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id_1711471329.54555 | Megan Keller |
Nov 22, 2023 9:40
78662804726
HEWITT ADMIN DEPT
PAGE 1/19
patient name:
Megan Keller
MRN: 25-889329
Encounter:
Dec 16, 2017 11:15AM
Physical Exam
GENERAL: Patient in no acute distress. Tcarful throughout
HEENT: PERRLA, EOMI,conjunctiva normal, TMs normal, oropharynx clear
NECK: supple, no lymphadenopathy, normal thyroid.
LUNGS: Clear to auscultation bilaterally.
HEART: RRR, no murmurs.
ABDOMEN: soft, non-tender, without hepato-splenomegaly.
EXTREMITIES: No edema
NEUROLOGIC: Alert and oriented, grossly intact.
Assessment
Acute stress disorder (308.3)
Plan
As SX are work related, d/w pt eval by wep as well but she states that they have not helped her in the past
Advise 1 mo off work due to high stress at work
SSRI and psychotx d/w pt
She wishes to hold off starting SSRI at this time, but agrees to psychotx
Advise weekly or more tx in the first mo
f/u 1 mo or pm.
Signature
ELECTRONICALLY SIGNED BY : Dr Mary Mckee MD; Mar 15, 2023 12:12 PM PST; Author.
2 of 2
MRN: 25-651409
2-3-2014
2013252242
44201503342452230
SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.
[6688932-01] 145
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711475741.573894 | Wesley Roberts |
Wesley Roberts DOB: September 19, 1999 (71 yo M) Acc No. CR848861
[Doc Name: April 28, 2023 MRI CERVICAL SPINE]
Wesley Roberts (MRN8328419)
canal. Left neural foramina is patent. Mild right neural foraminal narrowing..
C5-C6 There is a posterior disc osteophyte complex with uncovertebral joint hypertrophy and
superimposed right paracentral protrusion. This causes mild spinal canal narrowing. Moderate
narrowing of the medial aspect of the left neural foramina. Moderate right neural foraminal
narrowing
IMPRESSION:
Impression:
Scattered degenerative changes as discussed above.
Of note at C5-C6 there is a posterior disc osteophyte complex with uncovertebral joint
hypertrophy and superimposed right paracentral protrusion. At that level there is moderate
narrowing of the medial aspect of the left neural foramina and moderate right neural foraminal
narrowing. There is also mild spinal canal narrowing at that level.
See above for additional details.
Read By - Patrick Natter M.D.
Read By:Natter, Patrick E, MD
Electronically Verified and Signed by: Patrick E Natter June 01, 2016 4:16 PM
JP UF HEALTH JTB KERNAN
5/2/2023
Mon Apr 10, 2023 4:19PM
veneral
conseybal
Page 2 of 2
Wesley Roberts DOB: September 19, 1999 (71 yo M) Acc No. CR848861
Page 73 of 166
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711472787.095588 | Caitlin Morales |
Spine
Pain
MORRIS, ANN
Visit Note - 2016-09-22
PMS ID:
Sex:
dob:
Phone:
MRN:
3964983 Female 1985-06-30 (325) 525-8250 3292563
Screening: 0 days
The following recommendations were made during the visit:
Exercise: Never
Patient has a history of chronic diffuse pain due to Ehlers-Danlos syndrome. She is responding well
Smoking status - Former smoker
to low-dose naltrexone.
- We decided to titrate up her medications to 6 mg nightly for improved pain coverage.
ROS
- She may try meloxicam as an alternative NSAID to aid with her arthralgias.
Provider reviewed on Mar 22,
consider this option.
A focused review of systems
was performed including
Constitutional / Symptom, Eyes,
MIPS
Hematologic / Lymphatic,
Follow up for: F/U evaluation
Staff:
Jasmit Brar, MD (Primary Provider) (Bill Under)
Electronically Signed By: Jasmit Brar, MD. 03/22/2023 10:59 PM EDT
Jasmit Brar, MD (Primary Provider) (Bill Under)
Reston
Page :
(725) 258-4325 Work
1860 Town Center Dr
(253) 425-2549 Fax
Suite 430
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711476767.166991 | Shannon Wells DDS |
21/15/01
02:58 PM
TO: 16103548946 FROM: 8333674968
Page 48
SIMONS, CHARLES
C11920 DOB:08/18/1961
PRADA, S. MD
PATIENT REGISTRATION FORM
Date
Patient Name
Social Security Number
21/15/01
Charles SIMONS
26359xxxx
Date of Birth
Home Phone
Cell Phone
Address including City, State and Zip Code:
16/86/06
877833xxxx
Marital Status:
Hispanic or Latino
American Indian or Alaska Native
White
Single
Divorced
Non-Hispanic or Latino
Asian
Other
Black of African American
Unknown
May the Surgery Center leave a detailed voice message on your phone
Yes
No
May the Surgery Center email you detailed information via the email you provided
Yes
No
Email Address
Patient Employer/Phone
Insured Subscriber Name, Date of Birth and Social Security Number
If under LOP Attorney Name and Phone Number
Emergency Contact Info:
Sherry Name:
wits
Relationship:
Phone:
Commercial/Medicare/Auto/Workman's Compensation Lifetime Assignment
OWNERSHIP ACKNOWLEGEMENT/ANTI-DISCRIMINATION POLICY
have received a written copy of my patient rights and responsibilities.
I have received a copy of the center's Anti-Discrimination Policy.
08/21/10
Signature of Patient or Patient's legal representative if Patient is unable to sign
Date
Relationship to Patient if Patient is unable to sign
M a
4/4/85
Signature of Witness
Date
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711477182.997281 | David Bird |
LOUISIANA PAIN
SPECIALISTS
PAIN DIAGNOSIS & INTERVENTION EXPERTS
RADIOLOGY ORDER
PATIENT DEMOGRAPHICS
GUARANTOR & INSURANCE INFORMATION
Patient: Craig Park
Insurance:VA CCN OPTUM
DOB: 1989 June 14 Age: 71 year Sex: Male
Guarantor: Craig Park
Address: 4161 1ST AVE Bay Saint Louis MS 39561
Policy# 426183761
Group#
RAD VENDOR DETAILS
ORDERING PHYSICIAN DETAILS
Rad Name:
Ordering Physician Name: Suneil Jolly MD
Address:
Order#: RAD23861
Phone:
Fax:
Order Date: 2024 March 12
Sr.No.
Test Name
Test Status CPT Code ICD Code Instructions
M54.5;
1
X-ray Lumbar Spine 5 views
Routine
72110
M47.897;
M47.27
M47.27;
MRI Lumbar Spine without contrast
Comments:
S Idly
Suneil Jolly MD
This has been electronically signed on 2023 September 29.
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711473238.12604 | Julia Russell |
DIAGNOSTIC IMAGING SERVICES
4241 VETERANS BLVD
METAIRIE LA 70006
(523) 423-3230
Patient:
Julia Russell
9161 Walker Gardens
Brittneyport, NM 84296
Responsible party:
Julia Russell
9161 Walker Gardens
Brittneyport, NM 84296
Srvc. Date
Procedure Description
Location
Charge
Balance
Physician
Modifier (s)
Diagnosis Code (s)
2021-04-13
72141 - MRI, Cervical Spine s/ 5 - SLI
$2,000.00
$0.00
Satterlee, Arthur Jerry
M54.2
Payment Information
Insurance Payment (652 - DMA) : 2017-11-14 of $0.00
Adjustment: $1,425.00
Insurance Payment (652 - DMA) : 2016-03-20 of $575.00
Adjustment: $0
TOTAL BALANCE: $0.00
Print Date: 09/29/2023
Reproduced: Friday, September 29, 2023 04:17:46 PM (1pepp)
This report has been Reproduced from the Original
Reproduced Friday, September, 29, 2023 04:17:46 PM (1pepp)
Page 1 of 1
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711477275.407615 | Wendy Phillips |
Orange County Corrections Health Services Dept
Nov 20, 2020
PO Box 49Xx Orlando, FL 328xx
Page 19
4072548306 Fax:
Chart Document
DARIUS DESHAWN BOUEY
Home: Work:
Male DOB: Aug 04, 1992
P005613xx
Tremors: No
Endocrine
Vomiting: No
Breath Odor: No
Mental Confusion: No
Weight Changes: No
Heme/Lymphatic
Lymph Glands: Non-Enlarged
Bleeding: No
Bruising: No
Allergic/Immunology
Eye discharge: No
Nasal Discharge: No
Sneezing: No
Shortness of Breath: No
Dental
Missing Teeth: No
Broken tooth/teeth: No
Broken appliance: No
Bleeding gums: No
Oral/Facial Swelling: No
Drainage: No
Dentures present? No
Inmate Trustee Status: Y-A
Medical Grading
Medical Grading(Housing Recommendation) GP
HIV Survey Printed: Yes
Sick Call Scheduling
Scheduled? No
Created on 07/24/2010 11:03 AM
Electronically signed by Ellarea Farwell, RN on Aug 09, 2020 01:10 PM
Electronically signed by Edwin Pont, MD onAug 09, 2020 05:52 AM
PHA:Physical Assessment Export on Wednesday, December 6, 2023 12:14 PM by InDxLogic Chart Exporter
Page 4 of 19
(MD178@orang637469 - Orange County Health Services)
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711472590.747252 | Daniel Buckley |
Daniel Buckley
Hillside Healthcare
Visit Note - 01/2018/30
PMS ID:
Sex:
DOB:
MRN:
54643 Female 07/1984/07 54643
Medications
Chief Complaint: Chronic Low Back Pain
Duexis 864-64.6 mg Oral tablet
Medical History
HPI: This is a 82 year old female who is being seen for a chief complaint of chronic low back pain involving the spine.
Social History
with tramadol
Smoking status Unspecified
ROS
Vitals:
Provider reviewed on 04/2023/06.
Date
Taken By
B.P.
Pulse
Resp.
02 Sat.
Temp.
Ht.
Wt.
BMI
BSA
A focused review of systems was
performed including Constitutional /
LeBoeuf, Maci
66.0 in
164.0
64.7
1.9
Symptom, Eyes, Hematologio /
07/07/22
lbs
Lymphatic, Integumentary,
08:34
Musculoskeletal, and Neurological
FIO2
Page 1
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711477275.243663 | Francisco Smith |
AEGIS
Laboratory Director Matthew T. Hardison PhD
CLIA Number 44D1083455
Laboratory Report
515 Great Circle Road Nashville, TN 37228
SCIENCES CORPORATION
(615) 255xxxxx Fax (615) 255-xxxx
Clinic Information
Patient Information
Sample Information
Client: South Texas Bone & Joint
Patient Name: Timothy Meyers
Lab Sample ID:
81181xxxx
601 Texan Trail
Specimen Type:
Urine
Corpus Christi, TX 78411
Patient ID:
45796xxxx
Collected:
02-18-2017
Requesting Provider:
Date of Birth:
03-05-1997
Received:
04-07-2016
JOHN MASCIALE
Male/Female:
Female
Reported:
04-24-2020
Copyright o 2018 Aegis Sciences Corporation All Rights Reserved
Page 2 of 80
767803
South Texas Bone & Joint - 00809
| What is Collection Date? | {"text": ["02-18-2017"], "answer_start": [473]} |
id_1711475741.307816 | Evan Kane |
A
The Gables Surgical Center
11/2.
Patient Name: Evan Kane Date of
Procedure:
2021-11-25
Diagnosis: M53.86, MUS.06, M47.26
ICD 9: M53.86, M48.06CPT: 22558
Procedure:
MU7.26.
Consent To Read: L45 interbody fusion with
bilateral pedical screws
Patient Address: asoo SW 48 St
City: Miami
State: FL
Zip: 33165
D.O.B: 1994-09-17 Age:
47.
Sex: M/F
Requires Transportation: ( ) Yes () No
Insurance Co. Name:
OMNi Atty: Edersy Suarez
Policy No:
Group No:
786-420-2893
Phone No:
Referral - Authorization No:
Worker's Comp ( ) Yes ( ) No Date of injury:
2022-02-16
Claim No:
Adjuster:
leonard - No: Cannula
Instrumentation:
Type of
Anesthesia: General
Local
LOC/Sed
Regional
Choice
PRE - OP ANTIBIOTICS
PHYSICIAN SIGNATURE DR. JACObson & DR. Berti
The Gables Surgical Center
401 SW Lejeune Road, Suit 201
Miami FI 33134
Telephone: 305-447-0882 Fax 305-447-0213
| What is the Procedure Date? | {"text": ["2021-11-25"], "answer_start": [93]} |
id_1711475189.824471 | Sara Smith |
V
VCO VOCATIONAL SPECIALISTS
Mark Alexander, MS
18 November 2016
Mr. Ulises J. Aguirre, Esq.
Law Offices of Robert T. Bledsoe
330 W. Hedding St., #153
San Jose, CA 9553 0
Subsequent Injuries Benefits Trust Fund
Department of Industrial Relations
153 0 Howe Avenue, Suite 353
Sacramento, CA 9553 5-353 7
Employee:
Sara Smith
dob:
10 January 1987
injury date:
11 May 2019
Employer:
Superstores Industries
SIBTF #:
SIF15339538
VCO File #
95378
Subsequent Injuries Benefits Trust Fund (SIBTF) Vocational Evaluation Report
I have been requested by Attorney Ulises J. Aguirre to perform a vocational evaluation report
addressing Mr. Edward Foster's ability.
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711472787.295658 | Deborah West |
DocuSign Envelope ID: CD6AFC36-CF28-36AE-AA73-C1B65436D293
I understand that this revocation will not apply to information that has already been released in response to
this authorization.
I understand that when this information is used or disclosed pursuant to this authorization, it may be subject
to re-disclosure and may no longer be protected.
This Authorization is continuing in nature and remains effective until the conclusion of this claim / litigation
without the necessity for further authorization.
A copy of this Authorization shall be considered as effective as the original.
I, the undersigned, have read the above and authorize the staff of the above named facility to disclose such
information as herein contained.
DocuSigned by:
fairn
83DBEBA2C8F836C
Signature of Patient / Parent or Legal Guardian
2022-08-19 0:16 PM PDT
Relationship to Patient
Date Exp 2021-04-30
This Authorization complies with 45 CFR 136.508
2
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711476578.394848 | Linda Ortiz |
Patient: Gregory Thornton DOB: 09/1995/29
OWENS, Shannon DOB: Nov 17, 1976 (46 yo F) Acc No. 7588xx
001 Pines University
Angel Rodriguez, MD
680N UNIVERSITY DR PEMBROKE PINES, FL
Internal Medicine
Tel: 855-xx Fax: 877-xxx
Patient:
Gregory Thornton
07/2016/16
DOB:
09/1995/29, Sex: Female
Address:
2653 JOHNSON ST, HOLLYWOOD, FL 33xxx-38xx
Phone:
754-2xx-1xxx
Ordered Date: 10/2019/06
Assessments:
Dyspepsia - R10.13
Lab:
H. pylori Breath Test
Fasting:
No
Specimen:
Collection Date: 08/2023/05 Time:2:56 PM Source:UP:
Clinical Info:
Name
Value
Reference Range
H. pylori Breath Test
No Specimen Received
Request Problem
H. pylori Breath Test
Negative
Negative
Result:
Received Date:
07/2016/16
Notes:
Patient Name: Owens, Shannon , DOB: 09/1995/29
OWENS, Shannon DOB:09/1995/29 (46 yo F) Acc No. 758856
Page 62 of 162
Document: 2023-09-05-Records
Printed: 07/2016/16 12:22:11
Page 62 of 162
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711476578.512379 | Colton Odonnell |
Patient: Amanda Schultz DOB:1986-02-11
Amanda Schultz DOB: 1986-02-11 (46 yo F) Acc No. 7588xx
YM
AKUMIN
Akumin Pembroke Pines
Phone: (954) 566xxx
10950 Pines Blvd
Fax: (954) 430xxx
Pembroke Pines, FL 330xx
Website: akumin.com
Thank you for referring your patient to Akumin Pembroke Pines
Dr Dominique Robinson, M.D
Electronically Signed: 2020-02-16
Exam requested by: JAIME ARANGO CIFUENTES MD
BIRADS: BI-RADS 2
The information contained in this facsimile message is privileged and confidential information intended only for the use of the individual or entity named as recipient. If
the reader is not the intended recipient, be hereby notified that any dissemination, distribution or copy of this communication is strictly prohibited.
Thank you!
Printed 2014-08-04 310 PM
Amanda Schultz (Exam: 2015-12-20 1:15 PM)
Page 69 of 69
Amanda Schultz DOB: Nov 17, 1976 (46 yo F) Acc No. 7588xx
Page 169 of 169
Document: 2014-08-04 Records
Printed: 2014-08-04 12:22:11
Page 169 of 169
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711477183.11801 | Brenda Copeland |
Toxicology & Compliance
Laboratory Report
Patient Name: Cheryl Lambert
Sample ID: LB232136A
Collected: 08-16-2023 8:03:07 AM
Patient DOB: 03-07-1991
Received: 12-26-2023
Requesting Physician: Erik Davis
Tested: 05-18-2023
Requesting Practice: Louisiana Pain Specialists
Reported: 05-18-2023
-
Illicit Substances Detected
Reported Prescriptions Detected
Substance
Test Outcome
Reported Prescription
Anticipated Positives
Test Outcome
Patient Name: Cheryl Lambert
Specimen ID: LB232013A - Specimen Type: Urine
The perfomance characteristics of this test were determined by Louisiana Pain Specialists, LLC. It has not been cleared or approved
by the U.S. Food and Drug Administration.
LPS Toxicology Labs 2713 Hessmer Ave Suite A Metairie, LA 70002 504xxxxxxx
Lab Director: Eugene Schwilke, PhD
CLIA ID#: 19D2139613
Page 1 of 13
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711476990.265061 | Lee Anderson |
University of Oklahoma
68438
800 NE 15th Street Suite 205 Oklahoma City, OK 68438
Page 1
4068438647 Fax: 405268438
Radiology Reports
Isabel Luna
Male DOB: 1991-02-19
2708046
Ins: BLUE CRO (22) Grp: 116443
07/18/2016 - Radiology Reports: - PET/CT TUM SKUL BS MIDTHIGH
Provider: Adam S Asch MD
Location of Care: College of Medicine
Patient: JIM CURTIS PARRY
ID: HCA RAD E0027368438
Note: All result statuses are Final unless otherwise noted.
Tests: (1) - PET/CT TUM SKUL BS MIDTHIGH (TUMSBMT)
! - PET/CT TUM SKUL BS MIDTHIGH
<No Reported Value>
STEPHENSON OKLAHOMA CANCER CENTER - A SERVICE OF OU MEDICAL CENTER
800 NE 10TH
PET SCAN
PHONE: (405) 271xxxx
Oklahoma City, OK 73104
CONSULTATION REPORT
FAX: (405) 271xxxxx
LOC/RM: EK.PETCT/
PACS ID: E2168438
MRN:
E002733117
PT. TYPE: REG RCR
CAMPUS: K
PT:
PARRY, Isabel Luna
ACCT#: E00655310983
DOB: 1991-02-19 AGE: 48
SEX: M
ORD PROV: 1154434405 Asch, Adam S MD
EXAM START: 2014-06-07 1204
ATT PROV: 1003111972 Luetkemeyer PAC, Jessica L
EXAM ENDED: 2016-05-31 1404
ADMISSION CLINICAL DATA: C83.30
DIFFUSE LARGE B-CELL LYMPHOMA
EXAMS:
CPT:
004968438 PET/CT TUM SKUL BS MIDTHIGH
68438
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711476578.188474 | Robert Fry |
BAYLOR SCOTT & WHITE
Williams, Charles Eugene
BaylorScott&White
HEART AND VASCULAR
MRN: 9211625, DOB: 19/02/93, Sex: M
HEALTH
HOSPITAL - DALLAS
Date of Service 12/11/22
621 N HALL ST
DALLAS TX 75256-1325
05/08/21 - Procedure Pass in Hospital
Visit Information
Admission Information
Arrival Date/Time:
Admit Date/Time:
17/06/15
IP Adm. Date/Time:
Admission Type:
Point of Origin:
Admit Category:
Means of Arrival:
Primary Service:
Secondary Service: N/A
Transfer Source:
Service Area:
Unit:
Admit Provider:
Attending Provider:
Referring Provider:
05/08/21 - Procedure Pass in Baylor Scott & White Heart and Vascular Hospital - Dallas
Facesheet
Patient Information
Patient Name
Legal Sex
DOB
Williams, Charles Eugene (2511625)
Male
19/02/93
Basic Information
Date Of Birth
Legal Sex
Race
Ethnic Group
Preferred Language
Language for Written
19/02/93
Male
Black or African
Not Hispanic or
English
Material
American
Latino
English
Printed on 19/02/93 10:22 AM
Page 125
7525 8-25
Baylor Scott & White Heart & Vascular Hospital - 00125
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711476766.992839 | Emily Jordan |
MPT I McLaughlin Physical Therapy
3120 20th St
Physical Therapy
Metairie, LA 70002xxxx
Initial
Phone: xxxxxxxxxxx
Fax: xxxxxxxxxxx
Examination
Patient Name: Mary Wade
Date of Initial Examination: 14/11/01
Date of Birth: 97/02/27
Injury/Onset/Change of Status Date: 22/11/23
Referring Physician(s): Pappas, Nick MD
Diagnosis: ICD10: M25.511: Pain in right shoulder
Surgery: (Date/Type) 16/11/04 C Spine Fusion
Treatment Diagnosis: ICD10: M25.511: Pain in right
shoulder, M75.111 Incomplete rotator cuff tear or rupture of
right shoulder, not specified as traumatic
Subjective
Treatment Side: Right
History of Present Condition/Mechanism of Injury: Pt is a 61 year old female who presents to PT complaining of neck and
(R) shoulder pain 2 partial RC tear / bursitis with history of multi level C spine fusion.
Objective
Outcome Measurement Tools
Upper Extremity
Upper Extremity Quick DASH
65.91/100
Observation
Standing Posture Rounded Shoulders
Range of Motion
1 of 60
Powered by
WebPT
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711477090.321591 | Jennifer Jackson |
IVICIN
2764 Napoleon Avenue
Briana Young
New Orleans LA 70115
MRN: 1645364, DOB: 08/2001/05, Sex: F
Acct #: 64002782564
Adm: 09/2016/18
10/2015/11 - ED in Baptist - Emergency Dept (continued)
Scans for Entire
Hospital Authorization - Electronic signature on 12/2016/24 7:21 AM (effective from 02/2023/21) - E-signed
Karen Marie Johnson
Ochsner
MRN: 1645364
DOB: 08/2001/05
Health
Age: 59 y.o.
Sex: female
HOSPITAL AUTHORIZATION
A.
Health Consent for Examination and Treatment: I hereby authorize the providers and employees of Ochsner
System ("Ochsner") to provide medical treatment/services which includes, but is not limited
not performing limited and administering tests and diagnostic procedures that are deemed necessary, including, to, but
the to, imaging examinations, blood tests and other laboratory procedures as may be required by
special instructions of my physician(s).
1.
I understand and agree that this consent covers all authorized persons, including but not limited to
residents, nurse practitioners, physicians' assistants, specialists, consultants and independently
procedures and medical or surgical treatment.
contracted physicians who are called upon by the physician in charge to carry out the diagnostic
2. I hereby authorize Ochsner to retain or dispose of any specimens or tissue, should there be such
remaining from any test or procedure.
Generated on 02/2023/21 4:20 PM
Page 164
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711472285.266888 | Rebecca Young |
7609521074
16:08:03
11-09-2017
4/6
STATE OF CALIFORNIA
DOCTOR'S FIRST REPORT OF OCCUPATIONAL INJURY OR ILLNESS
PATIENT NAME (first name, middle initial, last name)
Sex
57. Date of
Mo. Day
Yr.
Age
Rebecca Young
Birth 25
Address:
8549 No. and Street SUC Box City Vidoroille Zip CA 92345
19. Telephone number
10. Occupation (Specific job title)
Social Security Number
Diseuse
Teacher guiste
526-23-7241
13 Date and hour of injury
MaDal
2020-21-04
4. Date last worked
Mo. Day Yr.
Occupation
or onset of illness
a.m.
p.m.
Oct, 13, 2017
15. Date and hour of first
Mo. Day Yr.
Hour
Return Date/Code
examination or treatment
2023-22-05 if Others
a.m.
p.m.
treated patient?
Doctor's Signature
/ JV Jonethan Luna, PA
CA License Number A044696 / PA17660
Doctor Name and Degree (please type) Roger A. Moushabek, M.D.
IRS Number 10/16/17
Address 12408 Hesperia Road
Suite # 25
Victorville
CA
92395
Telephone Number 760-952-1222
01/09/2018
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711471329.742699 | Kevin Murray |
2020/23/08 11:16 TEXAS_MRI (FAX)24113070152 P.000/003
Meadowbrook Medical
Patient name: Kevin Murray exam date: 2023/16/07 12:15 PM
dob: 2001/15/10 Age 72 Physician: Dr Eric Coleman
Date of Evaluation:2019/09/08
MRN: TXCS74353 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 - 00032
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711473530.782035 | Parker Jackson |
<<Back to Review>>180298-33-HYPERLINK Hyperlink-Page
23
TRI VALLEY ORTHOPEDIC . 4626 Willow Road, PLEASANTON CA 94788-8784
Parker Jackson (id #378178, BIRTH DATE: 29 June 2000)
List each specific requested medical services, good, or items in the below space or indicate the specific page numper(s)
of the attached medical report on which the requested treatment can be found. Up to five (5) procedures may be entered:
Diagnosis (Required)
ICD-Code (Required)
1. Closed bimalleolar fracture - Right
S82.841P: Displaced bimalleolar fracture of right lower leg, subsequent
encounter for closed fracture with malunion
Service/Good Requested (required)
Right ankle ultra guidance cortisone injection
Requesting Physician Signature:Signature: SEAN DOUGHERTY, DPM
Date:17 November 2022
Sean Dougherty DPM
000023
0023
| What is signature date or signed on date? | {"text": ["17 November 2022"], "answer_start": [794]} |
id_1711476893.199531 | Sarah Brown |
.3
I declare under penalty of perjury that this report is true and correct to the best of my knowledge and that I have not
violated Labor Code 139.3.
Primary Treating Physician: Emily Liu, MD
Date of Exam: 01-27-2017
CA License #: A24311
Specialty: Urgent Care
Address:
558 ABBOTT ST STE A
Telephone:
Phone: 831-Random_7_digit_number
SALINAS CA 93901-4378
Dept: 831-Random_7_digit_number
Dept Fax: 831-755-7886
Signature: Steven Schumann
Date: 10-28-2016
241
GB IA Recv 2021121066894
Received 11-26-2023
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711476990.195368 | Sergio Arias |
University of Oklahoma
07/07/17
800 NE 15th Street Suite 238 Oklahoma City, OK 73138
Page 2
4055884181 Fax: 5884181
Lab Report
JIM C PARRY
Male DOB: 28/01/97
2708046
Ins: BLUE CRO (22) Grp: {Random 2}
(1) Order result status: Final
Collection or observation date-time: 23/01/18 14:50
Requested date-time:
Receipt date-time: 07/07/17 16:48
Reported date-time: 05/03/20 12:54
Referring Physician: Jennifer Cooley
Ordering Physician: Walter Wise (AASCH)
Specimen Source: 0238: PN: S00382R
Source: HCA_LAB
Filler Order Number: 0226:PN: S00382R LAB
Lab site: OU MEDICAL CENTER Laboratory, 1200 Everett Drive
Oklahoma City
OK 73138
Producer ID *1:OU MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73104
The following tests had no related values for dispersal to the flowsheet:
CHROMOSOME ANALYSIS REPORT, [No Value Reported], (F)
Electronically Signed by Walter Wise PA-C on 31/03/17 at 11:37 AM
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711473365.431126 | Daniel Webb |
X-RAY BREAK DOWN FORM
Modesto Radiology Imaging
1524 McHenry Ave, Suite 100
Modesto, CA 95350
Phone: 700-803-1946
Fax: 525-462-7875
ATTENTION:
Firm:
EQUICOPY
Telephone: 849-349-4950
Patient: EDWARD FOSTER
Order Number: 184998-37
Date: 10-26-22
Jacket/Medical Record #: 76-49-02/324925
PLEASE NOTE!!!
SERVICE DATE
Exam
Number of Films
May 05, 2016
CT RT ANKLE
7-16
Films: $15.00 per sheet
Cds: $25.00 per CD (can copy multiple exams on CD)
0002
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711472286.572284 | Jennifer Parker |
Jennifer Parker
MRN: 5606513
04/04/2023 - External Document in MULTICARE HEALTH INFORMATION (continued)
INJURY DATE:
Place of Injury:
2017-25-03 9:40 AM
Medical Records use only - -(HAR ID)
Hospital Account
Not on file
Visit Information
Department
Name
Address
Phone
Fax
MULTICARE HEALTH INFORMATION 419 South L Street MS: 419-2-CN
800-365-9919
253-465-4948
Tacoma WA 98655-3799
Call Information
Provider
Department
Center
4/4/2023 9:03 AM
HIM SCANNED DOCUMENT
HEALTH INFORMATION
MHS CALL CEN
MULTICARE CALL CENTER
Dufner, Raymond E
419 SOUTH L STREET
MRN: 5606513 , birth date: 1988-19-03, Sex: M
TACOMA WA 98465-0299
Date of Visit: 2022-12-12
Page 54
Printed by 414221 at 7/17/23 9:40 AM
| What is Date of Injury or DOI? | {"text": ["2017-25-03"], "answer_start": [147]} |
id_1711475620.787489 | Robert Blair |
Seafile
Report - Robert Blair - 537, 4-, 2022, pdf
Download(101.5 KB)
Current path: 50-Robert Blair / CHEST X RAY / Report - Robert Blair_537, 4-, 2022,.pdf
A&Y REHABILITATION CENTER
8326 SW 8 St. Miami, FL 33144
Patient Name: Robert Blair
Date of Birth: 29 June 1986 Sex: M
Study Description: STAT CHEST PRE OP
Date of Exam: 30 April 2022 12:54:59
Referring Physician:
Chest radiographs in PA and lateral views were obtained and submitted for interpretation.
There is no evidence of focal pneumonia, infiltrates or effusion. The cardiothoracic ratio is normal. No
mediastinal shifting or mass is present. The skeletal structure is unremarkable.
IMPRESSION
No acute cardiopulmonary process is demonstrated.
Electronically signed
Reading and Interpretation Only
Herb Pena, MD Diagnostic Radiology
+
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711475444.904441 | Kerri Williams |
Kerri Williams DOB: 13 December 2000 (69 yo M) Acc No. 29065
19 April 2018
Kerri Williams DOB: 13 December 2000 (69 yo M) Acc No. 29065 DOS: 02 February 2021
LA Health Solutions
Initial Visit Chiro-MVA
Patient: Kerri Williams
Provider: Matthew Laudun, D.C.
DOB: 13 December 2000 Age: 69 Y Sex: Male
Date: 24 December 2015
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: 03 January 2020
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.
Kerri Williams DOB: 13 December 2000 (69 yo M) Acc No. 29065
Page 25 of 47
| what is the DOB or date of birth? | {"text": ["13 December 2000"], "answer_start": [26]} |
id_1711471330.792159 | Stephen Walter |
Patient Name: Stephen Walter PI 11.06.21, Latoya, DATE OF BIRTH: 09/08/86 Account No: 28999 Consultation Notes for Stephen Walter PI 11.06.21 on 20/04/23 Current Medications Reason for Appointment None 1. Back Pain Active Problem List Assessments Problem List has not been verified 1. Radiculopathy, lumbar region - M54.16 (Primary), bilateral. Acute Past Medical History since slip and fall on 11/6/21. MRI with disc protrusion with resultant Medical History Verified. severe left L4/5 stenosis. Chiropractic helps short term. Onset: sudden since slip and fall on water while no blurring of vision. Psychology: walking in a convenience store. She went to ER at S and W hospital. Severity: 10/10, Aggravated by: sitting, standing ideation. no anxiety. no physical abuse. bending, Relieved by: none, Nature: sharp, Associated Symptoms: no mental abuse. no numbness, weakness. He (she) denies any previous low back pain. Chiropractic helps some for short period.
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711476990.034835 | Taylor Hobbs |
Pacific Pain
Institute
Visit Note - Follow-up Visit
Provider:
Supervising: Ryan Andrews, M.D.
Performing: Dylan Hanson, PA-C
Encounter Date: 2016-30-01
Patient: Mejia, Florentino (PT00001958)
Gender: Male DOB: 2003-23-01 Age: 28 year 2 month
Race: Other
Address: 1678 Travion #t #1, Fairfield CA 94533
Injury Date: 2015-27-12
Employer: Chevys Fresh Mex
Case Insurance: Gallagher Bassett 14278
Complaint:
Mr. Florentino is a 28 year old male here today for a follow up visit. He sustained injury at work
on Dec. 6, 2011. He is having pain in back and right leg pain. His current pain level is a 8 on the
1-10 pain scale. His pain is constant and he describes it to be a aching, dull, sharp and shooting
pain. His pain radiates up his neck and down his right leg. He is also experiencing numbness,
pins/needles in right leg and weakness in right leg due to the pain. Any prolong sitting, walking
and bending worsens his pain. To relieve the pain he takes medication and uses ice packs.
Patient reports some nausea and dizziness to his medications. Patient states his current pain level
is without any medications.
Current Medication:
1 Cyclobenzaprine 7.5 Mg Tablet SIG: Take 1 tab at bedtime
2 Medrox SIG: Apply to affected area 2-3 everyday
3 Pantoprazole 20 Mg Tablet Dr SIG: Take 1 tab daily everyday
ROS:
Neurologic: (+) numbness, (+) tingling.(+) right lower extremity weakness.
Examination:
Patient: Taylor Hobbs DOB: 2003-23-01 Visit: 2020-06-03 Page: 78
678
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711473239.366854 | Casey Kelley |
Datavant Release of Information
Patient:
Casey Kelley
birthdate:
19/90/08
Court Case #:
340799407
CERTIFICATION OF RECORDS
Enclosed are the medical records of Casey Kelley
. Datavant is producing
the records as the Health Insurance Portability and Accountability Act business associate of
GABLES SURGICAL
and pursuant to a subpoena or patient authorized request issued to
GABLES SURGICAL.
No records for dates requested
No patient found
NO PHYSICAL FILMS KEPT AT SITE
Number of pages:
165
Includes billing records: No
Number of Images/CDs:
N/A
BILLING SENT BY MBS ATTORNEY GROUP
Date: 02/24/02
640-540-1409
Datavant - Release of Information Vendor for
GABLES SURGICAL
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711476578.007479 | Kayla Ellis |
BAYLOR SCOTT & WHITE
Williams, Charles Eugene
BaylorScott&White
HEART AND VASCULAR
MRN: 9211614, D.O.B: 25/97/10, Sex: M
HEALTH
HOSPITAL - DALLAS
Date Service 29/16/05
621 N HALL ST
DALLAS TX 75226-1339
02/09/2023 - Telephone in Baylor Scott & White Heart and Vascular Hospital - Dallas (continued)
Clinical Notes (continued)
Patient s/p: EPS ablation
Pt denies other questions, comments or concerns at this time.
Electronically signed by Rachel Galvan To. RN at 27/21/05 10:17 PM
02/09/2023 - Telephone in Baylor Scott & White Heart and Vascular Hospital - Dallas
Facesheet
Patient Information
Patient Name
Legal Sex
DOB
Williams, Charles Eugene
Male
2/4/1959
Patient Demographics
Address
Phone
E-mail Address
6563 ASHLAND DR
963-263-7630 (Home) *Preferred*
lorinewilliams63@yahoo.com
GREENVILLE TX 75463-7628
963-263-88637 (Work)
63-631-6388 (Mobile)
Basic Information
Date Of Birth
Legal Sex
Race
Ethnic Group
Preferred Language
Language for Written
15/19/12
Male
Black or African
English
Material
American
Latino
English
Page 2
75208-63
Baylor Scott & White Heart & Vascular Hospital - 00063
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711473530.7518 | Jordan Singh |
TOWER PHYSICAL THERAPY, INC.
Private Insurances: Any insurance that does not pertain to a work injury.
Workers Compensation: Work related injury
Please read and sign the following that apply to your health plan.
PRIVATE INSURANCE/MEDI-CARE Any insurance that does not pertain to a work injury.
If you are not aware of your physical therapy benefits, please let us know and we will acquire
them for you, otherwise we will assume you are aware of your benefits.
Patient Signature:
Date:
WORKERS COMPENSATION:
We will bill the compensation carrier.
Patient
Signature: Ed Foster
Date: 2021-16-03
000083
0083
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711471328.312552 | Linda Martinez |
04 Jul 2019 45:45am Pre-cert Team
19875573607
p.7
Lakeside Health
PEDIATRIC AND ADULT
PROCEDURE NOTE
ALLERGY
patient name: Linda Martinez
Account No: 19875573607
Kathryn Baldwin, MD
birth date: 30 Apr 1986
(614) 19875573607 Columbus
D.O.S: 29 Jan 2018
(614) 19875573607 Gahanna
Preoperative Diagnosis: Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease.
Postoperative Diagnosis: Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease.
Procedure: Left myringotomy and tube placement.
Attending Surgeon: Dr Daniel Sullivan MD, M.D.
Anesthesia: Topical Phenol.
(454) 891-0545 Columbus
(645) 766-4503 Dublin
Indications for Procedure: The patient is a 45-year-old female who has been experiencing
Chronic Obstructive Pulmonary Disease (COPD) for a number of years. She is currently pregnant and has severe hearing
loss in her left ear. She has extensive pain and Coronary Artery Disease.
She has been on steroids without improvement. Physical examination demonstrates a serious
Gout. Due to these constellation
of symptoms and findings, I recommended Appendectomy in 2005.
The risks and benefits were reviewed with her. All questions were answered and plan was agreed
upon.
Procedure in Details: Appendectomy in 2005
D.O.S Dr Daniel Sullivan MD, M.D., 08 Nov 2015 8:22 AM
Scott Solomon, MD
Taylor Costa, MD
John Watson, MD
Denise Martin, MD
BILLING
(645) 19875573607
you can now request an appointment/consultation at
www.ohioentandallergy.com
Columbus Delaware - Dublin Gahanna Port Dannychester Newark ~ Westerville
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475444.730213 | Lauren Cervantes |
15 Mar 2015 FROM- CWFMD
936-703-5455
T-252 P0053/0063 F-236
Methodist Server P11 12 Apr 2014 4:53:01 PM ACST PAGE
2/002
Fax
Server
HOOSTON'
XR HIPS BILATERAL AP LATERAL W AP PELVIS
Methodist
LEADING MEDICINE
Lauren Cervantes
MRN: 108987192, Legal Sex Female, 25 Mar 1999 (51 yrs), Outpatient
Accession #: IM99791631
Final Result
Appointment Info
EXAMINATION: XR HIPS BILATERAL AP LATERAL W AP PELVIS
Exam Date
02 Jun 2023
INDICATION: M25.552 Pain in left hip, M25.511 Pain in
right shoulder, M25,552 M25. 51
Department
COMPARISON: None
111-111-1111
4015 I-45 NORTH SUITE 120
IMPRESSION:
CONROE TX 77304-5076
No visible fracture or dislocation.
Reason for Exam
No significant joint space narrowing of the right or
M25.552 M25.51
left hips.
Bone island of the left femoral neck.
Diagnoses
Left hip pain
1SB1RAD_PS01
Right shoulder pain, unspecified
Signed by Trakhtenbroit, Michael Alan, MD on 20 Mar 2023 4:18 PM
chronicity
00
Lauren Cervantes MRN: 108987192 ACC: IM99791631 XR Hips Bilateral Ap Lateral W Ap Pelvis
Page 1 of 1
:
Name: Lauren Cervantes
DOB: 25 Mar 1999
Date:
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711477090.777044 | Alyssa Lee |
02/2019/02 19:59:15 EDT
To: 19549226864
Page: 02/625
From: Lauris Rigdon
Plan of Care
Patient:
Leslie Johnson
ONONDAGA
DOB:
07/1996/27 Sex: F
PHYSICAL THERAPY
Visit:
01/2022/19 Visit # 1
Provider:
Maria Stalder, PT, DPT
NPI#
1992425722
Clinic Details
Case Details
Clinic
Address
Injury Description
Date of Plan of Care
Onondaga Physical Therapy
15 East Genesee Street
SIJ dysfunction
6/7/2023
Suite 130
Injury Onset Date
3156355xxx
M99.04, M25.551
12/2017/12
Fax #
Referring Physician
3152553625
MICHAEL MINCOLLA
Assessment
Patient: Leslie Johnson (DOB: 07/1996/27)
Treated by Maria Stalder, PT. DPT (License #049147)
DOS: 07/2022/30
Page 1 of 25 of Plan of Care
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711473238.018694 | Cheryl Banks |
<<Back To Review>>180298-16-HYPER LINK - Page
178
Legal Copy
SGMF-PRIMARY CARE
Cheryl Banks
Sutter Health
95355-4276
MRN: 53154848, birthdate: 02/1989/27, Sex: M
Single Notes
VISITING DATE: 11/2015/02
Notes (continued)
Patient Instructions by Dr Gabriella Mcclure MD at 12/30/16 1528
Author: Dr Gabriella Mcclure MD
Service: -
Author Type: Physician
Filed: 12/30/16 1528
Date of Encounter: 05/2017/22
Status: Signed
Editor: Dr Gabriella Mcclure MD (Physician)
electronically signed by Dr Gabriella Mcclure MD at 10/2017/14 1388
Notes
Progress Notes by Kobrine, Steven E, MD at 07/2020/13 1383
Printed by [S273822] at 10/28/21 11:27 AM
00178
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711471329.169072 | Eileen Jenkins |
Recv'd Date: 2022 July 25 Bill DCN: 2020095GM000018
Patient:
PATIENT NAME: Eileen Jenkins
00023
THISPAPY
Acct #:
80312940428
Visit Day: 2016 April 20
D.O.B:
1989 January 14
Manual Therapy Techniques
30604
1
14
Therapeutic Activities
97410
2
29
Assessment
Patient presents with ongoing moderate TTP at her medial epicondyle with moderate aberrant tension along her volar medial forearm during
STM/IASTM. Pt. was able to perform her extrinsic flexor stretches without pain. Pt. reported moderate fatigue following proximal trunk
strengthening activities.
Plan
Left Wrist/Hand
Daily Plan:
Progression Under Current Plan.
mL
Cassie. Tseng, OT, OT(CA Lic: 18151)
Signed on 2020 June 27 11:20:01
Document ID: 265041A5.007
Status: Signed off (secure electronic signature)
Page 4 of 4
Cassie. Tseng, OT,OT(CA Lic: 18151)
30604
GB IA Recv 2020032333470
Received 2022 July 25
| what is the DOB or date of birth? | {"text": ["1989 January 14"], "answer_start": [177]} |
id_1711471328.29483 | Matthew Hall |
Harbor Community Health
24/04/18 43:43
Fax
33273701477
date of birth: 09/11/86
p.43
Matthew Hall clinical impression
Diverticulitis L TMJ M26.642, probable Articular Disc Disorder M26.633, Myalgia M79.11 and M79.12
Today, we spent 43 minutes face-to-face, predominately counseling, reviewing test results and other findings and discussing the risks,
benefits, alternatives and limitations of therapy.
Treatment Plan
nPSG-Doesn't wish to do another sleep test-feels just needs to use Nasonex-feels congested in nose when she sleeps
43 mg Hyalgan L TMJ-send PreAuthorization for Hyalgan
We would like to see the patient in
43 weeks
Dr Alexander Ryan
Digitally signed on 10/07/17 at 43:43 PM
000043
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711476893.045289 | John Patrick |
NORTHBAY MEDICAL CENTER
NorthBay Hospital Campus: 1200 B. Gale Wilson Blvd.
Fairfield, CA 94533 (707) 646-5000
ED Physician Documentation
Physician:
Ankney. William A M.D.
Signed:
Dec 30, 2017 03:42:46
Status:
Auth (Verified)
Document:
ED Physician Notes
Fall
Patient: MEJIA-GALLEGOS, FLORENTINO
MRN: 608698
FIN: 010998039
Age: 26 years Sex: Male DOB: May 07, 1989
Associated Diagnoses: None
Author: Ankney, William A M.D.
Basic Information
Time seen: Date & time 12/06/11 23:04:00.
History source: Patient.
Arrival mode: Walking.
Allergies: Include allergy profile.
Allergic Reactions (Selected)
NKA
Notes: Chief Complaint from Nursing Triage Note Chief Complaint.
May 19, 2020 22:30
Chief Complaint
Right leg and right lower back pain. Ambulating with limp.
No head injury.
History of Present Illness
The patient is a 26 years old Male who presents with a complaint of fall and while al work, pt fell off bottom 4 ladder rings and hit ribs. hip
and knee.
Patient Name: Robert King
Medical Record No: 608698 Financial No: 010998039
Medical Records
DOB: May 07, 1989 Age: 28 years Sex: Male Pt Type: Emergency
N/A
Admit Date: Jan 14, 2018 Discharge Date: Feb 13, 2018
Admitting Physician:
Attending Physician: Ankney, William A M.D.
Printed 09/09/13 at 11:14 AM
(Page 11 of 28)
ED-NB
149
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711476990.670991 | Richard Hunter |
23/22/07, 11:51 AM
Print Preview
SWANN, Lisa A DOB: 15/99/09 (64 yo F) Acc No. 28922 DOS: 28/14/06
Swann, Lisa A
64 Y old Female, DOB: 28/14/06
14/23/10
Account Number: 28935
1330 Waterwood Dr, Lutz, FL-33559
Home: 813-388-2387
Guarantor: Veronica Romero Insurance: FL MEDICARE PRIMARY
Payer ID: SMFLo
PCP: ALEJANDRO I. MICHEL Referring: ALEJANDRO I. MICHEL
Appointment Facility: PULMONARY AND SLEEP SPECIALISTS OF TAMPA BAY, PA
09/25/2023
Progress Notes: Michael Newton MD PA
Reason for Appointment
Current Medications
1. Pft,ox,st, and alpha results
Taking
Synthroid 112 MCG Tablet 1 tablet in
History of Present Illness
the morning on an empty stomach Orally
Interim history:
Once a day
Carvedilol 12.5 MG Tablet 1 tablet AM,
9/25/2023. In office visit. Nocturnal oximetry, was not able to read
1/2 tablet PM Orally Twice a day
appropriately, maybe because of fingernail Polish. Will try the ring next.
Ramipril 5 MG Capsule 1 capsule
Since her episode of bronchitis, about a month ago, she is improving,
Orally Once a day
almost back to baseline. Still has cough and still brings up some phlegm.
patient is awake, alert, and oriented, able to answer all questions, and
Progress Note: Michael Newton MD PA 23/22/07
Note generated by 漏ClinicalWorks EMPSM Software (www.eClinicalWorks.com)
1/22
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475621.036557 | Christopher Baxter |
Associates MD
Christopher Baxter, 44 Y,M, 03 June 1996
4780 Davie Road, STE 103, Davie, FL 33314
786-253-8738
CUMULATIVE REPORTS
Urine Test, Dip Stick
COLLECTION DATE
09 July 2019
Order Date
31 January 2023
Result Date
11 August 2017
Ordering Physician
Carlos G Levy
Color
YELLOW
Appearance
CLEAR
SG
1.020
pH
6.0
Protein
NEG
Glucose
NEG
Bili
NEG
Ketones
NEG
Blood
2+
Urobili
NEG
Nitrites
NEG
WBC
NEG
Christopher Baxter, 03 June 1996
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711473238.01951 | Tammy Dickson |
<<Back To Review>>180298-16-HYPER LINK - Page
178
Legal Copy
SGMF-PRIMARY CARE
Tammy Dickson
Sutter Health
95355-4276
MRN: 53470498, DOB: 24/05/91, Sex: M
Single Notes
Date of Visit: 26/07/15
Notes (continued)
Patient Instructions by Dr Sandra Hicks MD at 12/30/16 1528
Author: Dr Sandra Hicks MD
Service: -
Author Type: Physician
Filed: 12/30/16 1528
ENCOUNTER DATE: 16/10/14
Status: Signed
Editor: Dr Sandra Hicks MD (Physician)
Electronically Signed by Dr Sandra Hicks MD at 04/09/15 1128
Notes
Progress Notes by Kobrine, Steven E, MD at 04/09/23 1123
Printed by [S271222] at 10/28/21 11:27 AM
00178
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711471328.220619 | Emily Burke |
08 March 2024 10:08:03 EDT
To: 18003806151
Page: 24/33
From: 8332845756
Fax: 8332845756
Initial Evaluation Note
PATIENT NAME:
Emily Burke
BIRTH DATE:
27 September 1994
Sex: F
visiting date:
24 February 2019
Visit # 1
Provider:
Brandon Bensing
NPI # 1225662943
Clinic Details
Case Details
Clinic
Address
Injury Description
Injury Onset Date
Pleasant Valley Hospital
4125 Dick Pond Road
Back Pain
08 March 2024
Phone #
Myrtle Beach, SC 29588-6807
Diagnosis Codes
G40
Fax #
8332845756
Referring Physician
Ashley Maybin
Subjective Analysis
Previous History of Symptoms
YES
Patient Chief Complaint
Patient Goals
Patient Problem List
Patient suffers from or currently has Hepatitis
Thyroid problems, Arthritis, Other orthopedic problems,
Osteporosis, Chronic pain, Chronic migraines
Treated by Dr Juan Lloyd (License #10144)
DOS: 11 April 2016
Page 1 of 6 of Initial Evaluation Note
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711477090.375552 | Thomas Kelley |
CASA COLINA
Hospital and Centers for Healthcare
31/20/12
Barbara Perry
905 Painter Ct Apt C
Pomona, CA, 91766
Dear Barbara Perry:
and Centers for Healthcare, Imaging Center - Outpatient. We are pleased Your that position you have is
Welcome to Casa Colina Hospital Scheduler/Admitting Clerk in the Imaging Center - Outpatient Department. worked.
chosen to work with us asia hourly rate of $15.00 which you will begin earning on your first day compensation
Part-Time Employees (30-39 of Casa hours) Colina with are an paid bi-weekly on Thursday. Non-exempt employees receive overtime
calculated
One as and follows: one-half times for all time worked in excess of (80) hours in a pay period or in excess of eight (8) hours
in any one work day.
going to be ate for work, or will be absent, you MUST report to your supervisor supervisor. each day. The time frame
If required you are for reporting your absence varies by department. Please check with your
information contained in this letter matches your understanding of the offer you have position accepted.
at Casa Colina is at the mutual consent of you and Casa Colina. This means that either extended. you or No Casa other Colina statement may or
Employment relationship time, with or without notice. This is the only offer and background
promise is binding. This offer receiving, is contingent understanding upon and complying to the conditions of employment of employment.
Casa Colina. Failure10 I acknowledge comply with conditions of employment will result in immediate termination
Sincerely,
Human Resources
I accept this offer:
Barbara Perry
11/16/02
Date
Signature
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711476990.781225 | Sara Hayes |
Tampa Bay
Pulmonary
Medicine, P.A.
Roger Bennett, M.D., F.A.C.P., F.C.C.P
Jonathan Johnson, M.D., F.C.C.P.
402 Noland Drive
Brandon, FL 33511xxxxx
Ph: 813-xxxxxxx Fax: xxxxxxx
SWANN, USA
DOB: 27/03/91
DOS: 24/05/21
SPIROMETRY TEST RESULTS:
Spirometry reveals a reduction in FVC at 59% or 1.85L and FEV1 at 63% or 1.55L No bronchodilator
response is noted.
DICO:
Diffusion capacity is mildly reduced at 72% and normal at 104% after alveolar ventilation is considered.
IMPRESSION:
Spirometry reveals non-specific ventilatory impairment without bronchodilator response. Flow volume
loop suggests a restrictive impairment. DLCO is normal after correction for alveolar volume.
Thank you for allowing me to assist with the care of this patient.
Sincerely yours,
Dr David Powell M.D., F.A.C.P., F.C.C.P.
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711475956.081578 | Timothy Cooper |
OrthoSC . 210 Village Center Blvd., MYRTLE BEACH SC 29579-6706
Timothy Cooper (id #88816, dob: 18/04/1993)
Page 1/1
OrthoSC . 2376 Cypress Circle. CONWAY SC 29526-8995
Timothy Cooper (id #88816, dob: 18/04/1993)
Referral Order
23/12/2022
To Provider
From Provider
SCOTT SAUER DO
ERKAN ALCI, MD
Main-CW
210 VILLAGE CENTER BLVD STE 150
2376 Cypress Circle Suite 300
MYRTLE BEACH, SC 29579-6683
CONWAY, SC 29526-8995
Phone:
Phone: 843-353-3460
Phone: (843) 353-3460
Fax: 843-353-3461
Fax:
Fax: (843) 347-3305
Patient Information
Patient Name
Timothy Cooper
Sex - DOB - Age
F 18/04/1993 20yo
Electronically Signed by: ERKAN ALCI, MD
Aakon
the
ERKAN ALCI, MD
Consult Orders
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711475741.636054 | Devin Chavez |
MN
I
Neurological, Orthopedic & Spine Center
PREOP REQUEST
PATIENT NAME: Luces, David Jose Gregoric
D.O.B.:
15/02/04
D.O.A:
23/14/05
PHONE: 786-253-8738
ADDRESS: 801 Brickell Key Blvd Apt 3304
Miami
FL
33131
SURGERY TYPE: Lumbar discectomy
LABS REQUIRED: CBC ,CMP, PTT, PT/INR, U/A, EKG, CHEST XRAY
ATTORNEY: Edersy Suarez
ATTORNEY CONTACT: 786-420-2893
DATE OF PROCEDURE: 29/15/08
SURGEON: Robert Jacobson MD, Miami I
Requested By: Gretchen
Comments: Please schedule STAT
Send Results to:
Surgerydept1@omniorthoandspine.com
Fax to 954-440-3115
817 S. University Drive #109 Plantation, FL 33324 T.954-279-2170 F.954-440-3115
5040 NW 7th Street #530 Miami, Fl 33126 T.305-461-3116 F. 954-765-3206
13526 Village Park Drive Orlando Fl 32837 T. 407-794-1465 F. 954-440-3115
| What is the Procedure Date? | {"text": ["29/15/08"], "answer_start": [414]} |
id_1711471328.608712 | Carolyn Walker |
12/07/2023
14:29
(FAX)
P. 078/087
Downtown Medical Center
Dr Tiffany Patterson, MD
14940 N 99th Avenue, STE #100
Sun City, AZ 84951
T. (623) 349-5700 F. (623) 328-9491
Nerve Conduction Study & Electromyography Report
Full Name: Carolyn Walker
Gender:
Female
MRN:
249402
dob: 05/08/03
visit:
25/06/15 7:50 AM
Age:
24 Years
Examining Physician:
Dr Tiffany Patterson, MD
Referring Physician:
DR SIMRAT KAUR
Height:
5 feet 8 inch
Weight:
170 lbs
BMI:
25.8
Patient History:
NEUROPATHYY
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711477183.301666 | Barbara Bautista |
MaineHealth
Shared Electronic
Vallier, Paulette A
Health Record
MRN: E38383xx, DOB: October 07, 1991, Sex: F
Visit date: July 14, 2017
February 24, 2018 - Appointment in MAINE MEDICAL PARTNERS MAINEHEALTH CARDIOLOGY
Visit Information
Appointment Information
MH CVIS CLINIC DEVICE REMOTE
Completed
February 24, 2018 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 February 24, 2018 1:15 PM
Page 22
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711472591.343247 | Eric Blair |
From dcatalyst16
18443858095
8/29/2022 10:58:59 PDT
Page 13 of 17
Dr Adam Prince MD
Today's Date: 07/02/21
RehabOne Medical Group, Inc.
All Clinics' US Mail Address: 13980 Blossom Hill Road, STE B Los Gatos, CA 92432
Industrial Injury Info:
DATE OF BIRTH:
02/02/89
Adjuster: Jennifer Restori
Claim #
00546184961-WC-01
Phone # 916-247-2436
doi:
25/01/20
Fax #
866-240-0248
Insurance: Gallagher Bassett (Corona)
Patient Info:
Address:
6351 Cody Manor Apt. 551
New Victoria, MH 69290
Phone (C): 831-240-3249
Pref. Lang.:
English
Diagnosis:
M24.17
Intervertebral disc disorders with radiculopathy, lumbosacral region
Case Type:
Work Compensation
176 Eric Blair : Aug 25, 2022
page 12
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711475620.637357 | 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 Ordered Date? | {"text": [], "answer_start": []} |
id_1711475741.366154 | Nathaniel Lopez |
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: Nathaniel Lopez
MEDICAL RECORD #: 1199262
DATE OF BIRTH: 31/07/84
PHYSICIAN: ROBERT JACOBSON, M.D.
DATE OF SURGERY: 18/10/21
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: 06/10/23
DT: 06/10/23
OPERATIVE REPORT - PAGE 2 of 2
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711471328.918099 | Robert Page |
Countryside Regional
6880 Tara Keys Apt. 554
Charlesville, TX 75414
Facility Phone #: 925-972-1142
patient: Robert Page
DATE OF BIRTH 27/07/1999 Age: 59 years
Sex M
MRN: 3813757023(SBM)
admission date: 20/11/2023
Acct #: 53423442735
Disch Date: 20/12/2023
Pt loc: SBMC 6TNS; 643;75
Physician:
Dr Thomas Alexander DO
PCP:
PCP,Not on Staff
Operative and Procedure Reports
Electronically Signed By:
Dr Jessica Beck MD
On 17/02/2015 16:30
Co Signature By:
Dr Courtney Malone MD
On 17/02/2015 16:30
Modified Signature By:
Dr Jessica Beck MD
On 17/02/2015 16:30
Date/Time Printed 22/06/2019 12:52 PST
Report Request ID: 231118813
Page 247 of 379
97
| What is the Date of Discharge? | {"text": ["20/12/2023"], "answer_start": [262]} |
id_1711475189.849491 | Anne Gordon |
RE: Anne Gordon
Page: 2 of 39
injury date: 24/02/2024
Legal Principles Analysis: Disability; Employment Determination: The PDRS; The Ogilvie
Case
In order to provide a complete analysis, in this case, it is important to discuss the familiarity with
the basic legal principles involved.
The AMA Guides on page 8, 1.2 Disability:
"A disability determination also includes information about the individual's skill, education, job
history, adaptability, age, and environmental requirements, and modifications."
The AMA Guides, 5th Edition on page 14 under 1.9 Employability Determination state:
"More complicated are the cases in which the physician is requested to make a broad judgment
regarding the individual's ability to return to any job in his or her field."
| what is the DOB or date of birth? | {"text": [], "answer_start": []} |
id_1711471330.510643 | Christina Thomas |
08/05/10 08:21 AM Willowbrook Clinic via VSI-FAX
Willowbrook Clinic
FINAL REPORT
58054 Simpson Causeway
Ronaldshire, MN 38053
DISCHARGE SUMMARY
PATIENT NAME=Christina Thomas
Acct #=1{Random_7_digit_number}
MRUN=57-42-95
D.O.B= 26/02/1987
DATE OF ADMIT-20/12/2023
Loc/Svc=/OBSV
DISCHARGE DATE=19/01/2024
ADMITTING DIAGNOSIS:
Pulmonary Embolism.
DISCHARGE DIAGNOSIS:
Peptic Ulcer.
HOSPITAL COURSE:
The patient was admitted or July 28, 2010, after having left upper
quadrant pain and constipation. However, she had had a recent bowel
movement that just was not normal; it was more difficult for her.
DISCHARGE MEDICATIONS:
1. Insulin one tablet by mouth daily.
2. Vitamin D 1000 international units one tablet by mouth daily.
PATIENT NAME: Christina Thomas
DOB_question: 26/02/1987
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711473365.799578 | Mark Espinoza |
Consult
541 mg with meals
Epogen 10,410 units/mL injectable solution
10,410 units Subcutaneous Dialysis
Histories
Past Medical History:
Past Medical History
HTN Hypertension
Atrial fibrillation
Hemodialysis
Past Surgical History:
Procedure List:
23/07/10 Ankle Open Reduction Internal Fixation
Family History:
No qualifying data available.
, Family history review on 23/01/11.
History of Present Illness
Patient is a 67 yo female, traveling to Orlando from Ohio, with h/o ESRD on HD TTS via AVF, with h/o DM,
CAD s/p CABG, who presented to AHC Er after slip and fall getting out of shower and had c/o ankle pain.
Review of Systems
Constitutional: Negative except as documented in history of present illness.
Patient name:
Mark Espinoza
MRN: 74126415
Printed On:
10/30/2023 05:11 EDT
Page 58 of 516
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711475620.902318 | 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 Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711476578.254116 | Michael Sanchez |
athena
01/20/04 2:37:31 pm EDT
c1b3164-d76e-4d16-bbb4-176167d36416
Page: 26/29
OTOLARYNGOLOGY CONSULTANTS . 10116 Hagen Ranch Rd
OWENS, Shannon (id #131624, dob: 08/94/10)
OTOLARYNGOLOGY CONSULTANTS * 10150 Hagen Ranch Rd
OWENS, Shannon (id #131624, dob: 08/94/10)
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 20/15/01 11:23 AM
Ord Prov:
Vengerovich, Gennediy
Address:
116 SE 15 Avenue
Ft Lauderdale FL 33301-3985
Tue May 24, 2022 11:26 AM
Page 2 of 2
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711473238.012325 | Eric Garcia |
<<Back To Review>>180298-16-HYPER LINK - Page
178
Legal Copy
SGMF-PRIMARY CARE
Eric Garcia
Sutter Health
95355-4276
MRN: 53959548, birth date: 1996 Jul 17, Sex: M
Single Notes
DATE OF VISIT: 2022 Feb 28
Notes (continued)
Patient Instructions by Dr Tina Pittman MD at 12/30/16 1528
Author: Dr Tina Pittman MD
Service: -
Author Type: Physician
Filed: 12/30/16 1528
ENCOUNTER DATE: 2017 Jan 30
Status: Signed
Editor: Dr Tina Pittman MD (Physician)
signature Dr Tina Pittman MD at 2019 May 12 1468
Notes
Progress Notes by Kobrine, Steven E, MD at 2022 Jun 05 1463
Printed by [S274622] at 10/28/21 11:27 AM
00178
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711477183.026843 | Gary Martin |
Patient
seeds this form filled
US. Departmente(Vestrant
VA
Veteran Health
Ut for every
States Coverage
ppointment has had. Southeast Louisiana Veteran Health
Care System
2454 Canal Street
New Orleans, LA 70154
Facility Name: Louisiana pain Specialists
Address of Facility: 5600 Read Blvd 10th flower, N.O, (A 70154
Phone number of Facility:
504. TEA 2354
Time of appointment:
9:40 Am
Date of appointment(s):
January 06, 2016
Veteran's Name
Anne Cooper
Veteran last four (SSN): 37154
I certify that the veteran named above attended said appointment as per Department of Veteran Affairs.
Signature: Spaymeno
Date: February 26, 2020
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711475190.013772 | Ian Case |
NOVANT
NOVANT HEALTH
Ian Case
N
REHABILITATION CENTER
MRN: 56424647, BIRTH DATE: 2004-03-18, Sex: M
HEALTH
KERNERSVILLE
Adm: 2014-05-16, D/C: 2014-06-15
1730 Kernersville Medical
Pkwy,Ste 201
Kernersville NC 27284
03/28/2023 - GWSM REHAB PT CONTINUOUS APPT in Novant Health Rehabilitation Center Kernersville
(continued)
Clinical Notes Acute (continued)
Erika Klein, PT at 3/28/2023 1445
Author: Erika Klein, PT
Service: Physical Therapy
Author Type: Physical Therapist
Filed: 03/28/23 1538
service date: 2014-06-20
Status: Signed
Editor: Erika Klein, PT (Physical Therapist)
Daily Treatment and Progress Report
Patient Name: Ian Case
BIRTH DATE: 2004-03-18
Today's Date: 2016-11-16
Referring Provider:Dr Eric Decker, MD
Generated on 4/11/23 8:32 PM
Page 8
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475741.393366 | Kelly Ayala |
The Gables Surgical Center
IMMEDIATE POST PROCEDURE PROGRESS NOTE
Date: 24/07/2018
PRIMARY SURGEON:
Berti
ASSISTANTS: NONE / NAME: Secular
PRE-OPERATIVE DIAGNOSIS:
L4-5diss diguster + instality
POSTOPERATIVE DIAGNOSIS SAME LOTHER, LIST:
TECHNICAL PROCEDURES (PROCEDURES PERFORMED):
Q Ly-5 pedrle seven 50 X 7 Am
2,445 interbody optimest
SPECIMEN(S) REMOVED AND SENT TO LAB PER POLICY: NONE / YES, LIST:
Lyndhi
COMPLICATIONS DURING PROCEDURE: NONE YES, EXPLAIN:
DRAINS: NONE/YES, DETAIL:
ESTIMATED BLOOD LOSS (EBL): MINIMAL LOTHER, DETAIL:
ANESTHESIA TYPE: GENERAL + MAC / LOCAL Immunity
PLEASE INDICATE LATERALITY WHEN APPLICABLE
Physician's
Operative Signature: note to be dictated John immediately following procedure
ID / Visit: 117744 / 4
DOS: 08/09/2021
Kelly Ayala
Sex: M
DOB: 22/06/2003
Age: 26
Phys: Jacobson, Robert
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711476578.034992 | Valerie Savage |
BAYLOR SCOTT & WHITE
Williams, Charles Eugene
BaylorScott&White
HEART AND VASCULAR
MRN: 9221622, DOB: Apr 13, 1993, Sex: M
HOSPITAL - DALLAS
Acct #: 33000xxxxx
621 N HALL ST
Admitted Feb 07, 2015. D/C Mar 09, 2015
DALLAS TX 75226-1339
02/08/2023 - Admission (Discharged) in Baylor Scott & White Heart and Vascular Hospital
Reason for Visit
Visit Diagnoses [last edited by Donsky, Alan Stuart, MD on 2/8/2023 1331]
Typical atrial flutter (HCC)
Essential (primary) hypertension
Revision History
Action
Name
User
Date/Time
Diagnosis #1
Modify
Typical atrial flutter (HCC)
Donsky, Alan Stuart,
Mar 12, 2022 1322
MD
Add
Typical atrial flutter (HCC)
Hernandez, Minerva
Mar 12, 2022 1352
Visit Information
Admission Information
Arrival Date/Time:
Admit Date/Time:
Feb 07, 2015 0923
IP Adm. Date/Time:
Admission Type:
Elective
Point of Origin:
Physician Or Clinic
Admit Category:
Referral
Means of Arrival:
Primary Service:
Hospitalist
Secondary Service:
N/A
Transfer Source:
Service Area:
BAYLOR SCOTT &
Unit:
Baylor Scott & White
WHITE HEALTH
Heart and Vascular
Hospital Dallas
MD
Discharge Information
Date/Time: Mar 09, 2015 1623
Disposition: Home Or Self Care
Destination: -
Provider: -
Unit: Baylor Scott & White Heart and Vascular Hospital - Dallas
[There is no Transfer Center request information to display]
Printed on Dec 05, 2017 10:23 AM
Page 22
22208-22
Baylor Scott & White Heart & Vascular Hospital - 00022
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711471329.228914 | Michael Jones |
84276 English Courts
South Melissafort, MO 15902
Michael Jones (id #922514, DATE OF BIRTH: 1994-21-02)
date of encounter: 2017-05-11
Patient
Patient name
Michael Jones (33yo, F) ID# 922512
Appt. Date/Time
2023-18-02 11:00AM
DATE OF BIRTH
1994-21-02
Service Dept.
MGPC_Grove City Broadway
-
Provider
MOIRA SKURATOWICZ, APRN
Insurance
Med Primary: AETNA
Insurance # : W212544738
Policy/Group # : 010986743840258
PCP : MILLER, TERESA
Prescription: CVS|CAREMARK - Member is eligible. details
Patient's Care Team
Primary Care Provider (Primary Insurance): MILLER, TERESA: 3667 MARLANE DR, GROVE CITY, OH 43123, Ph 812-581-5010, Fax 814-553-1545
Vitals
2023-18-02 03:12 pm
Ht: 5 ft 4 in
Measurements
None recorded.
Allergies
Reviewed Allergies
Ibuprofen: Hives (Moderate)
DIPHENHYDRAMINE HCL: - COMMENT: CAUSATIVE AGENT: BENADRYL;
YEAST: - REACTION: HIVES, RASH;
Medications
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711473237.401031 | Deborah Webb |
021/025
NuHealth, NASSAU UNIVERSITY MEDICAL CENTER
Deborah Webb
F
BIRTH DATE:87-03-28
Result
[Reference Range|
Report Date
CT Head/Brain; w/o Contrast
Exam Report
03/24/2022 17:33
W
Department of Radiology
Final
Patient: TRAUMA, ESCONDIDO
121YF
BIRTH DATE:87-03-28
Dr:Dr Albert Gentry
exm date:17-05-11
Order #: CT7762-22 CT HEAD/BRAIN W/O CONTRAST
The undersigned attending reviewed and agreed with the
Interpretation.
Interpreter:
(13761)
Transcriptionist: (776)
Report Date:
03/24/2022 04:22:42
Report Status: Preliminary
Result Flag Key: A-Abnormal, L-Low, LL-Low critical, H-High, HH-High critical, [NDET]-Not Detected
Page: 1 of 6
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475444.791645 | Angela Roberts |
Angela Roberts DOB: 09/1998/12 (Random 2 yo M) Acc No. 20237 Doc Name: Controlled Substance Agreement
Angela Roberts DOB: 09/1998/12 (Random 2 yo M) Acc No. 20237
08/2017/05
I will keep follow-up visits as directed by LA Health Solutions. If I must cancel an appointment, I will give at least
24 hours notice and reschedule. I will also keep all therapy appointments with LA Health Solutions. If I do not
show up for therapy appointments I understand that LA Health Solutions may cancel my appointment with the
medical doctor and that I may not be able to obtain a refill on my prescription.
I acknowledge treatment with controlled substances is contingent on evidence of benefit. I am aware my case will be
reviewed periodically to determine whether I am improving or that progress is being made to improve my function and
quality of life. If my treatment regimen does not show any evidence of this, I know I may be tapered off controlled
medications and a new treatment may be prescribed.
I will use caution and common sense while taking this medication. I will ask questions if I do not understand something
or if I feel I may be having trouble with the medication.
X
/
Patient?s Name (Print)
Patient?s Signature
Date
Signed On:08/2015/26
03:19:14 PM CDT
efile:///C:/Users/ashton/AppData/Local/Temp/eCW.5fkglis2.pj3/63ae77f4-1e94-4ade-a192-c9a67765b950.html
2/2
Angela Roberts DOB: 09/1998/12 (Random 2 yo M) Acc No. 20237
Angela Roberts DOB: 09/1998/12 (Random 2 yo M) Acc No. 20237 Doc Name: Controlled Substance Agreement
Page 38 of 47
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711472786.667186 | Anthony Kelley |
athena
09-18-2023 2:23 PM ET
613-195916329
pq 40 of 42
Privia . CCA . Cardiac Care Associates PC . 224D Cornwall St. LEESBURG VA 91632-2700
Anthony Kelley (id #1542666, date of birth: 1999/19/11)
MEDICAL IMAGING CENTER
Name: Anthony Kelley
1260 Town Center Drive #126
Phys: Dr Michael Evans MD
Reston, VA 20260
date of birth: 1999/19/11 Age: 27
Sex: F
PHONE #: (263) 268-2601
date of examination: 2023/04/12 Status: REG CLI
EXAMS:
002916325 CT CHEST W IV CON
- CT CHEST W IV CON
HISTORY: Shortness of breath, chest pain.
TECHNIQUE: Multiple thin elice axial images were obtained through the
chest were obtained after the administration of 100mL Isovue
intravenously without adverse reaction.
COMPARISON: Multiple prior CT cheet without contraet, most recently
dated 5/11/2017
FINDINGS:
Lungs: The lungs are clear.
Thoracic Aorta: Within normal limits.
IMPRESSION:
No acute pulmonary process.
Minimal amount of residual thymus tissue, unchanged.
signature Dr Michael Evans MD on 2019/24/01 at 1629
**
Reported and signed by: Dr Michael Evans, MD
PAGE 1
Signed Report
(CONTINUED)
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711471329.627324 | Cynthia Whitehead |
10:35 AM FROM: Fax California Orthopaedic Surgery and Hand Institute
PAGE: 001 OF 003
BP: 162/80
P:86
Resp: 12
Wt: 530
Ht:60
BMI: 53
(Vital signs recorded by Medical Assistant)
Objective Findings: (Include significant physical examination, laboratory, imaging, or other diagnostic findings.)
No new local changes to the right elbow.
Diagnoses:
DI CODE
Description
1
M53.11
Kidney Stones
Treatment Plans:
Patient to start with outpatient Acupuncture, 6 sessions Advised to use over-the-counter oral analgesic medication and/or
over-the-counter oral nonsteroidal anti-inflammatory medication as needed.
Medications Prescribed: None.
Work Status: Modified duty - No lifting greater than 5 pounds.
Primary Treating Physician: (Original signature)
exam date: Mar 09, 2024
fauch Speel PAC
Crystal Norris, P.A. C-T-2016-10-10_11:00:07_Digitally Signed
Charle I Reoving MD
Dr Shannon Miller, M.D.-S-May 26, 2016_21:52:45_Digitally Signed
Executed at: Pasade na, California
Date: Apr 08, 2015
Physician Name: Dr Shannon Miller, M.D.
Specialty: Orthopaedic and Hand Surgery
Physician Address: 142 Lopez Rest
Zhangport, NC 25256
Phone: 772-517-7913
Next follow up visit: 4 weeks
DWC Form PR-2 (Rev. 10/2015)
Page: 2
1196
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711475190.121629 | Joseph Walker |
Novant Health Mothershed Foot Joseph Walker
N
NOVANT
& Ankle Specialist
MRN: 53624367, BIRTHDATE: 21/04/97, Sex: M
HEALTH
436 Pineview Drive Ste 360
visit: 19/03/16
KERNERSVILLE NC 27364-
3817
24/05/19 - Office Visit in Novant Health Mothershed Foot & Ankle Specialist (Kernersville) (continued)
Clinical Notes Amb (continued)
SIGNATURE Robb A Mothershed, DPM at 15/05/14 1362
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 visit date or date of visit? | {"text": ["19/03/16"], "answer_start": [172]} |
id_1711473237.429693 | Heather Harris |
-0400
PAGE 2
OF 3
Massapequa Imaging
An Affiliate of Northwell Health
1220 Hicksville Road, Seaford, NY 11783 (516) 266-3456 (516) 266-3490
RAND RODGERS
PATIENT NAME:Heather Harris
1000 NORTHERN BLVD
AKA: Heather Harris
GREAT NECK, NY 11021
MR#: 12509533
EPI #: 3450953
D.O.B: 20/89/11
AGE: 57Y FEMALE
Acc#: 57509533
EXAM: 57509533 - CT ORBITS - ORDERED BY: RAND RODGERS
PROCEDURE DATE: 18/14/10
INTERPRETATION: CLINICAL INDICATION: Orbital fracture, ruptured globe thin axial series through
the orbits were obtained with coronal computer-generated reconstructed views.
Dr Douglas Oneal MD; Attending Radiologist
Page 1 of 2
Date Printed: 6/20/2022 4:47 PM
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711472786.950651 | Glen Cobb |
MEDICAL IMAGING CENTER
Name: MORRIS, ANN CHRISTINE
1830 Town Center Drive #110
Phys: Dr Daniel Preston MD
Reston, VA 20190
DOB: 01/2002/11 Age: 57
Sex: F
PHONE #: (703) 808-3801
date of exam: 08/2015/18 Status: REG CLI
FAX #: (703) 807-5806
Radiology No:
Unit No: K000383000
EXAMS:
002383003 CT CHEST W IV CON
<Continued>
electronically signed by M.D. Dr Daniel Preston on 07/2023/06at 1428
**
Reported and signed by: DAVID DUBOIS, M.D.
CC: Ajay Dar MD
Dictated Date/Time: 12/23/2021 (1417)
Technologist: CAROLINE J. TOURTELLOTTE, RTRM
Transcribed Date/Time: 12/23/2021 (1417) By: DR.DUBDA
Printed Date/Time: 12/23/2021 (1500) BATCH NO: N/A
PAGE 2
Signed Report
| What is the Date of Exam or Examination date? | {"text": ["08/2015/18"], "answer_start": [212]} |
id_1711473530.69441 | Jeremiah Harrison |
<<Back to Review>>155255-41-HYPERLINK Hyperlink-Page
16
From icampusano 1.855.355.8555 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: Jeremiah Harrison
exm date: 18-08-18
Supervising Physician: Ronald Fujimoto DO
Performing Provider: Dr Luis Fuentes MD
Krewark
MD
Dr Luis Fuentes MD
Today's Date: 04/01/2019
RehabOne Medical Group, Inc.
Mailing Address: 13980 Blossom Hill Rd. Ste. B, Los Gatos, CA 95032
Phone: 455-455-8550 Fax: 455-455-0555
Providers' CA License Numbers:
Michael Post, MD - G75517
Ronald Fujimoto, DO - 20A6554
Allen Kaisler-Meza, MD - G74556
page 11
000016
0016
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711475444.637108 | Stephen Ramsey |
From: DAVID GOLDMAN
Fax:
To:
Fax: (610) 354-8946
Page: 4 of 72
2018 Sep 17 4:33 PM
Stephen Ramsey
Visit Note - 2017 Aug 24
PMS ID:
Sex:
DOB:
MRN:
438-5647467272
Female
2001 Sep 26
024986
Medications
OPHTHALMIC MEDICATIONS
Chief Complaint: Eye Irritation
NONE
extended release 24 hr
citalopram 40 mg Oral tablet
diphenoxylate-atropine 2.5-0.025 mg
Pt has not been using drops currently.
Oral - tablet
hydrochiorothiazide 25 mg Oral
Pt tried Restasis 2015, did not help (pt has no idea how long she used it for)
tablet
lorazepam 1 mg Oral tablet
No asthma, yes some seasonal allergies.
losartan 100 mg Oral tablet
S/P LASIK OU 2010
mirtazapine 15 mg Oral tablet
Pt has not tried plugs.
sumatriptan succinate 100 mg Oral
Pt states last eye exam 03/2019
tablet
temazepam 15 mg Oral capsule
Aimovig Autoinjector 70 mg/mL
On further history taking, pt has no grittiness, no burning, no irritation but pt's only complaints are a film over the vision
Subcutaneous auto-injector
OU that fluctuates (not like a floater or black spider web) and crusting (seldom) upon awakening
Last dilated exam over 1 year ago
Ocular History
Obtained and Reviewed December
28, 2020.
Allergic conjunctivitis
Tear film insufficiency
Eye Exam
Wears glasses
Vision
Distance Test Type: Snellen Chart
Mark Milner (Primary Provider) (Bill Under)
David A. Goldman MD LLC
Page 1
(561) 630-7120 Work
3502 Kyoto Gardens Dr
(561) 630-7122 Fax
Suite B
Palm Beach Gardens, FL 33410
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711472286.53424 | Leon Salazar |
Leon Salazar
MRN: 5603213
06/05/2023 - Telephone in MultiCare Rockwood Orthopedics & Sports Medicine
MultiCare Health System
PATIENT: Leon Salazar
MRN: 5603213
CSN: 296328619
Account Information
Admit Date
HAR#
Pt Class
Hospital Svc
Bed
2022 September 12
No service for
Admitting Physician:
Chief Complaint:
Forms
Adm Dx:
Gestational Age: <None>
Patient Information
Home Address:
1835 E 8th Ave
Telephone Information:
Spokane WA 99202-3409
Home Phone
Not on file.
Work Phone
Not on file.
SSN:
xxx-xx-8028
Mobile
509-993-4659
Age:
52 year old
Employer:
UNITED PARCEL SERVICE
dob:
1984 December 13 (40 yrs)
United Parcel Service
Sex:
male
Marital Status:
Significant Other
RIVER VIEW CORPORATE
Leon Salazar
CENTER
MRN: 5632313, dob: 1984 December 13, Sex: M
16201 East Indiana Ave
Visit: 2016 January 24
SPOKANE VALLEY WA 99216-
1882
Page 20
Printed by 414221 at 7/17/23 9:40 AM
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711476578.310544 | Laura Reynolds |
UNIVERSITY OF MIAMI
UMHC
Owens, Shannon
HEALTH
HOSPITAL AND CLINICS
1475 NW 12th Avenue Suite
MRN: 50770250, DOB: 1997 Oct 01, Sex: F
3050
Enc. Date: 2023 Oct 10
Miami FL 50136-1050
05/05/2023 - Office Visit in UHealth at UMHC Sylvester Spine Institute (continued)
Clinical Notes (continued)
Miami, FL 33136
Fax: 305-250-6505
Electronically signed by Dr Chase Armstrong, MD at 2014 Oct 27 12:51 PM
Eismont, Frank J., MD at 5/5/2023 1530
Author: Eismont, Frank J., MD
Service: -
Author Type: Physician
Filed: 5/5/2023 5:43 PM
Encounter Date: 2023 Oct 10
Creation Time: 5/5/2023 4:40 PM
Status: Signed
Editor: Dr Chase Armstrong, MD (Physician)
Electronically signed by Dr Chase Armstrong, MD at 5:43 PM
USER, SCANNING at 5/9/2023 0301
Author: USER, SCANNING
Service:
Author Type: Resource
Filed 5/8/2023 11:01 PM
Encounter Date: 2023 Oct 10
Creation Time 2021 Aug 14 11:01 PM
Status: Signed
Editor: Onbase, Scanning
Generated on 2021 Aug 14 4:18 PM
Page 50
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711475741.364397 | Regina Payne |
THE GABLES SURGICAL CENTER
401 S.W. 42nd Avenue, Suite 201
Miami, Florida 33134
Tel: (305) 447-0882 Fax: (305) 447-0213
OPERATIVE REPORT
PATIENT NAME: Regina Payne
MEDICAL RECORD #: 8756500
DATE OF BIRTH: 12/1988/01
PHYSICIAN: ROBERT JACOBSON, M.D.
DATE OF SURGERY: 06/2018/19
and expanded filling the cavity fo disc space across midline and expanding the colipase to the right. that
the position was across the midline. This crossed the disc space. This was removed. Then, an OptiMesh
was placed in the disc space and then 3.5 pipettes of bone was impacted into the disc space.
X
Aldo Berti M.D.
JOB#: 537954 RJ: med: anu/nss/im DD: 11/2018/14
DT: 11/2018/14
OPERATIVE REPORT - PAGE 2 of 2
| What is the Procedure Date? | {"text": ["06/2018/19"], "answer_start": [289]} |
id_1711473365.716026 | Brian Lopez |
PROGRESSIVE IMAGING MEDICAL ASSOCIATES
3501 Coffee Road, Ste. 2, Modesto CA 95335
Phone: (233)433-4330
PATIENT NAME: Brian Lopez
PATIENT ID NO.: P733417
BIRTHDATE: 08/12/02
AGE: 79 years
SEX: M
RADIOLOGIST:
Dr Kayla Cooper, MD
Date of Examination: 13/07/21 5:45:00 AM
ACCESSION NO.:
RAM933694
REFERRING MD: CARRIE JANISKI, DO
EXAM DETAILS: XR ANKLE COMPLETE
EXAMINATION PERFORMED AT:
GREAT VALLEY IMAGING
EXAM: XR -RIGHT ANKLE- 3 VIEWS
(AP, lateral, oblique views right ankle.)
HISTORY: Right ankle pain, Date of injury 03/02/21.
FINDINGS: There is a fracture seen of the distal fibular.
IMPRESSION:
1. Partially united lateral distal fibular fracture as well as ununited medial malleolar
fracture.
Released by MARK GOLDBERG, MD at 06/01/15 4:25:43 PM
Page 1 of 1
0002
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711475741.508114 | Samuel Ellis |
Samuel Ellis DOB: 1996 January 06 (53 yo M) Acc No. CR842859
2023 April 21, 9:09 AM
Samuel Ellis DOB: 1996 January 06 (53 yo M) Acc No. CR842859 DOS: 2020 February 17
Savani, Rajendra
JAX
53 Y old Male, DOB: 1996 January 06
Account Number: CR842859
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
2020 February 17
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 2014 April 25
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
Samuel Ellis DOB: 1996 January 06 (53 yo M) Acc No. CR842859
Page 8 of 166
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711471329.117217 | Scott Richardson |
ciox
Fee Approval Request
HEALTH
CIOX HEALTH
Please deliver this to the following medical record requester:
Attention :
Facility:
Downtown Medical Center
Requester :
TScan
Site :
64580
Address :
0257 Victoria Isle
West Sandy, FM 99490
Address :
0257 Victoria Isle
West Sandy, FM 99490
City, State,
City, State,
Zip :
Seattle, WA 98199
Zip
Detroit, MI 48201
Rep
Telephone :
374-592-9180
CIOX Rep:
Vernette Gordon
#:
825121
Fax :
294-441-1438
Fax to:
Records
CIOX HEALTH REP Vernette Gordon
Fax Number: 313-993-0763
Phone: 313-745-3021
Dear Medical Record Requester :
Date: 22-05-07
CIOX HEALTH has contracted with Downtown Medical Center (Medical Facility/State) to copy
it's authorized requests for medical records.
03/28/2019
Patient name :
Scott Richardson
birth date :
03-10-21
Soc. Sec. # :
DATE OF SERVICE
23-09-22
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
18-08-17
(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 Date of operation? | {"text": [], "answer_start": []} |
id_1711477183.09147 | Charles Willis |
Toxicology & Compliance
Laboratory Report
Patient Name: Alyssa Ali
Patient DOB: 03-01-25
Requesting Physician: Erik Davis
Requesting Practice: Louisiana Pain Specialists
Specimen ID: LL222039A
Collected: 21-03-05 8:05:41 AM
Received: 23-04-21
Reported: 23-09-05
Current Reported Prescriptions
Hydrocodone (Vicodin,Lorcet,Hycodan,Lortab,Norco)
Patient Name: Alyssa Ali
Specimen ID: LL222398A - Specimen Type: Urine
The perfomance characteristics of this test were determined by Louisiana Pain Specialists, LLC. It has not been cleared or approved
by the U.S. Food and Drug Administration.
Louisiana Pain Specialists, LLC 2706 Hessmer Ave Suite A Metairie, LA 70002 539.xxxxx
Lab Director: Eugene Schwilke, PhD
CLIA ID#: 19D2119639
Page 3 of 3
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711472590.670396 | Christopher Grant |
Page 1 of 1
Notice: This is NOT a bill. Do not pay. If it is
庐
determined that this service or a portion of
THIBODAUX REGIONAL
these services is not payable by your health
HEALTH SYSTEM
plan, you will be responsible.
Responsible Party:
Buggage, Nadine
126 Jacobs St
Napoleonville, LA 70390-2429
Name: Christopher Grant
Guarantor Number: GN09150841
Account Number: V00091508411
Service Dates: 2015 Mar 07-06/22/22
Bill Date: 07/06/22
Insurance Coverage
Insurance Policy Number
Blue Cross Louisiana
IHQ862849150841
For additional information, please contact us at 348-589-1632.
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711473366.003969 | Theresa Nguyen |
BERNARD TUMARKIN, M.D.
JAY FRANKEL PH.D.
and Psychiany
PAUL TUMARKIN. PH. D.
Clinical Perchalegy
227 ALCAZAR AVENUE
CORAL GABLES, FLA 33134
C
0
0
7
15 Mar 2022
Psychological tv
CONT FIDENTIAL
Zmistowski, Jeff
date of evaluation: 27 Oct 2019
Referring Physician: Dr Ryan Moore M.D.
Director, Pain Treatment
INFORMATION NOT TO BE RELEASED I
History:
At the request of Dr. Dooley. director of the Baptist Hospital Pain Treatment Center,
Mr. Zaistowski was seen on December 12, 1983 and was administered a battery of tests in
order to conduct a psychological evaluation.
PartJane
Paul Tumarkin, Ph.D.
RECEIVED
05 Jan 2023
DELRAY BCH., FL
CLAIMS OFFICE
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711473239.031299 | Paul Lynch |
RE2132527
MRI Patient History and Questionnaire
Patient Name JUSTIN GARIBALDI
CIS323332
D.O.B 02-05-1993
Patient 256
The following list consists of items that can interfere with MR Imaging, or if present, can be hazardous to
your safety.
Pacemaker/ Defibrillator
Yes
No
Cardiac Stent
Yes
No
Brand and ID#
List ALL Surgeries
0
Please remove all jewelry and hairpins prior to going into MRI suite for exam
I have completed this questionnaire and answered all questions to the best of my knowledge.
01-11-2023
Patient Signature
Date
Patient% Representative
Date
Kelly
Signature Babing
01-11-2023
Technologist's
Date | What is Collection Date? | {"text": [], "answer_start": []} |
id_1711475189.823488 | Troy Martinez |
V
VCO VOCATIONAL SPECIALISTS
Mark Alexander, MS
August 02, 2021
Mr. Ulises J. Aguirre, Esq.
Law Offices of Robert T. Bledsoe
330 W. Hedding St., #178
San Jose, CA 9578 0
Subsequent Injuries Benefits Trust Fund
Department of Industrial Relations
178 0 Howe Avenue, Suite 378
Sacramento, CA 9578 5-378 7
Employee:
Troy Martinez
date of birth:
May 10, 1996
Date of Injury:
April 02, 2020
Employer:
Superstores Industries
SIBTF #:
SIF17839788
VCO File #
97878
Subsequent Injuries Benefits Trust Fund (SIBTF) Vocational Evaluation Report
I have been requested by Attorney Ulises J. Aguirre to perform a vocational evaluation report
addressing Mr. Edward Foster's ability.
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711472786.953375 | Stacy Gray |
MEDICAL IMAGING CENTER
Name: MORRIS, ANN CHRISTINE
1830 Town Center Drive #110
Phys: Dr Ashley Thornton MD
Reston, VA 20190
date of birth: 93/08/22 Age: 52
Sex: F
PHONE #: (703) 138-3131
date of exam: 19/02/22 Status: REG CLI
FAX #: (703) 137-5136
Radiology No:
Unit No: K000579860
EXAMS:
002579863 CT CHEST W IV CON
<Continued>
ELECTRONICALLY SIGNED BY M.D. Dr Ashley Thornton on 24/02/15at 1428
**
Reported and signed by: DAVID DUBOIS, M.D.
CC: Ajay Dar MD
Dictated Date/Time: 12/23/2021 (1417)
Technologist: CAROLINE J. TOURTELLOTTE, RTRM
Transcribed Date/Time: 12/23/2021 (1417) By: DR.DUBDA
Printed Date/Time: 12/23/2021 (1500) BATCH NO: N/A
PAGE 2
Signed Report
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711473530.781116 | Charles Henry |
<<Back to Review>>180298-33-HYPERLINK Hyperlink-Page
23
TRI VALLEY ORTHOPEDIC . 4626 Willow Road, PLEASANTON CA 94428-8424
Charles Henry (id #342142, birth date: 10 May 1985)
List each specific requested medical services, good, or items in the below space or indicate the specific page numper(s)
of the attached medical report on which the requested treatment can be found. Up to five (5) procedures may be entered:
Diagnosis (Required)
ICD-Code (Required)
1. Closed bimalleolar fracture - Right
S82.841P: Displaced bimalleolar fracture of right lower leg, subsequent
encounter for closed fracture with malunion
Service/Good Requested (required)
Right ankle ultra guidance cortisone injection
Requesting Physician Signature:Electronically signed by: SEAN DOUGHERTY, DPM
Date:07 May 2021
Sean Dougherty DPM
000023
0023
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711475444.293053 | Jesse Cole |
07 May 2014 FROM- CWFMD
936-703-5455
T-252 P0031/0063 F-236
Conroe Regional Medical Center - Women's Imaging
504 Medical Center Blvd.
Conroe, TX 77304
Patient:
Jesse Cole
Facility ID:
BH55448111/AA
DOB_question:
22 May 2002
Height / Weight:
65.0 in. 100.0 lbs.
Measured:
07 December 2021
Sex / Ethnic:
Female White
Analyzed:
07 December 2021
AP Spine Bone Density Trend
Densitometry Ref: L2-L4 (BMD)
Trend: L2-L4 (BMD)
BMD (g/cm2)
YA T-score
%Change vs Baseline
1.456
Normal
Trend: L2-L4
1
Change vs
Measured
Age
BMD
Previous
Previous
Date
(years)
(g/cm2)
(g/cm2)
(%)
07 December 2021
46.7
0.965
COMMENTS:
-0.155
-13.8'
07 December 2021
37.8
1.120
GE Healthcare
Lunar iDXA
ME+200592
Name: Jesse Cole
BIRTH DATE: 22 May 2002
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711476768.809071 | Alan Mitchell |
12/27/22, 10:19 AM
Alan Mitchell I M I 11/20/1963 I 59Y
TBI
PATIENT NAME:
Alan Mitchell
DOB:
08/08/1994
PATIENT NUMBER:
T67179
REFERRING PHYS:
ATHANS
DATE OF SERVICE:
28/09/2020 10:32:42 AM
MRI OF THE CERVICAL SPINE:
HISTORY: MVC dated 12/12/22 with neck pain.
TECHNIQUE: Multisequence T1 and T2 weighted images were obtained.
FINDINGS: The posterior fossa structures are normal.There is loss of the normal lordotic curvature of the cervical spine. In the correct
clinical setting, this may reflect injury. Clinical correlation is recommended. No prevertebral
or
paravertebral masses or fluid collections are identified. Segmental analysis of the cervical spine
is as follows:
At C2-3, there is no evidence for disc herniation, canal stenosis or neural foraminal stenosis.
At C3-4, there is bulging of the disc. This results in an anterior impression on the thecal sac.
There is no central canal stenosis or foraminal stenosis.
IMPRESSION:
TAMPA BAY IMAGING
2700 WEST DR. MLK JR. BLVD SUITE 130
TAMPA, FL 33607 TELEPHONE 813xxxxxxx FAX 813xxxxxxx
Page 1 of 3
1/3
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711472590.744496 | Cynthia Khan |
Cynthia Khan
Bayside Hospital
Visit Note - 15/07/2021
PMS ID:
Sex:
DOB:
MRN:
54403 Female 21/04/2000 54403
Medications
Chief Complaint: Chronic Low Back Pain
Duexis 840-40.6 mg Oral tablet
Medical History
HPI: This is a 77 year old female who is being seen for a chief complaint of chronic low back pain involving the spine.
Social History
with tramadol
Smoking status Unspecified
ROS
Vitals:
Provider reviewed on 31/08/2014.
Date
Taken By
B.P.
Pulse
Resp.
02 Sat.
Temp.
Ht.
Wt.
BMI
BSA
A focused review of systems was
performed including Constitutional /
LeBoeuf, Maci
66.0 in
140.0
40.7
1.9
Symptom, Eyes, Hematologio /
07/07/22
lbs
Lymphatic, Integumentary,
08:34
Musculoskeletal, and Neurological
FIO2
Page 1
| what is the visit date or date of visit? | {"text": ["15/07/2021"], "answer_start": [52]} |
id_1711472590.671313 | Kathryn Howe |
Page 1 of 1
Notice: This is NOT a bill. Do not pay. If it is
庐
determined that this service or a portion of
THIBODAUX REGIONAL
these services is not payable by your health
HEALTH SYSTEM
plan, you will be responsible.
Responsible Party:
Buggage, Nadine
126 Jacobs St
Napoleonville, LA 70390-2429
Name: Kathryn Howe
Guarantor Number: GN05322730
Account Number: V00053227301
Service Dates: 08/05/14-06/22/22
Bill Date: 07/06/22
Insurance Coverage
Insurance Policy Number
Blue Cross Louisiana
IHQ862845322730
For additional information, please contact us at 786-634-4839.
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711477183.427202 | Reginald Butler |
Page 14 of 225
LADNER, James DOB: 1993-04-20 (72 yo M) Acc No. 204963 DOS: 2014-12-10
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 2020-05-13
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
hhttps://ladlssapp.ecwcloud.com/mobiledoc/jsp/catalog/xml/printMultipleChartOptions.jsp?e. 2020-05-13
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711471330.514099 | Matthew Torres |
08/05/10 08:21 AM Southwest Medical via VSI-FAX
Southwest Medical
FINAL REPORT
37128 Daniel Estates
South Erikmouth, NE 28840
DISCHARGE SUMMARY
Patient Name=Matthew Torres
Acct #=1{Random_7_digit_number}
MRUN=57-42-95
BIRTHDATE= October 02, 1990
date of admit-October 02, 2020
Loc/Svc=/OBSV
discharge day=November 01, 2020
ADMITTING DIAGNOSIS:
Parkinson's Disease.
DISCHARGE DIAGNOSIS:
Gastric Ulcer.
HOSPITAL COURSE:
The patient was admitted or July 28, 2010, after having left upper
quadrant pain and constipation. However, she had had a recent bowel
movement that just was not normal; it was more difficult for her.
DISCHARGE MEDICATIONS:
1. Insulin one tablet by mouth daily.
2. Vitamin D 1000 international units one tablet by mouth daily.
Patient Name: Matthew Torres
DOB_question: October 02, 1990
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711473365.773077 | Sandra Jones |
Consult
Renal (El Toukhy)
patient name: Sandra Jones
MRN: 75026505
FIN: 95010505
Age: 53 years Sex: Female birthdate: 11/2000/18
Documentation Date: 05/2015/15 2:56 EST
Author: ADAMS APRN, LEAH DANIELLE
Consultation Information
Date of Consult: 06/2019/10
Reason for Consult: ESRD on HD.
Requesting physician:
Attending Physician: Dr Autumn Medina MD.
Admission Information
Date of Admit: 06/2019/01
Visit Reason: RIGHT ANKLE PAIN
Allergies
naproxen (hives)
Visit Information
Medications:
Active Scheduled Medications 1
amiodarone
150 mg PO qDay
Comments: pt home med dose
Comments: Start if pt becomes NPO for more than 4 hr.
patient name:
Sandra Jones
MRN: 75026505
FIN#: 95010505
Printed On:
10/30/2023 05:11 EDT
Page 56 of 516
Report Request ID#: 350350250
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711472591.055706 | Shane Wilson |
Shane Wilson
ID / Visit: 48470
Gender: F
BIRTH DATE: 14-09-1995
Age: 83
Phys: Dr Christopher Robertson
Cervical MBB
D.O.S: 09-05-2019
Diagnosis:
M47.82 Other specified inflammatory spondylopathies, cervical region
M47.472 Other spondylosis, cervical region
M47.893 Other spondylosis, cervicothoracic region
The patient was brought to the procedure suite and placed in the side lateral lying position. The
operative site'was prepped : x3 with alcohol and Betadine, and draped in a sterile fashion.
Stimulation: Slow injection of solutions DID provoke pain.
Moderate Sedation Documentation:
Before the procedure, cardiac and pulse oximetry was established and monitored throughout the
procedure.
Total moderate sedation time
25mi minutes.
B
22-10-2021
Dr Christopher Robertson, MD
Date/Time
| what is the DOB or date of birth? | {"text": ["14-09-1995"], "answer_start": [64]} |
id_1711476578.447214 | Amanda Taylor |
BRAVE HEALTH INC . 1962 NW 7th Avenue, Suite 300, MIAMI FL 36236-1162
OWENS, Shannon (id #92962, dob: 25 Jul 1998)
Return to Office
Patient will return to the office as needed.
Encounter Sign-Off
Encounter signed-off by Dana Vega DDS, Frances Wall, 27 Nov 2023
Encounter performed and documented by Dana Vega DDS, Frances Wall
Encounter reviewed & signed by Dana Vega DDS, Frances Wall on 27 Nov 2023 at 7:54pm
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711476578.597799 | Kevin Pineda |
INBOUND NOTIFICATION FAX RECEIVED SUCCESSFULLY
TIME RECEIVED
REMOTE CSID
DURATION
PAGES
STATUS
December 16, 2021 at 3:22:24 PM EST
SVMC
266
Received
SVMC
07/2015/13
12:17:46 PM
PAGE
6/016
Fax Server
DOD Salinas
Kevin Pineda
558 Abbott St Ste A
MRN: 311xxxx, DOB: 09/1988/19, Sex: F
DOCTORS
ON DUTY
State of California
Division of Worker's Compensation
PRIMARY TREATING PHYSICIAN'S PROGRESS REPORT
Other:
PATIENT:
Last:
Corona
First: Araceli
Middle:
Zip: 93xxx
Date of Injury: 08/2018/18
DOB:
09/1988/19
Occupation:
SSN: 617xxxxxx
Phone: 83xxxxx
CLAIMS ADMINISTRATOR:
Name: Gallagher Bassett
Claim #: 0054850xxxx
Address: Po Box 28xxx
City:
Clinton
Zip:
52733xxxx
Phone: 866xxxx
EMPLOYER NAME: Healthcare Services Group
Subjective Complaints: Worker's Compensation (WC DOI 01/2016/09 BACK)
Diagnoses:
1.
Lumbar strain, subsequent encounter
Treatment Plan:
TREATMENT PLAN: Light work starting 12/15/2021.Physical therapy. Return 12/23/2021.
DATE OF SERVICE
06/2021/25
CHIEF COMPLAINT:
Chief Complaint
Patient presents with
Worker's Compensation
BACK
Ashley Rosales
558 Abbott St Ste A
MRN: 311xxxx, DOB: 09/1988/19, Sex: F
Salinas CA 9390xxx
Page 16
Printed by Arizpe, Crystal, MA at 01/2016/09 12:16 PM
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711473237.372752 | Amy Sims |
39
FAX
MRN: 1940366H
Amy Sims
Nassau Unly. Medical
Gender: Female
Center
Age: 49y (02-12-1995)
Current Location:
Surg-Pediatric Eye Clinic
AMB OPHTH New Patient Ophthalmology Visit [Charted Location: Surg-Pediatric Eye
Clinic [DATE OF SERVICE: 03-25-2016 8:20, Authored: 07-Apr-22 10:53]- for Visit:
7742879X4204042031,
Notice of Status and Rights Involuntary Admission:
Patient's Name: Amy Sims
MRN: 1942742H
Sex: Female
BIRTH DATE: 02-12-1995
Facility Name: Nassau University Medical Center
Date of Admit: 04-16-2018 10:31
Date & Time: 10-08-2018 11:01
Allergies:
Allergy, Intolerance, Adverse Event:
Allergies:
No Known Allergies: Active
HPI:
Ophthalmology HPI:
Chief Complaint
Left ruptured globe
Page 1 of 6
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711477090.228647 | Christopher Cook |
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(970995) 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
2022 October 07
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 2022 October 07 10:08 AM
PVHC At Pomona
1770 N Orange Grove
Ste 101
Pomona, CA 91767070
(909)709-9470
Electronically signed by Snezana Begovic MD on2015 September 01 10:32 AM
Jarero, Elizabeth 000000079924 10/24/1978 05/15/2014 02:00 PM 3/3
0070
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711476990.519299 | Christopher Lewis |
2019-01-25 10:13:54
Oklahoma Spine 4058789460
11/60
Page 60
PATIENT NAME Caitlyn Rivera
MR#: M000143760
ADM DATE: 2020-05-25
DOB: 1999-06-20 SEX: M
10:50 AM
DC DATE: 2020-06-24 01:20
ATTENDING PHYSICIAN: Joseph Fuller, M.D.
PM
2. Continue on present medications.
3. Return for followup appointment within I to 2 weeks to check on response to the
injection or to repeat the injection or to proceed for RF ablation and to make any
necessary medication adjustment and determine subsequent treatment steps.
Electronically signed at 2023-10-18 7:08
AM (GMT -5)
Khali
Khan
MA
Joseph Fullern, M.D.
KK epins
Dietated: 08.16.2023 01:48 PM Transcribed: 2016-08-29 05:53 AM Doc: X161565
CC:
Muhammad M Gillan, M.D.
| What is the Procedure Date? | {"text": [], "answer_start": []} |
Subsets and Splits