per day: None.
Dip, Chewing Tobacco, Electronic
Palpable Findings
Cigarettes: No.
Progress Note: KATE MCDONALD, MD Oct 12, 2023
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
Jonathan Young DOB: Mar 08, 1997 (63 yo M) Acc No. 43709
Page 9 of 123
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711475955.729961 | Angelica Lopez |
Central City Clinic
EMERGENCY ROOM CLINICAL REPORT WITH DISCHARGE
Patient Name: Angelica Lopez
EMERGENCY ROOM
PATIENT ACCT: X0022492040
UNIT #: G0191497
DATE OF ADMIT: 12 Feb 2022
DISCHARGE DATE:
Patient Name: Angelica Lopez Clinical Report - Physicians/Mid Levels
MRN: G0491187 Central City Clinic
Time Seen: 12:13 09 Apr 2018.
Arrived- By private vehicle. Historian- patient and family.
HISTORY OF PRESENT ILLNESS
Chief Complaint: ; PROBLEM IN THE RIGHT KNEE. This started 3 days ago and
is still present and now worse.
Recent medical care: The patient was seen recently at this facility in the
emergency department.
REVIEW OF SYSTEMS
No cough, chest pain, difficulty breathing, fever or skin rash.
PAST HISTORY
See nurses notes. ( Angioedema.
Renal Insuffi.ciency.)
Hunt Patient Care Inquiry **LIVE** (PCI: OE Database HUD)
Run: 05 Nov 2014-15:53 by WARREN, CATHERINE
Page 1 of 7
000517
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711475741.453865 | Krista Harding |
Krista Harding DOB: 07/02/87 (27 yo M) Acc No. CR653672
JAX SPINE & PAIN CENTERS
Krista Harding, 27 Y, M, 07/02/87
5191 FIRST COAST TECH PKWY THIRD FLOOR, JACKSONVILLE FL 32224-0609
904-223-3321
904-887-5708 MRN: 0
FINAL RESULT
Accession ID: 65367
Ref ID: 2797L2984396
Specimen Source: Urine
Collection Volume: 50
OrderDate.14/07/22
Received: 31/07/15 20:58:12
Collection Date21/12/20
Report: 31/07/15 20:51:00
Requesting Physician: Delaparte, Courtney
Ordering Physician: Delaparte, Courtney
OPIOIDS
NAME
VALUE
REFERENCE RANGE
F Norfentanyl
Negative
<10 (ng/mL)
F Fentanyl
Negative
<2 (ng/mL)
F Tramadol
Negative
<200 (ng/mL)
PERFORMING LAB: MAIN, Jax Spine and Pain Centers - Main, 5191 First Coast Tech Parkway, Jacksonville FL, Director -
32224
Krista Harding I 07/02/87
Accession ID: 12947
Krista Harding DOB: 07/02/87 (27 yo M) Acc No. CR653672
Page 47 of 166
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475190.516448 | Mary Washington |
<<Back to Review>>194126-2 HYPERLINK-Hyperlink-Page
188
KAISER PERMANENTE庐
Mary Washington
MRN: 110584075888, BIRTH DATE: 31/07/02, Sex:
F
SSN: xxx-xx-3584
VISITING DATE: 18/12/23
06/02/22 - Work Comp in OCC PHYSICAL THERAPY -STE 5038
All Charges for This Encounter
Code
Description
Service Date
Service Provider
Modifiers
Qty
97014
APPLICATION MODALITY TO 1 OR MORE
13/10/17
Lattupally, Shirisha (P.T.)
1
AREAS; E-STIM
Physical Medicine Notes
THERAPIST, PHYSICAL
Progress Notes by Lattupally, Shirisha (P.T.) at 9/25/2007 1010
Version 1 of 1
Author: Lattupally, Shirisha (P.T.)
Service: -
Author Type: THERAPIST, PHYSICAL
Filed: 9/25/2007 10:10 AM
Encounter Date: 26/02/24
Creation Time: 9/25/2007 10:10 AM
Date of Injury: 13/02/22
Generated on 4/12/22 10:33 AM
000188
0187
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711475190.613853 | Christopher Farley |
May. 15. 2023 2:57PM
No. 1285
P.
16
11/24/2023 1/:01
Conway Medical Center
RRD 18775489/21
2/3
Conway Medical Center
300 Singleton Ridge Road
Conway, SC 29526
CMC
(843) 347-7111
Patient:
Christopher Farley
MRN;
673207356
Admit:
24/05/22
DOB/Age/Sex: 03/10/88
58 years
Female
Admilting: Johnson, MD, Donovan
Magnetic Resonance Imaging
Accession
Exam Date/Time
Exam
Ordering Physician
Patient Age at Exam
MR-73-0073274
06/07/21 16:13 EST
MRI Lower Joint w/o
Johnson, MD, Donovan 66 years
Contrast Right
Report Request ID: 22428010
Page 1 of 2
Print Date/Time: 2/24/2023 17:01 EST
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711475741.660563 | Kristy Lane |
22/06/14 FROM- CWFMD
936-703-5455
T-252 P0062/0063 F-236
Fax Server
22/06/14 AM PAGE
1/002
Fax Server
GHPMA Radiology
22710 Professional Drive
Kingwood, TX 77339
Phone (281)-312-8500
Fax (281)-358-2543
Patient Name:
Kristy Lane
Physician:
Jason Rodney Laningham,
M.D.
Patient Birthdate:
12/04/90
Patient ID:
WFPPRIERI
Date of Service
20/01/20
EXAMINATION:
LEFT THIRD FINGER, TWO VIEWS
These images were performed at Willis Family Practice and provided to [ Imaging for interpretation
HISTORY:
Finger pain
FINDINGS:
Two views of the left third are submitted for evaluation,
There is no evidence of fracture, dislocation or destructive osseous lesion.
The articular spaces are maintained and the soft tissues are normal,
Thank you for choosing 1960 Digital Imaging.
Page 1 of 2
This fax contains confidential patient information If you receive this transmission in error, please destroy
the faxed materials and contact the sender at 281-453-7999
Name: Kristy Lane
DOB: 12/04/90
Date:
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711471330.588456 | Mary Bruce |
Unity Medical Center
Mary Bruce
MRN: 33773659, dob: 04-20-1994, Sex: M
02985 Amy Lane Suite 404
Port Michele, NY 27337
Visit Day: 07-25-2016
Result Summary (continued)
Documents - Encounter Level on 01-17-2022: (continued)
Dr Christopher Patterson, MD
Phone: 332-136-3811
02985 Amy Lane Suite 404
Port Michele, NY 27337
Please sign and return this page only by fax or mail.
Plan of Care Approval for Mary Bruce
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:
Adam Clark, PT, DPT PT60388818
02-14-2017 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 Christopher Patterson, MD
Approval Date:
04-16-2017
Progress Evaluation for Mary Bruce
Page 6
dob: 04-20-1994
| What is signature date or signed on date? | {"text": ["02-14-2017"], "answer_start": [670]} |
id_1711477182.904863 | Katherine Ward |
LOUISIANA PAIN
SPECIALISTS
PAIN DIAGNOSIS & INTERVENTION EXPERTS
George Escobar
Sex: Male, Date of Birth: 89-03-23
Visit Date: 15-03-19
Attending Provider: Suneil Jolly, MD
Referring Physician: Suneil Jolly
History of Present Illness
Follow Up - PF
Follow up details: The patient returns today for an office visit 9/18/20: Patient f/u for ongoing neck pain radiating to
left upper shoulder area and lower back pain. Patient s/p Cervical ESI (9/10/20) with limited relief. Since last OV,
patient reports pain unchanged. He brought in disc from VA of Lumbar X-ray. Images were personally reviewed per
Dr. Jolly in clinic today and then reviewed with pt. In clinic today. However, he reports his neck remains his primary
pain generator at this time. Will recommend Lumbar MRI if indicated in future. Patient denies any new pain
generators, weakness, injuries, bladder/bowel incontinence or saddle anesthesia. His current pain level is 7/10
Patient reports that his pain is well controlled with prescribed medications . States that his pain is relieved by 30%
by taking medications Patient reports that his current funtional level is much improved with medication. States that
his quality of sleep is fair. He denies any misuse or abuse of medications, denies taking any illicit drugs or any pain
medications from any other source. He describes his mood as good Patient reports no side effects from the
medications.
Past Medical History
Diabetes () . Anxiety ()
Surgical History
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711475190.1839 | Jorge Jimenez Jr. |
NOVANT
Novant Health North Point
Jorge Jimenez Jr.
N
Medical Associates
MRN: 52324237, date of birth: 12-22-2003, Sex: M
HEALTH
1235 Bethabara Road
Visiting Date: 03-06-2020
Winston-Salem NC 27236-3235
11-25-2021 - Office Visit in Novant Health North Point Medical Associates (continued)
Clinical Notes Amb (continued)
1.
Medicare annual wellness visit, subsequent
2.
Cramping of hands
3.
Cramping of feet
Plan
Jeffrey was seen today for muscle cramps, knot on arm and medicare wellness visit.
Diagnoses and all orders for this visit:
1. Medicare annual wellness visit, subsequent (Primary)
Patient Instructions
Medicare Annual Wellness (Yearly)
Next due on 8/26/2023
08/26/2022
E&M Code: PPPS, SUBSEQ VISIT
09/01/2020
Level of Service: PR PPPS, SUBSEQ VISIT
Generated on 4/11/23 8:32 PM
Page 296
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475620.902297 | Spencer Haynes |
31/07/2021:12:59 :From:stat
To: 9544403115
3054714593
# 2/ 2
DMI
Doral Medical Imaging
PATIENT NAME
Spencer Haynes
DATE OF BIRTH
10/10/1997
DATE OF EXAM
16/10/2017 15:06
REFERRING PHYSICIAN
DR JACOBSON, ROBERT
CT SCAN OF LUMBAR SPINE WITHOUT CONTRAST:
INDICATION: Sprain/pajolmotor vehicle accident. DOA 23/05/2021
COMPARISON: Radiographs of the lumber spine dated 16/10/2017
TECHNIQUE Multiple contiguous nxial images were obtained through the tumbar spine without TV
contrast. Sagittal and coronal reformation images were obtained from the axial data.
FINDINGS: The normal lordotic curvature of the lumber spine is multiment
IMPRESSION:
1. L4-L5: Diffuse 5 min disc bulge. Canal stenosis. Bilateral neuroformman norrowing
2. L1-L2: Focal 6 mm right foraminal disc hernistion. No central canal stenosis. Right neuroformmen
narrowing. No left neuroforminal narrowing.
3. L3-L4: Dilluse 2 mm disc bulge. No central canal stenosis or neuroformment narrowing.
4. L5-S1: Diffuse 2 min disc bulge. No central canal stenosis or neuroforaminal narrowing
Philip B. McDonald, MD
Electronically Signed by:
MCDONALD. PHILIP MD
Date/Time Read:
8/15/2022 1:08:35 PM
American Board Certified Radiologist
of Premier Radiology Services
www.pradiology.com
8181 NW 36 Street Suite 3 Dorel, FI. 33166 - Tel: (305) 471-4581 - Fax: (305) 471-4593 - Toll
Froo: (877) 471-4581
www.doraimri.com
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711477090.814344 | Robert Macdonald |
2014 Jul 02 19:59:15 EDT
To: 195572268657
Page: 03/657
From: Lauris Rigdon
Patient Self-Report
Patient Assessment/Diagnosis
History of Present Condition:
Patient presents with acute LBP and right hip pain that
presents with acute low back and right hip pain following
started on May 20th following elevator accident. Functional
accident that occurred on May 20th. Pt explains that she was battling with
established with patient input.
allow patient to return to prior level of function,
independence and safety.
Onset Date: May 20th
Comorbidities:
- Psychosocial: Battling with high anxiety, difficulty talking
about accident
- Car accident in with back pain and left shoulder (2007)
e Currently experiencing excessive vaginal bleeding (being
monitored by OBGYN)
Pre Morbid Level of Function:
- Independent prior to injury
Current Level of Function/Current Deficits:
- Unable to get into/out of car without onset of pain
- Unable to stand for prolong periods of time
- Unable to walk her dog due to fear of worsening
symptoms.
Work tasks: Desk job at home, mostly on the computer
Sleep disturbance: Reports no change in sleeping pattern
Imaging:
X-ray: no abnormal findings.
CT scan of abdomen and pelvis: results pending
Red flags: Pt denies all red flags including but not limited to
weight loss/gain > 10
Patient Terri Ellis (DOB: 2001 Aug 08)
Treated by Nathaniel Powers, PT. DPT
DOS: 2014 Aug 23
Page 2 of 57 of Plan of Care
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711471329.086226 | Billy Williams |
Springfield Regional
6381 Phillips Street
Jessicaborough, AR 06933
Workers' Compensation Medical Status Questionnaire
Patient Name: Billy Williams
Today's date: 2014/07/04
Patient ID #: 0452351
doi: 2020/07/03
Employer: FOOD LION
Carrier: RETAIL BUSINESS
SERVICES
Treating physician: Dr Christopher Young
IC file: 2022224556
1. Diagnosis: Gastric Ulcer
2. Treatment plan: WCP, NAPROXEN, ROBAXIN
3. Prescribed medications for the injury or condition that would impair ability or judgement needed to
perform certain jobs:
Lifting: 52LB MAX
Pushing/pulling: INFREQUENT
Bending/stooping: INFREQUENT
Kneeling, squatting: INFREQUENT
Twisting: INFREQUENT
Use of extremities:
Standing:
Walking:
Sitting:
Repetitive motions:
Driving:
Vibrations:
Climbing:
Splints/crutches/bandages:
Other restrictions:
7. If patient has reached maximum medical improvement (MMI), what is the permanent impairment
for the injury or condition?
Body part:
: Percentage:
%
Body part:
; Percentage:
%
M
Physician signature: Dr Cassandra Bell, MD
Date: 2016/18/03
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475190.118043 | Jennifer Schultz |
Novant Health Mothershed Foot Jennifer Schultz
N
NOVANT
& Ankle Specialist
MRN: 53024307, D.O.B: Apr 16, 1986, Sex: M
HEALTH
430 Pineview Drive Ste 300
DATE OF VISIT: Feb 01, 2021
KERNERSVILLE NC 27304-
3817
Jun 18, 2021 - Office Visit in Novant Health Mothershed Foot & Ankle Specialist (Kernersville) (continued)
Clinical Notes Amb (continued)
SIGNATURE Robb A Mothershed, DPM at Jan 21, 2016 1302
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 Procedure Date? | {"text": [], "answer_start": []} |
id_1711475190.584071 | Samantha Anderson |
Recv'd Date 20275715
Bill DCN: 2075196GJ756811
IDEAL MEDICAL RECORDS SERVICE, INC.
303 W. Katella Ave. Suite 300, Orange, CA 97567
Invoice
Phone: 714-380-6714 Fax: 875-758-3759
Date: 05-12-2018
Email: billing@imrservice.com
To :
Gallagher Bassett
P.O. Box 610, CA, Roseville,, 95661-0610
975-757-2750
975-753-8752
CLAIMANT NAME:
Maria Barajas
ORDERED BY:
Claim#:
007593-007556-WC-01
Law Firm - Perona, Langer, Beck,
DATE OF INJURY:
06-12-2021
Serbin, Mendoza, Harrison
UR Denial Date:
06/10/2021
Records Type
Date of Service/Records Pick Up
Fax Date
Date
Medical for
09-06-2019
07/14/2021
Independent
Medical Review
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711477183.30075 | Vincent Austin |
MaineHealth
Shared Electronic
Vallier, Paulette A
Health Record
MRN: E38383xx, DOB: 1992-10-02, Sex: F
Visit date: 2015-04-18
2019-05-20 - Appointment in MAINE MEDICAL PARTNERS MAINEHEALTH CARDIOLOGY
Visit Information
Appointment Information
MH CVIS CLINIC DEVICE REMOTE
Completed
2019-05-20 10:15 AM
Time
Provider
Department
Length
10:15 AM
MMP RMG SCR DEVICE
MMPMH CARD TEST SCAR
15 min
DOWNLOAD 5
Referral Provider:
SESSELBERG, HENRY W
Arrival Time:
10:14 AM
Enc Form Number:
21227xxx
History
Made On:
6/1/2023 10:14 AM
By:
Fisher, Leviathan
RIS
Acknowledged by: Sesselberg, Henry W, MD on 06/05/23 1717
Generated on 2019-05-20 1:15 PM
Page 55
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475620.666066 | Julie Jones DDS |
Julie Jones DDS DOB: 1996/24/08 (38 yo M) Acc No. 33816
Julie Jones DDS DOB: 1996/24/08 (38 yo M) Acc No. 33816 DOS 2020/20/09
LA Health Solutions
Progress Note
Patient: Julie Jones DDS
Provider: Harley Augustine, PA-C
DOB: 1996/24/08 Age: 38 Y Sex: Male
Date: 2020/20/09
Reason for Appointment
1. Cervical, thoracic and lumbar pain
History of Present Illness
Interim History:
Patient continues to have neck and lower back pain.
New accidents or injuries since last visit: Light sensitivity has become worse.
Neck Pain:
The patient has neck pain: Yes.
The pain is present: Once a week.
The pain radiates: Does not radiate.
Numbness or tingling: None.
Arm weakness: None.
Headaches associated with the neck pain: Yes, occipital.
NECK pain from 0 to 10 (10 being the worst): 6 worst 8.
RIGHT ARM pain from 0 to 10 (10 being the worst): 0.
LEFT ARM pain from 0 to 10 (10 being the worst): 0.
Current Medications
Taking
Magnesium 300 MG Capsule 1 capsule with a meal Orally Once a day
Not-Taking/PRN
Cerefolin NAC 6-90.314-2-600 MG Tablet 1 tablet Orally Once a day
Meclizine HCI 25 MG Tablet Chewable 1 tablet as needed Orally Once a day
Melatonin 5 MG Tablet 1 tablet in the evening Orally Once a day
Pregabalin 200 MG Capsule 1 capsule Orally Twice a day
DULoxetine HCI 20 MG Capsule Delayed Release Particles 1 capsule Orally Twice a day
Past Medical History
No medical hx.
Carpal tunnel- bilateral.
Julie Jones DDS DOB: 1996/24/08 (38 yo M) Acc No. 33816
Page 2 of 15
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711471330.645502 | Antonio Rodriguez |
PATIENT NAME
Antonio Rodriguez
Gender
Female
MR #
35843775894
admitting date/Time
08/23/10 7:11:00 AM
Reg #
004118867004
Visit Status
DSC
birth date
06/95/05 12:00:00 AM
discharge date/Time
07/23/11 9:31:00 PM
1. Vital Signs Adult
17/22/11 02:00
Entered By
Heart Rate
Heart Rate Heart Rate (beats/min)
68
IM
beats/min
Comments :
Heart Rate Method
device
IM
Comments :
1/12/2023 12:47:18 PM
Page 269 of 101
SVI 0828
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711475955.575368 | Andrea Phillips |
16-11-268 PM
TO:53090576327 FROM: 8675024377
Page: 66
Account No: 33539
Citrus Cardiology - 308 Inverness
308 W HIGHLAND BLVD
INVERNESS, FL 34452-4716
Tel: 352-726-8353
Fax: 352-726-5038
Progress Note: KACI DYMOND 21-01-03
Note generated by eClinicalWorks EMR/PM Software (www.CCirica/Works.com)
M 61
Andrea Phillips
DOS : 23-01-03
DOB: 89-06-04
Acct: C11920
PrimProv: Prada, Stefan, MD
To: 360 Ortho and Spine. Subject: Progress Notes, Fax#: 833-367-4968. SendDate: 16-11-2652:47, page 3/3 [-ufg2.4.1.12in]
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711475741.047288 | Margaret Stevens |
Margaret Stevens DOB: 1985-03-28 (20 yo M) Acc No. CR162734
[Doc Name: 2022-04-10 MRI LUMBAR SPINE]
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: Margaret Stevens
PATIENT ID: 8283873
REFERRING PHYSICIAN: AMY WU, PA-C
DOB:
1985-03-28
REFERRING PHONE:
DOS:
2021-06-19
REFERRING FAX:
EXAMINATION: MRI LUMBAR SPINE WITHOUT CONTRAST
GEORGE VEGA, MD
Electronically signed on: 2019-11-26 9:10:40 AM
Transcribed by: JN on: 2019-11-26 7:12:17 AM
L3-51
Page 2 of 2
Margaret Stevens DOB: 1985-03-28 (20 yo M) Acc No. CR162734
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711475189.941908 | Sandra Hartman |
NOVANT
Novant Health North Point
Sandra Hartman
N
Medical Associates
MRN: 57024707, BIRTHDATE: January 22, 1988, Sex: M
HEALTH
1705 Bethabara Road
Visit: July 13, 2019
Winston-Salem NC 27706-3705
May 29, 2023 - Office Visit in Novant Health North Point Medical Associates (continued)
Clinical Notes Amb
Progress Notes
Dr Kyle Luna, MD at 4/7/2023 1934
Author: Dr Kyle Luna, MD
Service:
Author Type: Physician
Filed: 04/07/23 1954
encounter date: September 10, 2017
Status: Signed
Editor: Dr Kyle Luna, 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_1711476578.281888 | Grace Harris |
Patient: OWENS, Shannon DOB:88-05-29
OWENS, Shannon DOB: 88-05-29 (46 yo F) Acc No. 758856
19-10-30, 3:51 PM
Owens, Shannon (MR#21770262) Printed by SOUTO ALMENTEROS
UNIVERSITY OF MIAMI
JHealth
MILLER SCHOOL
UNIVERSITY OF MIAMI HEALTH SYSTEM
of MEDICINE
MRI CERVICAL SPINE CONTRAST
Owens, Shannon
MRN: 21770262, Sex Assigned at Birth: Female, 88-05-29 yrs)
Accession #: UR3111390
Final Result
Appointment Info
Exam Date
MRI of the Cervical Spine without contrast
16-07-21
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 305-243-5562
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 33146-2562
left C5-6.
2. No abnormal signal within the cervical spinal cord.
Signed by Dagher, Azar Peter, MD on 15-10-30 4:42 PM
Owens, Shannon MRN: 21770262 ACC: UR3111390 MRI Cervical
Spine W/O Contrast
Document: 19-10-30-Records
Printed: 19-02-18 12:22:11
Page 162 of 628
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711472786.830856 | John Santiago |
athena
09-18-2023 3:06 PM ET
511-242018070
pq 95 of 105
Privia - CCA - Cardiac Care Associates PC . 44084 Riverside Pkwy, Lansdowne VA 20110-108
John Santiago (id #1144776, birth date: 97/02/24)
SPEC #: YS:RS10-105
Patient Name: John Santiago
#K85421144773
(Continued)
Dr Trevor Jackson, M.D.
DS/ds
*** Addendum Electronically Signed
Dr Trevor Jackson, M.D.
21/09/06 at 121
REFERENCE LABORATORY REPORT
FISH Analysis IgH/BCL2 (14;18) from Neogenomics Laboratories:
Patient Name: John Santiago
Interphase FISH was performed with a dual color, dual fusion IgH/BCL2
probe set used to
detect the (14:18) translocation most commonly associated with follicular
lymphoma.
Comments:
The results of this assay have been determined within the limitations
described and should
not be used interchangeably with resulting values from other methods or
kits.
*** Addendum Electronically Signed
Dr Trevor Jackson, M.D.
21/09/06 at 1212
CONTINUED ON NEXT PAGE
RUN DATE: 18/03/17
PAGE 5
SPEC #: YS:RS21-995
Patient Name: John Santiago
#K85442018073
(Continued)
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711477090.230496 | Matthew Johnson |
Immunizations:
Childhood immunizations given.
Currently pregnant: no.
Egg allergy: no.
Gelatin allergy: no.
Neomycin allergy: no
Assessment/Plan
Code
*
Description
V70.0
A
Routine Medical Exam
P
Send to PSC(954995) to be performed.
D
immunizations up to date,labs to do,hpv pap done with cultures
240.9
A
Enlarged thyroid gland
P
CBC with Diff, Vitamin B12 and Folate, HEMOGLOBIN A1C, T4 FREE, URINALYSIS, TSH, CMP, LIPID
PANEL, RPR, Vitamin D, 25-Hidroxy andHIV SCREEN to be performed Today. Further diagnostic
evaluations ordered today include US Head/Neck (thyroid, parathyroid, parotid) to be performed.
She is to schedule a follow-up visit upon completion of work-up.
D
Medications (Added, Continued or Stopped this visit)
Started
Medication
Directions
Comment
Stopped
12/2019/24
Marl ssa a 5
take 1 tablet by oral route
mg-30 md tablet every day
Provider: Snezana Begovic MD
Document generated by: Shezana Begovic 12/2019/24 10:08 AM
PVHC At Pomona
1754 N Orange Grove
Ste 101
Pomona, CA 91765454
(909)549-9454
Electronically signed by Snezana Begovic MD on04/2019/18 10:32 AM
Jarero, Elizabeth 000000079924 10/24/1978 05/15/2014 02:00 PM 3/3
0054
| what is the DOB or date of birth? | {"text": [], "answer_start": []} |
id_1711475741.508987 | Christopher Simmons |
Christopher Simmons DOB: 1989-05-09 (38 yo M) Acc No. CR274759
2021-07-06, 9:09 AM
Christopher Simmons DOB: 1989-05-09 (38 yo M) Acc No. CR274759 DOS: 2021-03-01
Savani, Rajendra
JAX
38 Y old Male, DOB: 1989-05-09
Account Number: CR274759
SPINE&PAIN
1329 SOARING FLIGHT WAY, JACKSONVILLE, FL-32225-6828
CENTERS
Insurance: BCBS OF NORTH CAROLINA Payer ID: 59201
PCP: Unknown Referring: Referred Self
Appointment Facility: JAX SPINE & PAIN CENTERS
2021-03-01
Follow Up: Courtney Delaparte, APRN
Reason for Appointment
Current Medications
1. Neck pain
Taking
2. Low back pain
Tylenol 325 MG Tablet 1 tablet as
needed Orally every 4 hrs
History of Present Illness
Medication List reviewed and reconciled
HPI Neck:
with the patient
Respiratory:
Shortness of breath denies.
Vital Signs
Wheezing denies.
Pain scale: 8, Ht: 65 in, Wt: 185 lbs, BMI: 30.78 Index, Temp: 97.8 F, HR:
Cardiovascular:
63 /min, BP: 140/87 mm Hg, Oxygen sat %: 98 %.
Chest pain denies.
Palpitations denies.
Examination
Gastrointestinal:
General Exam:
Blood in Urine denies. Blood in
Constitutional no apparent distress, , well developed, well nourished.
stool denies. Change in bowel
Orientation alert oriented to time, oriented to place, , oriented to person.
Progress Note: Courtney Delaparte, APRN 2022-24-10
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
Christopher Simmons DOB: 1989-05-09 (38 yo M) Acc No. CR274759
Page 8 of 166
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711475620.870354 | Katherine Gibson |
V
VITRO MOLECULAR
LABORATORIES
www.vitromolecular.com
Patient Name: Katherine Gibson
Physician: Robert Jacobson, MD
Accession #: S22-04715
Sex: Male
Specialty Group: The Gables Surgical Center
Collected: 28-09-2018
DOB: 21-04-1986 (21)
Received: 28-09-2018
Reference #: S22-04715
CC:
Reported: 22-11-2014
Surgical Pathology Report
Clinical History
Previous Vitro pathology report:
*S21-12983, 12-09-2018 A)Lumbar disc, L4-5; discectomy:Cartilage and disc material with degenerative changes;
*S21-15703, 24-12-2023 A)Disc, C4-C5, discectomy:0 Cartilage with degenerative changes
DIAGNOSIS
A. DISC L4-5:
- Fibrocartilaginous tissue with degenerative changes
- Negative for atypia or malignancy in this sample
Images
Gross Description
A. Received in formalin there are multiple white fibrocartilaginous tissue fragments measuring 2.5 X 2.0 X 0.3 cm in aggregate. Specimen is submitted in
toto in one green cassette. IG/rms
Electronic Signature Hadi Yaziji, M.D.
CPT Code(s): 88304 (1)
***
END OF REPORT
E-MAILED
09-10-2020
Vitro Molecular Laboratories
8700 West Flagler Street, Suite 100, Miami, FL 33174
Tel: 305-267-7979
Fax: 786-513-0175
CLIA: 10D1055514
Page 1 of 1
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711477090.173147 | Scott Garcia |
PVHC at Pomona - Primary Care
1770 North Orange Grove Avenue, Suite 101
Pomona, CA 91745-
Patient:
Scott Garcia
MRN:
000267345
Date of Service: 07/08/15
FIN:
545854745
Provider:
Laura Smith, Mohamed Yehia
DOB/Age/Gender: 03/11/90 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: Elaine Lee
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: 45364045
Page 28 of 145
Print Date/Time: 28/10/20 10:12 PDT
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711477090.812423 | Brittany Mendoza |
06-02-2022 19:59:15 EDT
To: 195222268622
Page: 03/622
From: Lauris Rigdon
Patient Self-Report
Patient Assessment/Diagnosis
History of Present Condition:
Patient presents with acute LBP and right hip pain that
presents with acute low back and right hip pain following
started on May 20th following elevator accident. Functional
accident that occurred on May 20th. Pt explains that she was battling with
established with patient input.
allow patient to return to prior level of function,
independence and safety.
Onset Date: May 20th
Comorbidities:
- Psychosocial: Battling with high anxiety, difficulty talking
about accident
- Car accident in with back pain and left shoulder (2007)
e Currently experiencing excessive vaginal bleeding (being
monitored by OBGYN)
Pre Morbid Level of Function:
- Independent prior to injury
Current Level of Function/Current Deficits:
- Unable to get into/out of car without onset of pain
- Unable to stand for prolong periods of time
- Unable to walk her dog due to fear of worsening
symptoms.
Work tasks: Desk job at home, mostly on the computer
Sleep disturbance: Reports no change in sleeping pattern
Imaging:
X-ray: no abnormal findings.
CT scan of abdomen and pelvis: results pending
Red flags: Pt denies all red flags including but not limited to
weight loss/gain > 10
Patient John Peters (DOB: 11-28-1985)
Treated by Jennifer Flores, PT. DPT
DOS: 08-23-2018
Page 2 of 22 of Plan of Care
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711472786.860083 | Kenneth Hoffman |
Virginia Cancer
Specialists
Specializing in Cancer and Blood Disorders
LOCATION: VCS Loudoun
PATIENT: Kenneth Hoffman
MRN: 359968
birthdate: Nov 16, 1984
ATTENDING PHYSICIAN: Dr Andrew Tran
Date of Service Oct 03, 2014
REASON FOR VISIT
Non-Hodgkin's lymphoma/lymphadenopathy
HPI
60-year-old lady admitted to Reston Hospital with enlarged neck lymph nodes.
INTERVAL HISTORY
Developed a rash all over her body with itching after her discharge. No fevers.
PAST SURGICAL HISTORY
Right sided neck lymph node biopsy
REVIEW OF SYSTEMS
15 systems review detailed below is negative unless otherwise indicated
Constitutional: No weight loss, No fever, No chills, No night sweats. Energy level good
Eyes: No diplopia, No transient or permanent loss of vision, No scotomata
ENT/Mouth: No epistaxis, No dysphagia, No hoarseness, No oral ulcers, No gingival bleeding. No sore throat, No postnasal drip, No
nasal drip, No mouth pain, No sinus pain, No tinnitus, Normal hearing
09/19/2023
Page 1 of 3
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711473365.938144 | John Moran |
Date 16/08/01
Occupational Health A Northbay Affiliate
Page
]
1101 B. Gale Wilson Blvd, Suite 203
Fairfield, CA 94533
(743) 643-4430. Fax: (743) 436-4431
Work Status Summary
Provider:
Lederer, Sheila PA
Visit Date:
19/05/01 Time In: 9:22AM Out: 10:23AM
Purpose:
Worker's Comp Follow Up
Presenting Problem
DATE OF INJURY:
21/05/24
Case Number: 2043-04302
Diagnosis
E885.9
Ulcerative Colitis
Visit Referrals
Referred To: A Referral
Date: 6/22/12
Referred To: A Physician Referral - NOS
Date: 6/22/12
231
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711477275.548579 | Erica Williams |
Patient Portfolio
Page 2 of 56
Ordering Dr: William Higgins
Patient Status: REG ER
Attending Dr:
Admit Service Date: 2017/25/11
Signed by: Hanisch, Ryan J Signed on: 2022/19/08 15:58
http://spohnpacshrsd.christushealth.org/WPP/ShowReport.asp
2016/26/05
76756-3
South Texas Bone & Joint - 00456
| what is the service date or date of service? | {"text": ["2017/25/11"], "answer_start": [129]} |
id_1711475444.906376 | Travis Cannon |
Travis Cannon DOB: 1995-19-01 (49 yo M) Acc No. 64590
2021-26-10
Travis Cannon DOB: 1995-19-01 (49 yo M) Acc No. 64590 DOS: 2016-02-01
LA Health Solutions
Initial Visit Chiro-MVA
Patient: Travis Cannon
Provider: Matthew Laudun, D.C.
DOB: 1995-19-01 Age: 49 Y Sex: Male
Date: 2018-03-10
Reason for Appointment
1. Severe constant, throbbing headaches, low back and neck pain
History of Present Illness
Patient Subjective:
Pain (Dolor):
Region: Head (Cabeza), Neck (Cuello), Right trap (Trapecio Derecha), Upper back (Espalda Arriba), Mid back
(Espalda Media), Low back (Espalda Baja), Sacrum(T. Bone)/Sacro (hueso de la Cola), Left Hip (Cadera
Izquierda), Right Hip (Cadera Derecha), Right shoulder (Hombro Derecha), Right Elbow (Codo Derecha)
Mechanism of Injury:
Accident Information:
Injury/Treatment Information
Date of injury: 2021-06-02
Did this injury occur while on the job? No
Parish where accident occurred: Orleans
The pain began That day
Treatment: Patient did not receive treatment following the accident prior to visiting our office
Diagnostic imaging was not performed.
Previous injury to affected areas was not reported.
Travis Cannon DOB: 1995-19-01 (49 yo M) Acc No. 64590
Page 25 of 47
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711473238.975319 | Kevin Floyd Jr. |
DIS Slidell
RE2170526
1310 Gause Blvd
Slidell
LA 70458
Phone: 542-788-9773
Fax: (531) 831-5314
RELEASE OF INFORMATION
AUTHORIZATION TO USE & DISCLOSE PROTECTED HEALTH INFORMATION
Date 08/2015/28
Pt ID: CIS231346
Acct #
Last Name: GARIBALDI
First: JUSTIN
MI:
birth date: 03/1993/17
Patient Address: 208 N SILVERMAPLE DR
SLIDELL
LA
70318
Patient Phone: (504) 316-8315
I specifically authorize the use and/or disclosure of the following highly confidential information: Mental health, HIV results,
AIDS information.
Signature:
I
HAVE READ THE ABOVE AND AUTHORIZE THE DISCI OSURE OF THE PROTECTED HEALTH INFORMATION AS STATED:
Signature of Patient/Guardian/Representative
02/2019/28
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711476893.318883 | Mark Stafford |
Apr 26, 2019 9. 22:29 AM. - NorthBay Health System 707-646-5000 Page 3 of 72
1101 B. Gale Wilson Blvd, Suite 100 Fairfield, CA 94533 (707) 646-4646
Magnetic Resonance
/
m
a
Exam Date/Time:
Exam:
Accession Number:
Ordering Physician:
Feb 25, 2022 09:26:3"
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.
DT: Jul 11, 2019 (1226 hours)
Final Report ***
Dictated by: Lisa Schultz N., M.D.
Signed by: Amanda Williamson, M.D.
Transcriptionist: McGraw, Tena
Aug 01, 2015 12:01
Paient
Name: Mark Stafford
Medical Record No: 608698
Financial No: 80107287
DOB: Jun 16, 2003 Age: 26 years Gender Male Pt Type: Outpatient
Diagnostic Imaging
Admit Date: Nov 08, 2020
Ordering Physician: Kitchens. Charles, M.D.
Solano Imaging Medical Associates
Lisa Schultz, M.D.
Amanda Williamson, M.D.
William N. Gonser, M.D.
Printed Apr 26, 2019 at 9:21 AM
Page 2 of 72
172
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711471328.882673 | Richard Jacobs |
Encounter #
MR#
Enc Start Date Time
Pt Location
72781384366
5558890
2022 May 13 07:11
ADLT ED Waiting Indy
ECD#
Level of Care
Clin Svc
EPT
Enc Type
4114296004
Other
EMR
ER
OP
City Health Clinic
Preferred Language
Admit Source
Confidential
Infectious Disease
English
Phys Ref
Email
Admit Type
Incident Date
Incident Type
prettygang222@gmail.com
Emergent
Advance Dir:
Race:
Soc Sec #
Gdr
MS
No
Black
F
S
Age
dob
Religion\ Church
Adm Clerk
81Y
1989 September 03
COG \ UKN
016
Patient Address, Phone
Employer Name, Address, Phone
Emplm Sts, Class, Cat
Richard Jacobs
EXTENDED STAY AMERICA
Empl
7165 John Extensions
East Molly, LA 12421
Indianapolis, IN 46254
County: Marion
Home: 812-851-6656
Day:
Cell: 413-637-4729
Guarantor Name, Pt Rel, Address, Phone
Guarantor Empr, Address, Phone
Empim Sts, Class, Cat
Richard Jacobs
Self
EXTENDED STAY AMERICA
Empl
Phone: 317-298-0651
317-514-7862
Emergency Contact 1
Emergency Contact 2
Richard Jacobs
PO Box 1575
Authorization #
Eligibility #
1989 September 03
Primary Physician
Reason for Encounter
Dr Michael Castillo
HBS
Admitting Physician
Copy to Physician
Emergency, Indianapolis
Attending Physician
Emergency, Indianapolis
Printed: 2017 January 17 7:20
User: jdunl614
02A
4118867004
SVI 0061
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711471329.898118 | Adam Huffman |
Primary Physician: Dr Jamie Chambers
patient: Adam Huffman DATE OF BIRTH: 01/08/31
Sex: Female Tel: 214-487-2549
Report Name: OPERATIVE NOTE
Report Status: Signed
REPORT
17993 Davidson Fields
Whiteview, KY 56393
ACCOUNT #:
X0004963852
SEX:
F
MED RECORD #:
X468788
DEP SDC
ATTENDING PHYS:
Dr Jamie Chambers MD
ADM DATE:
22/09/01
REPORT TYPE:
OPERATIVE NOTE
DIS DATE:
22/10/01
JN:
401197
Date of Service: 14/07/13
SURGEON: Dr Jamie Chambers, M.D.
ASSISTANT: Darlene Valdez, licensed first assist.
ANESTHESIA: General endotracheal anesthesia.
PREOPERATIVE DIAGNOSES: Diverticulitis.
POSTOPERATIVE DIAGNOSES: Peptic Ulcer.
PROCEDURE: Right shoulder decompression.
ANTIBIOTICS: Vancomycin
COMPLICATIONS: None.
CULTURES: None.
WOUND: Clean.
SPECIMENS: None.
ESTIMATED BLOOD LOSS: Minimal.
INTRAVENOUS FLUIDS: Less than 1000cc.
IMPLANTS: Multiple free FiberWire sutures.
DISPOSITION: Patient transferred to the PACU in stable condition.
DIAGNOSIS CODES: I10
CPT codes: 68788.
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711476578.224773 | Carly Perez |
athena
2016/13/10 2:12:31 pm EDT
:1b38234-d76e-4d00-bbb4-176b27d36417
Page: 12/12
OTOLARYNGOLOGY CONSULTANTS Hagen Ranch Rd, BOYNTON BEACH FL 33412
OWENS, Shannon (id #131224, dob: 11/17/1976)
OTOLARYNGOLOGY CONSULTANTS, BOYNTON BEACH FL 33437-3776
OWENS, Shannon (id #131224, dob: 11/17/1976)
University of Miami 2021/09/10 11:27:03 AM PAGE
2/012
Fax Server
Christine Murphy (MRN21770122)
University of Miami Health System
Health Imaging Services at Plantation
8120 SW 10th ST
PLANTATION, FL 33312
Final I maging Result
Name:
MRN
DOB:
Sex:
Christine Murphy
21770252
1997/08/07
Female
Procedures Performed
Exam Time:
Patient Class:
Diagnosis
CT Sinus Facial Bones W/O Contrast 05/24/2022 7:50 AM
Outpatient
Chronic sinusitis,
unspecified
Final
EXAMINATION: CT SINUS FACIAL BONES wo CONTRAST
EXAM DATE AND TIME 2021/15/12 7:53 AM
INDICATION: Chronic sinusitis.
COMPARISON: None available
TECHNIQUE CT imaging of the nasal cavity and paranasal sinuses with
axial, sagittal and coronal reformats was obtained without contrast.
FINDINGS:
The frontal sinuses and frontal recesses are well-aerated
The ethmoid air cells are well-aerated.
IMPRESSION:
Tue May 24, 20Exam Date 11:26 AM
Page 1 of 12
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711476767.092136 | Christina Barry |
2015/03/02 02:58 PM
TO: :16103548980 FROM 8333674980
Page: 80
SIMONS, CHARLES
TAMPA BAY
C11920 DOB:1998/29/01
SURGERY CENTER
CASS
Brittney Walker MD
SELFPAY
Perception of Care - Post-Op Telephone Call / Follow-up Information
PATIENT PHONE # xxxxxx
Caregiver: Sherry
Date of Service: 2023/30/07
Procedure: Leftc34 laminotomy
+ Bilat Cervical & Lumber
laser ablations
Comments/Narratives
1. Nausea/Vomiting
2. Fever >100掳
3. Swelling/Numbness/Tingling/Redness
4. Difficulty walking/resuming activities
5. Drainage from incision
If yes, narrative
6. Any catheters or drains?
Type
7. Pain level
(Circle One) No Pain=0 123456789 10=extreme pain
8. Postoperative complications?
Yes
No
N/A Reported to:
Comments:
Spoke with
No Answer
Date: 2015/03/02 Initials: a
Left Voicemail Message
Other
Patient Satisfaction Questionnaire completed
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711477090.475345 | Wayne Prince PhD |
CASA COLINA
Hospital and Centers for Healthcare
PERSONAL PHYSICIAN PREDESIGNATION FORM
I, the undersigned employee, in case of an industrial injury or illness, elect to receive medical
treatment from my personal physician.
I understand that Labor Code Section 4600 defines my "personal physician" as my "regular
physician and surgedn" who has previously directed my medical treatment and who retains my
medical records, including medical history.
Diana Barker
Employee Name:
Department:
Imaging
Elm
Date:
2015-10-01
Employee Signature:
Check one:
do not choose to designate a personal physician
do choose to designate a personal physician, see below
S:/Human Resources/FormsPersonalPhysicianPredesignationForm
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711473530.852143 | Elizabeth Mosley |
<<Back to Review>>180298-26-HYPERLINK-Hyperlink-Page
213
Work Wellness
2018 Nov 09
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: 1996 Jan 29
28790
SIGNATURE Jennifer S Wong DO on 2016 Dec 11 at 5:55 AM
000213
0213
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711475955.484566 | Edward Thompson |
2022-24-06 02:58 PM
TO: 16103548946 8333674968
Page: 60
account
No:
118562
CITRUS
Edward Thompson
CARDIOLOGY
32 Y old Male, DOB: 1994-19-01
Consultants, P.A.
Account Number: 6329746
1138 CR 457, LAKE PANASOFFKEE FL-33538-5314
www.citruscardiology.org
Guarantor: Simons, Sherry D Insurance: HUMANA MEDICARE HMO
PCP: Cathlen S Delva, M.D.
Appointment Facility: Citrus Cardiology - 308 Inverness
2020-04-12
Progress Notes KACI DYMOND
Current Medications
Reason for Appointment
Taking
1. 6 Month F/U
Propranolol HQ ER60 MG Capsule Extended
Edward Thompson
M 32
Release 24 Hour 1 capsule Orally Once a day
2. Pt denies any new cardiac concerns
DOS : 2018-21-06
DOB: 1994-19-01
Xarello 20 MG Tablet 1 tablet with food Orally Once
Assessments
Acct C11920
a day
Medication List reviewed and reconciled with the
1. Paroxysmal a-fib - 148.0 (Primary)
PrimProv: Prada, Stefan, MD
patient
2 Cardiomyopathy - 142.9
3. Medical History
Past
appendectomy
8. Permanent atrial fibrillation - 148.21
hernia repair
lapband
To: 360 Ortho and Spine, Subject: Progress Notes, Fax#: 833-367-4968 SendDate: 2022-24-06 page 1/3 [-ufg2.4.1.12in]
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711476578.25327 | James Jenkins |
athena
02/07/22 2:37:31 pm EDT
c1b3154-d76e-4d15-bbb4-176157d36415
Page: 26/29
OTOLARYNGOLOGY CONSULTANTS . 10115 Hagen Ranch Rd
OWENS, Shannon (id #131524, dob: 24/05/03)
OTOLARYNGOLOGY CONSULTANTS * 10150 Hagen Ranch Rd
OWENS, Shannon (id #131524, dob: 24/05/03)
University of Miami 5/24/2022 11:27:03 AM PAGE
37.003
Fax Server
owens Shannon (MRN21770252)
Right maxillary sinus mucus retention cyst.
I personally reviewed the images and the resident's/fellow's findings and
agree with the final report
Reading Radiologist: Saraf-Lavi, Efrat, MD
Matto, Eduardo Felipe, MD
Signed By: Efrat Saraf-Lavi, MD on 05/02/20 11:23 AM
Ord Prov:
Vengerovich, Gennediy
Address:
115 SE 15 Avenue
Ft Lauderdale FL 33301-3985
Tue May 24, 2022 11:26 AM
Page 2 of 2
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711477183.189704 | Lisa Blevins |
DIS Slidell
Page 1 of 26
DIAGNOSIK IMAGING SERVICES
PATIENT NAME: Nathan Schneider
PATIENT ID #: 265726
BIRTHDATE: 16 Feb 1990
ORDER #: CIS650126
GENDER: Male 9858179xxx
DATE OF SERVICE: 21 Feb 2023 12:35 PM
AGE: 71 y
ORDERING PHYSICIAN: Dhadha, Rommel
EXAM DESCRIPTION:MRI, Lumbar Spine s/ Contrast
STUDY
MRI, Lumbar Spine s/ Contrast
CLINICAL INDICATION
Back pain with lumbar radiculopathy on the right
COMPARISON
No relevant imaging examinations are available for review.
PROCEDURE DETAILS
Multiplanar multisequence images were performed on a 1.5 Tesla magnet.
FINDINGS
There is normal alignment throughout the lumbar spine. The height of the vertebral bodies and
disc spaces are maintained. There is disc desiccation however at L5-S1. The distal cord
terminates at T12-L1 and appears unremarkable.
At L1-L2, there is no disc protrusion, disc extrusion, lumbar stenosis or foraminal restriction.
At L2-L3, there is no disc protrusion, disc extrusion, lumbar stenosis or foraminal restriction.
At L3-L4, there is no disc protrusion, disc extrusion, lumbar stenosis or foraminal restriction.
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711477090.747621 | Joshua Davis MD |
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
12-01-2018
JabaraMayer
Service Date: 01-01-2021 12:00:00 PM
Released:
12-01-2018 9:28:06 PM
This document was printed from PIMSY EMR System It contains protected health information (PHI).
DOS: 03-26-2023 12:00:00 PM
Shauna Becker (B-C-14860)
B-C-14860-60557
12-01-2018
Date Of Birth
01-01-1990
Gender:
Female
CLIENTNUMBER B-C-14821
Page 3 of 21
| what is the DOB or date of birth? | {"text": ["01-01-1990"], "answer_start": [694]} |
id_1711475190.544619 | Richard Gonzalez |
Richard Gonzalez
MRN: 5572573
Preferred Pharmacy (continued)
Referral (continued)
Order
MRI ARTH SHOULDER W/ CONTRAST RIGHT [676335615]
signature: Dennis S Frerichs, PA-C on October 06, 2015 0579
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 July 03, 2015
Screening Form
General Information
patient name: Richard Gonzalez
MRN: 5572573
birthdate: January 08, 1998
Mobile: 557-957-4579
Sex Assigned at Birth: Male
MC ROCKWOOD MAIN CLINIC Richard Gonzalez
- SPOKANE
MRN: 5602313, birthdate: January 08, 1998, Sex: M
400 East 5th Ave
visit: September 18, 2014
Spokane WA 99202-1334
Page 89
Printed by 414221 at 7/17/23 9:40 AM | What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711477275.278368 | Lindsey Becker |
LAB* 10/04/2022 (#5480023, 09/27/2022)
LAB ACCESSION #
LAB ORDER NUMBER
REPORT STATUS
9223 Wall Street
WY019923
Partially
SW014574001423
Austin, Texas 78754
Completed
CLINICAL PATHOLOGY
(800)59xxxx
PATIENT NAME
PATIENT ID.
LABORATORIES
(800)595xxxx
David Wise
145741009231
PATIENT PHONE
SEX
D.O.B.
AGE
(361) 227xxxx
Female
06/12/1990
69 Years
PHYSICIAN NAME
IS FASTING?
MASCIALE, JOHN
Unknown
ACCOUNT:
ACCOUNT #
COLLECTED
ORDER RECEIVED BY LAB
SOUTH TEXAS BONE AND JOINT
14574
28/05/2017 14:10
09/27/2022 19:32
601 TEXAN TRAIL
REPORTED
PRINTED
CORPUS CHRISTI, TX 78411
24/12/2015 14:32
09/29/2022 13:08
Test
Within Range
Outside Range Units
Reference Range
Lab
CULTURE, MRSA
SEE NOTE
MAIN
CULTURE, MRSA: PENDING
CULTURE, URINE
SEE NOTE
MAIN
CULTURE, URINE
Page 1 of 23
76723-3
South Texas Bone & Joint - 00023
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711473365.459801 | Jennifer Collins |
MAY-02-2017 12:47 From:
2092165909
To: 2163365
Page: 3/4
Date: 5/1/2017 Time 12:10 PM To: 5123,6909,50125126 @ 12122112909
Page: 001
CRUM & FORSTER
common
1100 Town and Country Road Suite 550
Orange, CA 92868
1 1 812 129 9129
F +1 812 122 5121
5/1/2017
RE:
Employee:
Jennifer Collins
Employer: SUPER STORE INDUSTRIES; MID VA
INJURY DATE: 17 Jan 2022
Dear Patrick Guerrero, D.O.,
The request for medical treatment for the above referenced patient was received on 4/28/2017 and a decision was
made on 5/1/2017.
Please do not staple your billing documents.
Sincerely,
NANCY TURCIOS
Enclosed: Proof of Service
001248
0128
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711475190.612064 | Kristin Banks |
May. 15. 2023 2:57PM
No. 1285
P.
16
11/24/2023 1/:01
Conway Medical Center
RRD 18775489/21
2/3
Conway Medical Center
300 Singleton Ridge Road
Conway, SC 29526
CMC
(843) 347-7111
Patient:
Kristin Banks
MRN;
628202856
Admit:
08/15/10
DOB/Age/Sex: 04/89/02
58 years
Female
Admilting: Johnson, MD, Donovan
Magnetic Resonance Imaging
Accession
Exam Date/Time
Exam
Ordering Physician
Patient Age at Exam
MR-28-0028274
21/20/04 16:13 EST
MRI Lower Joint w/o
Johnson, MD, Donovan 18 years
Contrast Right
Report Request ID: 22428010
Page 1 of 2
Print Date/Time: 2/24/2023 17:01 EST
| what is the admit date or admission date? | {"text": ["08/15/10"], "answer_start": [260]} |
id_1711473237.83722 | Danielle Wolfe |
Electronically signed on 04-02-2019 6:37:19 PM America/New_York by Dr Teresa Gordon MD, MD.
PATJAN_27730771_New Brain Spa Progress Note.pdf
Page | 4 of 4
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711475190.548818 | Stephanie Vasquez |
Stephanie Vasquez
MRN: 5612613
Preferred Pharmacy (continued)
Referral (continued)
Order
MRI ARTH SHOULDER W/ CONTRAST RIGHT [676335615]
Electronically Signed by: Dennis S Frerichs, PA-C on 2023-09-23 0619
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 2021-01-18
Screening Form
General Information
Patient: Stephanie Vasquez
MRN: 5612613
birthdate: 1994-09-30
Mobile: 561-961-4619
Sex Assigned at Birth: Male
MC ROCKWOOD MAIN CLINIC Stephanie Vasquez
- SPOKANE
MRN: 5602313, birthdate: 1994-09-30, Sex: M
400 East 5th Ave
visit: 2018-01-08
Spokane WA 99202-1334
Page 89
Printed by 414221 at 7/17/23 9:40 AM | what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711475620.637348 | Gregory Clark |
Gregory Clark DOB: 1986 Feb 25 (38 yo M) Acc No. 37297 Doc Name: 2018 Aug 10 Inj
LA Health Solutions
PATIENT CONSENT FOR
VIDEOTAPING/PHOTOGRAPHING PROCEDURE
Gregory Clark
1986 Feb 25, 37297, male
I
( Patient') hereby consent to and
authorize LA HEALTH SOLUTIONS, L.L.C. ( LA Health Solutions) to videotape or
photograph the above-noted Procedure and retain a copy of said videotape/photograph (s)
in my patient record It is my understanding that such videotape/photograph (s) will be
made a part of my patient record and shall be subject to the Privacy and Security
regulations contained in the Health Insurance Portability and Accountability Act of 1996
( HIPAA ').
Except to the extent action has already been taken in reliance on this consent, this
consent may be revoked at any time by submitting a written notice to Louisiana Health
Solutions, L.L.C., 56634 Bosworth Street, Slidell, Louisiana 70458.
Date: 01-21-2023
PATIENT Signature
Relative signature
Name:
Date:
S
LAHS employee signature
Date:
2016 Dec 30
Gregory Clark DOB: 1986 Feb 25 (38 yo M) Acc No. 37297 Doc Name: 2018 Aug 10 Inj
Page 73 of 134
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711476767.95444 | Stephen Macias |
From: XcBee Records. LLC Fax:
To:
Fax: (863) 682xxxx
Page: 1 of 70
25/10/20 11:03 AM
2nd attempt 13/12/15
Please confirm once received at ccenina@xebee.com/ 720xxxxxxx
XeBee Records
4475 E. 74th Ave., Suite 203
Commerce City, CO 80022
XeBee
Phone: 855xxxxxxx
records
Fax: 866xxxxxxx
REQUEST ID: 617170
New Hope Chiropractic Center
4788 South Florida Ave.
DATE of REQUEST: 25/10/20
Lakeland, FL 33813
Phone: (863) 682xxxx
Fax: (863) 682xxxx
emailed
REQUEST FOR:
Medical Records and Itemized Billing Statements
ff 25/10/20
We are requesting materials on behalf of Abrahamson and Uiterwyk for the following individual:
Patient: Witter, Grace
Date of Birth:
15/11/95
Alias/AKA:
Date of Death:
DATES OF SERVICE: 06/11/18 to Present
Instructions:
Please send all medical records and itemized billing (including CMS-1500/UB-04 forms) for the time period above.
Confidentiality Notice
These documents contain confidential information that is legally protected under federal HIPAA law. If you are not the
intended recipient please contact us immediately.
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711473530.696332 | Christopher Gates |
<<Back to Review>>110210-41-HYPERLINK Hyperlink-Page
16
From icampusano 1.810.310.8105 Tue Oct 4 18:40:18 2022 EDT Page 26 of 106
Ronald Fujimoto DO
Physical Medicine and Rehabilitation
Apr 01, 2019
RehabOne
RehabOne Programs
-
PRESCRIPTION- Industrial
patient name: Christopher Gates
DATE OF EXAM: 27 March 2023
Supervising Physician: Ronald Fujimoto DO
Performing Provider: Dr Katherine Huynh MD
Krewark
MD
Dr Katherine Huynh MD
Today's Date: 04/01/2019
RehabOne Medical Group, Inc.
Mailing Address: 13980 Blossom Hill Rd. Ste. B, Los Gatos, CA 95032
Phone: 410-410-8100 Fax: 410-410-0105
Providers' CA License Numbers:
Michael Post, MD - G71017
Ronald Fujimoto, DO - 20A6104
Allen Kaisler-Meza, MD - G74106
page 11
000016
0016
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711472787.237928 | Crystal Lamb |
date of visit: 2014-07-16
Page 2 of 3
Name:Crystal Lamb
DATE OF BIRTH:1987-04-03
Vitals - PULM
Recorded: 2016-10-06
11:5PM
Systolic
111
Physical Exam
Constitutional: no acute distress
Cardiac: normal s1, s2
Procedure
EXAM: 28883313 - CT CHEST - ORDERED BY: DENA M DAGLIAN
DATE OF PROCEDURE 2016-03-25
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.
540 Community Drive " Manhasset, NY, 15401Tel (546) 545-5543 Fax (554) 545-5543
| what is the DOB or date of birth? | {"text": ["1987-04-03"], "answer_start": [80]} |
id_1711476990.514218 | Victoria Rodriguez |
2018 January 16 10:13:54
Oklahoma Spine 4058789415
11/15
Page 15
PATIENT NAME Heather Ford
MR#: M000143715
ADM DATE: 2015 April 11
DOB: 1990 November 12 SEX: M
10:50 AM
DC DATE: 2015 May 11 01:20
ATTENDING PHYSICIAN: Jacob Hogan, M.D.
PM
2. Continue on present medications.
3. Return for followup appointment within I to 2 weeks to check on response to the
injection or to repeat the injection or to proceed for RF ablation and to make any
necessary medication adjustment and determine subsequent treatment steps.
Electronically signed at 2019 March 16 7:08
AM (GMT -5)
Khali
Khan
MA
Jacob Hogann, M.D.
KK epins
Dietated: 08.16.2023 01:48 PM Transcribed: 2022 January 12 05:53 AM Doc: X161565
CC:
Muhammad M Gillan, M.D.
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711477090.665188 | Barbara Ferguson |
60001 2
SS
ethos laboratories
Lab Director: Leon Glass, Ph.D. NRCC, DABCC
Help Line: (877)98451 Fax: (877)98451
Patient ID: PT098451.PPITR
Patient Information
Provider Information
Specimen Information
PATIENT NAME:
Barbara Ferguson
CLINIC NAME:
Pacific Pain Institute TR
DATE COLLECTED:
July 14, 2018
D.O.B.:
July 04, 1998
PROVIDER NAME:
Mr. Timothy Sanchez MD
TIME COLLECTED:
09:35:00
HEIGHT:
0
CLINIC ADDRESS:
2410 Merced St
DATE RECVD:
March 05, 2023
WEIGHT:
0
CLINC PHONE:
(510)98451
REPORT DATE:
October 16, 2020
GENDER:
M
CLINIC FAX:
(510) 98451
SAMPLE I.D. #:
1413
ethos laboratories SNAPSHOT
.. ethos laboratories SNAPSHOT gives the healthcare provider a clear look at any inconsistant results based on the information submitted For complete reports for all screens please see following pages.
936
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475190.053419 | Phillip Pierce |
NOVANT
Novant Health Orthopedics &
Phillip Pierce
N
Sports Medicine
MRN: 55024507, date of birth: 1996 Jul 18, Sex: M
HEALTH
7210 Village Medical Cir
Visit Day: 2020 Feb 22
Ste 110
CLEMMONS NC 25012-8509
03/21/2023 - Ancillary Procedure in Novant Health Orthopedics & Sports Medicine (Clemmons)
(continued)
Imaging (continued)
XR Pelvis And Right Hip (Final result)
SIGNATURE: Karen M Wulf, RN, BSN on 2023 Dec 20 1533
Status: Completed
This order may be acted on in another encounter.
Ordering user: Karen M Wulf, RN, BSN 03/21/23 1533
Authorized by: Bradley S Taylor, PA-C
Ordering mode: Standard
Frequency: Routine 03/21/23 -
Class: Clinic Performed
Quantity: 1
Lab status: Final result
Instance released by: Jennifer M Bumgarner, RT 3/21/2023 3:33 PM
Diagnoses
Status post right hip replacement [Z50.641]
Testing Performed By
Signed
Electronically signed by Andrew Deibler, MD on 3/29/23 at 1501 EDT
Generated on 4/11/23 8:32 PM
Page 19
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711475956.107988 | William Kerr |
OrthoSC . 210 Village Center Blvd., MYRTLE BEACH SC 29579-6706
William Kerr (id #74640, dob: 1992 Mar 10)
Order Groups
Order Group Summaries
1. Cervical radiculitis
M54.12: Radiculopathy, cervical region
EPIDURAL STEROID INJECTION, CERVICAL (PROC) Order SUBMITTED (no result received) - Send To: PAIN-CF Note to
Provider: 62321, J0702 X 4, A4550
Location: C6-7 Midline
Date of surgery/procedure: 2020 Sep 13
Place of service: OFFICE
Procedure Orders
Pre-Op Orders
2017 Jan 16
From Provider
Place of Surgery
Pain-CF
PAIN-CF
210 Village Center Blvd Suite 150
MYRTLE BEACH, SC 29579-6706
210 VILLAGE CENTER BLVD SUITE 150
Phone: 843-353-3460
MYRTLE BEACH, SC 29579-6706
Fax: 843-353-3461
Phone: 843-353-3460
Ordering Provider: SCOTT SAUER, DO
Fax: 843-353-3461
Patient Information
Patient Name
William Kerr
Sex
F
DOB
1992 Mar 10
Age
25yo
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711475190.086985 | Alexis Perkins |
NOVANT
Novant Health Orthopedics &
Alexis Perkins
N:
Sports Medicine
MRN: 56124617, DOB: October 18, 1991, Sex: M
HEALTH
7210 Village Medical Cir
Visit: August 06, 2014
Ste 110
CLEMMONS NC 27612-8619
November 13, 2021 - Office Visit in Novant Health Orthopedics & Sports Medicine (Clemmons) (continued)
Clinical Notes Amb (continued)
SUBJECTIVE:
Jeffrey Craig Payne is a pleasant 66 y.o. male here today for scheduled postop follow-up evaluation.
Past Medical History:
Diagnosis
Date
ADD (attention deficit disorder)
Anxiety
Past Surgical History:
Procedure
Laterality
Date
Colonoscopy
October 21, 2016
Screening; adenoma 9/21/22; repeat 9/2029; Brian S Smith, MD (GAP)
Total hip arthroplasty
Left
02/2016
for aseptic necrosis + OA
Family History
Problem
Relation
Age of Onset
Cancer
Mother
breast and liver
Alzheimer's disease
Father
Social History
Generated on 4/11/23 8:32 PM
Page 21
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711473530.610145 | Emily Andersen |
KNMH EMERGENCY DEPARTMENT
Emily Andersen
180 W Esplanade Ave
MRN: 8278278, dob: 09/1989/09, Sex: M
Kenner LA 72765
Acct #: 82702782761
Adm: 01/2018/28
08/25/2022 - ED in Kenner - Emergency Dept (continued)
Medication Administrations
ibuprofen tablet 800 mg [827232722]
Ordering Provider: Dayna G. Toscano, NP
Status: Completed (Past End Date/Time)
ORDERED ON: 10/2020/21 1127
Starts/Ends: 08/25/22 1200 - 08/25/22 1127
Ordered Dose (Remaining/Total): 800 mg (0/1)
Route: Oral
Frequency: ED 1 Time
Admin Instructions: DO NOT CRUSH OR CHEW; SWALLOW WHOLE.
Discharge Orders (720h ago, onward)
None
ED Prescriptions
Medication
Sig
Dispense
Start Date
End Date
Auth. Provider
LIDOcaine (LIDODERM) 5 % (Expired)
Place 1 patch onto
7 patch
8/25/2022
9/1/2022
Dayna G. Toscano, NP
the skin once daily.
Generated on 10/3/22 11:37 AM
Page 28
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711475741.047255 | Margaret Stevens |
Margaret Stevens DOB: 1985-03-28 (20 yo M) Acc No. CR162734
[Doc Name: 2022-04-10 MRI LUMBAR SPINE]
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: Margaret Stevens
PATIENT ID: 8283873
REFERRING PHYSICIAN: AMY WU, PA-C
DOB:
1985-03-28
REFERRING PHONE:
DOS:
2021-06-19
REFERRING FAX:
EXAMINATION: MRI LUMBAR SPINE WITHOUT CONTRAST
GEORGE VEGA, MD
Electronically signed on: 2019-11-26 9:10:40 AM
Transcribed by: JN on: 2019-11-26 7:12:17 AM
L3-51
Page 2 of 2
Margaret Stevens DOB: 1985-03-28 (20 yo M) Acc No. CR162734
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711475741.367979 | Michelle Stanley |
THE GABLES SURGICAL CENTER
401 S.W. 42nd Avenue, Suite 201
Miami, Florida 33134
Tel: (305) 447-0882 Fax: (305) 447-0213
OPERATIVE REPORT
PATIENT NAME: Michelle Stanley
MEDICAL RECORD #: 3114897
DATE OF BIRTH: 95/11/10
PHYSICIAN: ROBERT JACOBSON, M.D.
DATE OF SURGERY: 18/03/14
and expanded filling the cavity fo disc space across midline and expanding the colipase to the right. that
the position was across the midline. This crossed the disc space. This was removed. Then, an OptiMesh
was placed in the disc space and then 3.5 pipettes of bone was impacted into the disc space.
X
Aldo Berti M.D.
JOB#: 537954 RJ: med: anu/nss/im DD: 23/12/04
DT: 23/12/04
OPERATIVE REPORT - PAGE 2 of 2
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711476990.486481 | Wendy Garcia |
2018-21-06 10:13:54
Oklahoma Spine 462 8789462
9/62
Summit
MEDICAL CENTER
OPERATIVE REPORT
PATIENT NAME: Abigail Alvarez MD
MR#: M006243762
ADM DATE: 2024-21-03
DOB: 1986-23-10 SEX: M
10:50 AM
DC DATE: 2024-20-04 01:20
ATTENDING PHYSICIAN: Amanda Walker, M.D.
PM
DATE OF OPERATION: 2020-13-09
PROCEDURES:
1. First diagnostic lumbar facet medial branch nerve block, right L4-L5, L5, and S1.
2. First diagnostic lumbar facet medial branch nerve block, left L4-L5, L5, and S1.
3. Flooroscopic imaging for needle placement.
4. IV medication for conscious sedarion was administered to the patient in my presence,
at my direction by an independent trained registered nurse for 23 minutes intraservice
time
RN: Joe Schwart. RN
Start time 1262 hours
Finish time: 1262 hours
REFERRING PHYSICIAN: Dr. Gillan
DIAGNOSIS: Chrome low back pain from lumbar spondylosis.
PATIENT POSITION Prone.
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711476990.455765 | Mark Vasquez |
06 February 2023 10:13:54
Oklahoma Spine 4058712900
4/19
Summit Medical Center
1819 Renaissance Blvd
Edmond OK 730133023
Phone: 405xxxxx Fax: 405xxxxx
Visit Note - Procedure
Provider: Kathryn Brown, MD
Encounter Date: 02 May 2018
Patient: Mark Vasquez (6475)
Sex: Male
DOB: 20 September 1994 Age: 55 Year
Race: Unreported/Refused to Report
Address: 171 Catfish Dr, Ponca City OK 12900 Pref. Phone(H): 918xxxxx
Insurance:
UMR (PP)
Insurance ID: 14012900
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 11 November 2017 at 03:27
PM.
Patient: Mark Vasquez
DOB: 20 September 1994 Visit: 11 September 2021
Page:
19
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711472591.396704 | Tammy Horton |
Salinas Valley
Tammy Horton
Medical Clinic
MRN: 3192366, DOB: 1999 December 22, Sex: F
SUPUS BALLEY MEMORAL REALINONA extra
Visit: 2014 December 15
2023 November 21 office Visitin DOD.Salinas - Abbott
Clinical Notes
Progress Notes
Schumann. Steven C. MD at 12/13/2021 0800
Author: Schumann, Steven C, MD
Service: Urgent Care
Author Type: Physician
Filed: 12/13/2021 8:53 AM
date of encounter: 2018 May 12
Status: Signed
Editor: Schumann, Steven C, MD (Physician)
service date:
[SS.1T]
2017 November 07 [SS.21
HPI:
[SS.1T]
Araceli Corona SS.2T] is [SS.1T] 19 y.o. female [SS.2T] [SS.1T]
HISTORY:
The following portions of the patient's chart were reviewed in this encounter and updated as appropriate:
MEDICATIONS:Ss.1T]
No Known Allergies
Current Outpatient Medications:
cyclobenzaprine (Flexeril) 5 MG tablet, Tak e 1 po hs for back pain. May increase ton 2 at bed time if needed and not
groggy in the morning., Disp: 20 tablet, Rfl: 1
Printed on 12/14/21 4:04 AM
Page 1
234
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711473237.427895 | Tammy Hall |
-0400
PAGE 2
OF 3
Massapequa Imaging
An Affiliate of Northwell Health
1220 Hicksville Road, Seaford, NY 11783 (516) 266-3456 (516) 266-3490
RAND RODGERS
PATIENT NAME:Tammy Hall
1000 NORTHERN BLVD
AKA: Tammy Hall
GREAT NECK, NY 11021
MR#: 12657083
EPI #: 3465708
D.O.B: 2000/05/10
AGE: 71Y FEMALE
Acc#: 57657083
EXAM: 57657083 - CT ORBITS - ORDERED BY: RAND RODGERS
PROCEDURE DATE: 2017/03/10
INTERPRETATION: CLINICAL INDICATION: Orbital fracture, ruptured globe thin axial series through
the orbits were obtained with coronal computer-generated reconstructed views.
Dr Austin Hudson MD; Attending Radiologist
Page 1 of 2
Date Printed: 6/20/2022 4:47 PM
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711472591.029554 | Christopher Mcmahon |
Gulf Coast Surgical Center LLC
Christopher Mcmahon
D.O.S: 27 January 2020 2:30:00 PM
ID / Visit: 48590 / 1
PATIENT INFO:
SEX: F
DATE OF BIRTH: 21 January 2003
AGE: 50
MAIN PHONE: 566-379-7497
ADDRESS: 034 Jimenez Valleys Apt. 894
Carolynmouth, ME 02615
RESPONSIBLE PARTY:
BUGGAGE,
NADINE
A
034 Jimenez Valleys Apt. 894
Carolynmouth, ME 02615
RSP SSN:
RSP OCC: TRMC
RSP PH: 623-567-5262
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
20 January 2017
1593
Witness
Date
Time
Signed
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475190.052262 | Alyssa Moore |
NOVANT
Novant Health Orthopedics &
Alyssa Moore
N
Sports Medicine
MRN: 52324237, Date of Birth: 03 April 2000, Sex: M
HEALTH
7210 Village Medical Cir
Date of Visit: 11 May 2014
Ste 110
CLEMMONS NC 22312-8239
03/21/2023 - Ancillary Procedure in Novant Health Orthopedics & Sports Medicine (Clemmons)
(continued)
Imaging (continued)
XR Pelvis And Right Hip (Final result)
electronically signed by: Karen M Wulf, RN, BSN on 25 September 2019 1533
Status: Completed
This order may be acted on in another encounter.
Ordering user: Karen M Wulf, RN, BSN 03/21/23 1533
Authorized by: Bradley S Taylor, PA-C
Ordering mode: Standard
Frequency: Routine 03/21/23 -
Class: Clinic Performed
Quantity: 1
Lab status: Final result
Instance released by: Jennifer M Bumgarner, RT 3/21/2023 3:33 PM
Diagnoses
Status post right hip replacement [Z23.641]
Testing Performed By
Signed
Electronically signed by Andrew Deibler, MD on 3/29/23 at 1231 EDT
Generated on 4/11/23 8:32 PM
Page 19
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711476767.587243 | Mary Hamilton |
2023 February 24 08:36
1
12
unknown
P 8/33
Laura Marquez
Coastal Neurology
Page:
7
610 Trenia Ann I
725 W Granada Blvd. Ste 22
Date: 2023 February 24
Orange City
FL
32763
Time:
Ormond Beach, FI 32174
7:50 AM
Patient: Patient ID is equal to 23633
Date: Service date of the Charge:
2018 March 28
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:
2018 January 07
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 operation? | {"text": [], "answer_start": []} |
id_1711472590.94713 | Nicholas Campbell |
04-20-2023
ORTHO SPORTS SPECIALISTS LOUISIANA
Page 1
Transaction History
Case # A - All Cases included
54063 -Nicholas Campbell
63411 Christopher Ranch Suite 093
South Courtney, MP 08130
Account Balance >
186.02
No Ser/Date Code
Description
PDr/IDr
Amount
Pmts
Adj
Ins/Bal
Pat/Bal
Bal
Balance Forward
0.00
1
2014 Jul 15
BD
BAD DEBT PAID
HIGG/HIGG
28.61
JASON HIGGINS, MI
Dr Christopher Poole, MD
2024 Jan 01
OFFICE/OUTPATIENT VI 99203
21.32
2024 Jan 01
X-RAY EXAM OF FOOT
76530
7.29
6 08-05-22
96514
OFFICE/OUTPATIENT VI
DUPL/DUPL 371.00
98.49
272.51
DX1 M65.812 - Spondylosis w/o myelopathy or radiculopathy, cervi
KEITH DUPLANTIS MD
DX2: M65.2 - Cervicalgia
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711471330.644623 | Michael Blair |
PATIENT
Michael Blair
Gender
Female
MR #
33293927974
DATE OF ADMIT/Time
21-08-21 7:11:00 AM
Reg #
004118867004
Visit Status
DSC
BIRTHDATE
88-01-18 12:00:00 AM
DATE OF DISCHARGE/Time
21-09-20 9:31:00 PM
1. Vital Signs Adult
19-05-27 02:00
Entered By
Heart Rate
Heart Rate Heart Rate (beats/min)
68
IM
beats/min
Comments :
Heart Rate Method
device
IM
Comments :
1/12/2023 12:47:18 PM
Page 327 of 101
SVI 0828
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711477182.932018 | Ronald Bush |
medications if possible to avoid further complications from escalating doses of opioids. The patient verbalized
understanding
PMP reviewed.
Discussed and gave patient information on plan of care.
Greater than 25 minutes was spent on patient evaluation, coordination of care, reviewing any lab/imaging findings,
and developing a plan of care at today's visit.
-Dr. Jolly present in clinic and agrees with the above note and plan. -MT
Services Ordered:
Left cervical TPI- Left upper trapezius, left rhomboids, and left cervical paraspinals.
UDS today 22/04/18
F/U 2 months
Prescription
Norco 7.5 mg-325 mg tablet 1 Tablet Once-Twice A Day PRN. Can fill 10/18/20 for 30 Days , Prescribe 45 Tablet
Norco 7.5 mg-325 mg tablet 1 Tablet Once-Twice A Day PRN. Can fill 11/16/20 for 30 Days , Prescribe 45 Tablet
tizanidine 4 mg tablet 1 Tablet At Bedtime PRN muscle spasms. for 30 Days , Prescribe 30 Tablet, Refills 1
Norco 7.5 mg-325 mg tablet 1 Tablet Once-Twice A Day PRN. Do not fill until 9/26/20. for 30 Days , Prescribe 45
Tablet
Norco 7.5 mg-325 mg tablet 1 Tablet Twice A Day PRN Pain. Do not fill until 10/01/20. for 15 Days , Prescribe 30
Tablet
Follow Up: 60 Months.
S
Jolly
Suneil Jolly MD
This has been electronically signed by Suneil Jolly MD on 15/02/24.
S Jolly
Suneil Jolly, MD
| What is signature date or signed on date? | {"text": ["15/02/24"], "answer_start": [1305]} |
id_1711476578.485746 | Chloe Blake |
Patient: Gary Johnson DOB: 06/03/12
Gary Johnson DOB: 06/03/12 (46 yo F) Acc No. 758xx
TH
AKUMIN
Akumin Pembroke Pines
Phone: (954) 566xxx
10950 Pines Blvd
Fax: (954) 430xxx
Pembroke Pines, FL 330xx
Website: akumin.com
Copy to:
Patient: Gary Johnson
Dr Gregory Padilla MD
Date of Birth: 06/03/12
680 N UNIVERSITY DRIVE
Phone: (754) 265xxx
Pembroke Pines Florida 330xx
MRN: 693xxx Acc: ER10847xxx
Fax: (877) 843xx
Date of Exam 14/15/01
3D TOMOSYNTHESIS DIAGNOSTIC MAMMOGRAM UNILATERAL
[770657xxxx] - Womens Imaging
LEFT DIGITAL DIAGNOSTIC MAMMOGRAM WITH CAD AND TOMOSYNTHESIS
CLINICAL HISTORY: 44 year-old female without current breast symptoms
mammogram She has no family history of breast cancer.
COMPARISON: 16/14/11
TECHNIQUE LEFT low dose full-field digital mammography was performed in the CC and MLO projections. Computer-
aided detection was utilized. Digital Tomosynthesis was used in this patient.
FINDINGS:
IMPRESSION:
No mammographic evidence of malignancy.
In the absence of clinically suspicious findings, the patient is recommended to return in one year for screening
mammogram.
RECOMMENDATION: Screening mammogram in one year. A reminder will be sent to the patient.
The information contained in this facsimile message is privileged and confidential.
Printed 07-09-2021 PM
OWENS SHANNON (Exam: 14/15/01 1:15 PM
Page 1 of 56
OWENS, Shannon DOB: Nov 17, 1976
Page 156 of 156
Document: 08/21/10 Records
Printed: 08/21/10 12:22:11
Page 156 of 156
| What is the Date of Exam or Examination date? | {"text": ["14/15/01"], "answer_start": [466]} |
id_1711471329.512058 | Jamie Miller |
21/15/07 1:1
47903127223
HEWITT ADMIN DEPT
PAGE 2/19
Silverlake Medical Center
Fee Invoice
Silverlake Medical Center
06570 Monica Tunnel Apt. 459
Joefort, CA 10992
22301 S WESTERN AVE #107
TORRANCE, CA 90501
355-157-3547
Patient_Address
21/15/07
PO BOX 1548
FARMINGTON, CT 06034
RE : Jamie Miller
MR#: : 25-647089
The policy of HealthCare Partners is to charge a reasonable clerical fee for
the completion, and reproduction of medical records, radiology films, and
business records.
The fee for the following request is: $ 59.00. Please return a copy of this
payment by mail.
Should you have any questions regarding this invoice, please contact our office
at 849-924-6858.
Thank You,
Correspondence Coordinator
Health Information Services Department
HCP TX ID # 95-4509662
Entry #: 106105
Case-W/O#:
PATIENT NAME: Jamie Miller
Amount Due: $ 59.00
Entry CL106105
Payment Type (check one) :
Credit Card #
American Express
MasterCard
Cardholder's Name
Visa
Check
Signature
Money Order
Exp Date
Amount Paid $:
Please send payments to:
Silverlake Medical Center
06570 Monica Tunnel Apt. 459
Joefort, CA 10992
22301 S WESTERN AVE #107
TORRANCE, CA 90501
2-3-2014
2077164742
44201503{Random_7_digit_number}0
SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.
[6687671-01] 143
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711473530.721832 | Jessica Bennett |
<<Back to Review>>180298-41-HYPERLINK - Hyperlink-Page
17
From icampusano 1.844.385.8095 Tue Oct 4 18:40:18 2022 EDT Page 27 of 106
Industrial Injury Info:
date of birth:
Apr 13, 1990
Adjuster:
Leticia Bailon
Claim #
PZC55955255
Phone #
755-255-1553 X 1551
injury date:
Dec 25, 2023
Fax #
855-552-6551
Insurance: Crum and Forester
Patient Info:
Address:
700 Flower St., Turlock, CA 95380
Phone (C):
Pref. Lang.:
Un
Phone (H): 255-551-3550
Diagnosis:
M24.255
Disorder of ligament, left ankle
M55.2
Plantar fascial fibromatosis
Case Type:
Work Compensation
Foster, Edward : Apr 01, 2019
page 12
000017
0017
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711477275.640727 | Julie Moreno |
ORTHOPAEDIC ASSOCIATES OF CORPUS CHRISTI
601 Texan Trail, Suite 300, Corpus Christi, Texas 78411
Telephone #: Fax #:
Preop Form
Name:
ELMA TREJO
DOB: 1990-02-09
SSN: 45796xxxx
Address: 601 HUGHES AVE
Room:
8
MRI:
Rad Ass 2024-06-01
ALICE, TX
78332
Phone:
Order: 1st
Clearance: cleared- Dr. Kapasi
361xxxxxxx
Ins: CENTENE-ALLWELL
Table: 4 poster jackson
Assist: Brandon Harris, Cert 1st
Hosp: SPOHN SOUTH
Cell Saver: yes
Home Health:
??
Arrival: 5:30 AM
Brace:
LSO- in hosp
1st postop: 2019-06-06
Date of Surgery: 2020-16-12
Xray:
2019-06-06 2V LUMBAR!!
PCP:
Lies: Francispo Rodriguez RNP-BC-CONVIA
Diagnosis:
Minimal thoracolumbar scoliosis, grade 1 L2 and L3 retrolistheses, grade 1 L4
spondylolisthesis, L4 and L5 degenerative disc disease
Procedure: L3, L4, and L5 laminectomies, radical L4 and L5 discoidectomies, transforaminal
lumbar interbody fusions at L4 and L5, internal fixation with PEEK cages, L3 to
sacrum posterolateral intertransverse fusion with local and iliac autograft.
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475190.454616 | Dylan Yoder |
NOVANT
NOVANT HEALTH MEDICAL
Dylan Yoder
N
PARK HOSPITAL
MRN: 52924297, DATE OF BIRTH: 15-08-2000, Sex: M
HEALTH
1290 South Hawthorne Road
Adm: 27-04-2018, D/C: 27-05-2018
Winston-Salem NC 27293-3292
26-09-2021 - Admission (Discharged) in NHMPH Surgical Services (continued)
Results
Imaging:
No results found.
Electronically signed:
Dr Daniel Morris, MD
24-05-2016 / 3:35 PM
Electronically signed by Brandon L Craven, MD at 10/20/22 1536
Op Note
Brandon L Craven, MD at 10/20/2022 1639
Author: Brandon L Craven, MD
Service: Urology
Author Type: Physician
Filed: 10/20/22 1641
Service Date: 02-02-2024 1639
Status: Signed
Editor: Brandon L Craven, MD (Physician)
NOVANT HEALTH MEDICAL PARK HOSPITAL
Operative Note
Surgery Date: 01-11-2023
Generated on 4/11/23 8:32 PM
Page 254
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711472591.262267 | Alicia Alexander |
TN
SimonMed鈩
See Tomorrow Today
PATIENT:
Alicia Alexander
Accession Number:
37023737
Patient ID:
1899317
Location:
SimonMed Northern CA Monterey
Gender:
Female
exam date:
15-10-01 10:52 Exam Date min_range
DOB:
84-11-15
Modality:
MR
Referring Physician: Dr Allison Douglas
Report Status:
Final
Report exported on Tue, Jun 7, 2022 13:00:41 -0310 - Page 2 of 3
312
GB IA Recv 2031031413128
Received 06/24/2022
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711476768.351465 | Keith Murphy |
Page: 2 of 2
South Lakeland Chiropractic Center P.A
DBA: New Hope Chiropractic
4788 S. Florida Ave.
Lakeland, FL 33343
Grace Witter
Patient ID: 131986471
DOB: 2000-28-03
Sex: F
Account No.:
Encounter ID: 28381534
Encounter Date: 2018-06-04
Encounter Type: Office Visit
-- Hydro Bed therapy was done for 10 mins, full spinal to help reduce discomfort of muscle spasms.
Care Plan:
-- Follow up for care in 2-3 days.
-- Treatment recommendation of 3 chiropractic visits per week for 2 weeks, followed by a review to see
changes to the condition.
Patient Instructions:
-- Patient was advised to keep moving, avoiding periods of inactivity and to avoid bed rest.
-- General range of motion stretching should be conducted at least three times a day.
Patient should use ice 15 mins on and 15 mins off; as needed.
Electronically Signed] - Date: 2018-30-05 3:47:19 PM
[Provider]: Ida Abraham, DC
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711471329.795092 | Mark Rodriguez |
Oceanside Medical
QED
STATEMENT OF ACCOUNT ( 0 )
Page 1
369 Knight Rest Suite 014
Kellyview, MP 30518
Statement Date: May 22, 2020
TAX ID# 75-7031571
Account Number: QED16103796390
PATIENT: Mark Rodriguez
Mark Rodriguez
6204 Aguilar Corners Apt. 567
South Sean, OR 03302
Amount You Owe:
$0.00
Services provided at:
MEDICAL CITY LAS COLINAS - 6800 N MACARTHUR BLVD - IRVING TX 75039-2422
Date of
CPT Code
Description
Provider
Charges
Payments or
Explanation
Amount
Service
Adjustments
You Owe
October 31, 2017
27840
REDUCE ANKLE DISLOC W/O ANES
Dr Joshua Hernandez
$3,082.00
$3,082.00
1,2,3,4
$0.00
October 31, 2017
99285
EMERG INJURY EVAL & MGMT-LVL 5
Dr Joshua Hernandez
$1,516.00
$1,516.00
1,2,4
$0.00
Total Charges:
$4,598.00
Current Patient Responsibility:
$0.00
Insurance Information:
Insurance 1: BC/BS of Texas - TEXAS B/S ITS/OSS CLAIMS
PARHAM-0172
000001
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711471329.118177 | Kimberly Ward |
ciox
Fee Approval Request
HEALTH
CIOX HEALTH
Please deliver this to the following medical record requester:
Attention :
Facility:
Silverlake Medical Center
Requester :
TScan
Site :
20331
Address :
8458 Theresa Curve Apt. 978
Klineport, VI 47154
Address :
8458 Theresa Curve Apt. 978
Klineport, VI 47154
City, State,
City, State,
Zip :
Seattle, WA 98199
Zip
Detroit, MI 48201
Rep
Telephone :
719-456-3302
CIOX Rep:
Vernette Gordon
#:
825121
Fax :
844-102-9434
Fax to:
Records
CIOX HEALTH REP Vernette Gordon
Fax Number: 313-993-0763
Phone: 313-745-3021
Dear Medical Record Requester :
Date: 01/2023/19
CIOX HEALTH has contracted with Silverlake Medical Center (Medical Facility/State) to copy
it's authorized requests for medical records.
03/28/2019
Patient :
Kimberly Ward
birthdate :
09/1990/01
Soc. Sec. # :
service date
11/2015/04
CIOX HEALTH Fee Schedule
FOR MEDICAL RECORD REQUESTER USE ONLY
In order for your request to be processed you will need to complete the five items inside this box.
Approved
Date:
By:
Hamal
j
11/2018/12
(Signature)
Print Name:
Phone:
Hannah Reifler
206-812-6911
Title:
Assistant Records Retrieval Specialist
MUST BE COMPLETED TO PROCESS REQUEST
Template Revision: 3.10.16
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475190.611151 | Timothy Garrett |
May. 15. 2023 2:57PM
No. 1285
P.
16
11/24/2023 1/:01
Conway Medical Center
RRD 18775489/21
2/3
Conway Medical Center
300 Singleton Ridge Road
Conway, SC 29526
CMC
(843) 347-7111
Patient:
Timothy Garrett
MRN;
612201256
Admit:
2022 Aug 23
DOB/Age/Sex: 1993 May 18
58 years
Female
Admilting: Johnson, MD, Donovan
Magnetic Resonance Imaging
Accession
Exam Date/Time
Exam
Ordering Physician
Patient Age at Exam
MR-12-0012274
2016 Jul 28 16:13 EST
MRI Lower Joint w/o
Johnson, MD, Donovan 28 years
Contrast Right
Report Request ID: 22428010
Page 1 of 2
Print Date/Time: 2/24/2023 17:01 EST
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |