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|---|---|---|---|---|
id_1711475444.904404 | 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 DOS or D.O.S? | {"text": ["02 February 2021"], "answer_start": [151]} |
id_1711475190.424292 | Becky Jackson |
N
NOVANT
Novant Health Orthopedics &
Becky Jackson
Sports Medicine
MRN: 56724677, BIRTH DATE: 03/11/2000, Sex: M
HEALTH
7670 Village Medical Cir
visiting date: 11/08/2021
Ste 110
CLEMMONS NC 27672-8679
13/02/2017 - Office Visit in Novant Health Orthopedics & Sports Medicine (Clemmons) (continued)
Clinical Notes Amb (continued)
Patient: Becky Jackson
MRN: 56724677
BIRTH DATE: 03/11/2000
DATE OF SERVICE: 13/08/2018
Referring Physcian: Frunza, Ana A, MD
Primary Physcian: Dr James Coffey, MD
SUBJECTIVE:
Jeffrey Craig Payne is a 35 y.o. male who presents today for evaluation.
Current Outpatient Medications
Medication
Sig
Dispense
Refill
alprazolam (XANAX) 1 MG
Take one tablet (1
tablet
mg dose) by mouth 3
(three) times a day
as needed.
Generated on 4/11/23 8:32 PM
Page 213
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711472591.08538 | Emily Jackson |
Gulf Coast
SURGICAL CENTER, LLC
Conscious Sedation
Educational Material and Informed Consent Form
The facts in this form will help you learn more about the type of anesthesia your doctor has
recommended for your procedure. Please read it carefully.
Your Health Problem
Your doctor has recommended that you have conscious sedation for pain control during your
procedure.
There are many types of anesthesia.
Local anesthesia is like the numbing medicine the dentist may use.
Minimal sedation involves different types of medicine to make you sleepy.
Your nurse will ask you about any allergies before the procedure.
First, an IV line will be started.
A plastic strip will be placed on one of your fingers and joined to a pulse oximetry machine.
The amount of medication is customized for each patient.
Emily Jackson
ID / Visit: 48170 1
Gender: F
DATE OF BIRTH: 2001/01/04
Age: 50
Phys: Dr Beth Stewart
DOS: 2015/21/08
Page 1 of 3
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711471328.634144 | James Woods | Central Regional Medical
Dr Karina Warner, MD
Dr Jenna Shaw, MD
PatientID: E80807
Patient name: James Woods
DOB: 1985/09/10 Age: 53 y
date of service: 2021/11/04
CHIEF COMPLAINT: Patient is seen today for incontinence.
DATE OF ONSET: 2006
REFERRING DOCTOR: Dr Howard Carrillo, MD.
MEDICATIONS: Ibuprofen,
FLU VACCINE
SURGICAL STAPLES
HEPATITIS VACICINE
HISTORY OF PRESENT ILLNESS:
VOIDING SYMPTOMS (LUTS): The need to urinate during the night occurs once.
URINARY INCONTINENCE: The patient loses urine with coughing, sneezing.
HISTORY:
625.6-FEMALE STRESS INCONTINENCE
PAST MEDICAL HISTORY:
MEDICAL: Thyroid
SURGICAL: Knee replacement in 2001
UROLOGIC SURGERY: Cystoscopy. 2006 & 2007 Urodynamic studies, all done in Shreveport
Louisiana
SOCIAL HISTORY:
MARITAL HISTORY: Widowed.
TOBACCO USE: Currently smokes 1 PPD. Has tried quitting with Chantix.
James Woods-KPJayaraman-000032 | what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711472786.923036 | Nancy Hamilton |
3296217
MEDICAL IMAGING CENTER
Name: Nancy Hamilton
AD
1830 Town Center Drive #110
Phys: Dr Brian Gonzalez MD
Reston, VA 20190
BIRTHDATE: 1994-10-02 Age: 50
Sex: F
1/12/22
date of examination: 2015-26-07 Status: REG CLI
Radiology No:
Unit No: K000171860
EXAMS:
002718983 CT CHEST W IV CON
CT SCAN OF THE CHEST WITH CONTRAST:
HISTORY: Lymphadenopathy. Easy bruising.
TECHNIQUE: Contiguous axial images were performed from the thoracic
inlet to the lung bases following the administration of 100 ml of
Isovue-300 (non-ionic) intravenous contrast.
COMPARISON: 3/8/2021.
FINDINGS: Previously seen mild mediastinal lymphadenopathy has
resolved.
IMPRESSION:
1. Interval resolution of mild mediastinal lymphadenopathy.
o
2. New 4 mm groundglass nodule right middle lobe. Recommend 3-6 month
7
follow-up CT to ensure stability or resolution.
PAGE 1
Signed Report
(CONTINUED)
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711476893.046199 | Joseph Shaffer |
NORTHBAY MEDICAL CENTER
NorthBay Hospital Campus: 1200 B. Gale Wilson Blvd.
Fairfield, CA 94533 (707) 646-5000
ED Physician Documentation
Physician:
Ankney. William A M.D.
Signed:
2022 May 03 03:42:46
Status:
Auth (Verified)
Document:
ED Physician Notes
Fall
Patient: MEJIA-GALLEGOS, FLORENTINO
MRN: 608698
FIN: 010998039
Age: 26 years Sex: Male DOB: 1998 January 17
Associated Diagnoses: None
Author: Ankney, William A M.D.
Basic Information
Time seen: Date & time 12/06/11 23:04:00.
History source: Patient.
Arrival mode: Walking.
Allergies: Include allergy profile.
Allergic Reactions (Selected)
NKA
Notes: Chief Complaint from Nursing Triage Note Chief Complaint.
2015 January 24 22:30
Chief Complaint
Right leg and right lower back pain. Ambulating with limp.
No head injury.
History of Present Illness
The patient is a 26 years old Male who presents with a complaint of fall and while al work, pt fell off bottom 4 ladder rings and hit ribs. hip
and knee.
Patient Name: Debra Jones
Medical Record No: 608698 Financial No: 010998039
Medical Records
DOB: 1998 January 17 Age: 28 years Sex: Male Pt Type: Emergency
N/A
Admit Date: 2024 January 30 Discharge Date: 2024 February 29
Admitting Physician:
Attending Physician: Ankney, William A M.D.
Printed 09/09/13 at 11:14 AM
(Page 11 of 28)
ED-NB
149
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711473365.827155 | Sara Wolf |
Electronic Physician Orders
Order: Activated Partial Thromboplastin Time (APTT)
Order Date/Lime 03-11-2016 09:56 EST
Order Status: Completed
Activity Type: General Lab
End-state Date/Time 12/4/2021 3:25 EST
Electronically Signed by: FERNANDEZ OLIVERO SR MD,
Consulting Physician:
GERARDO ANDRES
Entered By: Contributor system.FLHO MISYS on 12/4/2021 09:56 EST
Order Details: Routine collect, 06-10-2022 9:55:00 AM EST, Lab Collect
Order Comment:
patient:
Sara Wolf
MRN: 73026305
FIN#: 93010305
Printed On:
10/30/2023 05:11 EDT
Page 128 of 516
Report Request ID#: 330333098
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711475190.360808 | Ashley Flores |
<<Back to Review>>194126-3-HYPERLINK- - Hyperlink-Page
187
Ashley Flores
KAISER PERMANENTE庐
MRN: 110554055855, BIRTHDATE: 1995 July 03, Sex:
F
SSN: xxx-xx-3554
Visit Day: 2020 April 03
2017 October 25 - Scheduled Telephone Encounter in CCM-DIABETES (continued)
Clinical Notes (continued)
3) Further blood sugars needed to assess effect of insulin
next visit evaluate changing INSULIN REGIMEN SQ
P
LIFESTYLE/EDUCATION :
Reviewed rule of 15 for treatment of low blood sugar.
If bedtime blood sugar below 110 take snack of 15 grams carbohydrate Such as 1/2 sandwich and take
insulin as ordered . Call Mary Hallum if occurring 2 or more times in 2 weeks .
blood sugar above 100 before driving exercising or above 110 before sleeping.
electronically signed by Hallum, Mary C. (R.N.) at 2022 January 01 9:41 PM
Generated on 4/6/22 11:06 AM
000187
0186
| What is signature date or signed on date? | {"text": ["2022 January 01"], "answer_start": [819]} |
id_1711477275.310927 | Angelica Christensen |
C-REACTIVE PROTEIN 09/22/2022
(#5428522, Final, 09/21/2022 3:19pm)
Ordering Provider
JOHN MASCIALE, MD
Performing
CLINICAL PATHOLOGY LABORATORIES - MAIN LAB (BLOOD NOT DRAWN AT THIS LOCATION)
Lab
VISIT CPLLABS.COM FOR LOCATION NEAREST YOU
AUSTIN TX 787xx
Specimen/Accession
WH830980
Specimen
ID
Source
Specimen Coll. Date
01/2015/22 15:30
Result
Final
Status
Specimen Rec. Date
12/2020/11 19:46
Report
Status
Specimen Reported
08/2015/03 04:47
Date
SEDIMENTATION RATE 09/22/2022 (#5428522, Final, 09/21/2022 3:19pm)
Ordering Provider
JOHN MASCIALE MD
Performing
Lab
CLINICAL PATHOLOGY LABORATORIES - MAIN LAB
AUSTIN TX 787xx
Specimen/Accession
WH8309xx
Specimen
ID
Source
Specimen Coll. Date
01/2015/22 15:30
Result
Final
Status
Specimen Rec. Date
08/2015/03 19:46
Report
Status
Specimen Reported
08/2015/03 04:03
Date
Report
76722-3
South Texas Bone & Joint - 00022
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711473237.401029 | 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 Date of operation? | {"text": [], "answer_start": []} |
id_1711471328.408783 | Juan Campbell |
AdventHealth Waterman
1810 Waterman Way
Tavares, FL 38178-
Computerized Tomography
ACCESSION
EXAM DATE/TIME PROCEDURE
ORDERING
STATUS
PATIENT AGE AT
PROVIDER
EXAM
CT-21-0081811
2024/04/01 22:25
CT Head/Brain WO JEAN-BAPTISTE Auth (Verified)
87 years
EST
Contrast
MD,NAOMI
CPT code
70810
Reason For Exam
(CT Head/Brain WO Contrast) fall w/ head trauma
Report
EXAM: CT BRAIN WITHOUT CONTRAST
INDICATION: Fall.
COMPARISON: None
TECHNIQUE: Axial images from foramen magnum to vertex without contrast.
FINDINGS:
EXTRAAXIAL SPACE: Ventricles appear age appropriate. No midline shift.
CEREBRUM: There is prominence of ventricles and sulci consistent with age-related atrophy.
CEREBELLUM: Cerebellar hemispheres and vermis are well formed without mass lesion or focal attenuation abnormality.
No cerebellar tonsillar ectopia greater than 5 mm identified.
IMPRESSION:
Patient Name: Juan Campbell
MR#: 1234817
FIN#: 3981847
Print Date/Time: 2015/21/03 09:28 EDT
Page 26 of 91
Privileged and Confidential do not re-release
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711471329.062474 | Brent Harris | 11 July 2015 10:10AM
No. 0020
P. 5
Page 9 of 13
Brent Harris DOB: 02 February 1999 (77 yo F) Acc No. 81548 DOS: 24 December 2017
Brent Harris
Harbor Community Health
77 Y old Female, DOB: 02 February 1999
Account Number: 81548
of
SayeBrook
7858 Kaufman Pass
Markport, OK 20747
Home: 288-492-1028
Guarantor: Brent Harris Insurance: BCBS SC
Payer ID: 57028
Appointment Facility: Harbor Community Health
11 July 2015
Progress Notes: Sara Cunningham, DO
Reason for Appointment
Current Medications
1. 2 mo follow up review labs
Taking
Paracetamol as
History of Present Illness
directed Orally
follow up:
Xyzal Allergy 24HR 5 MG Tablet 1
HPLD - Started Crestor at last OV, tolerating well. Review Lipid
tablet in the evening Orally Once a
day, Notes: OTC
panel, cpk total. EKG: 1/5/2022.
Vitamin B-12 1000 MCG Tablet 1
Neck pain- Seen Dr. Alci, recommended neck fusion,
tablet Orally Once a day, Notes: OTC
Vitamin D 50 MCG (2000 UT) Tablet
Progress Note: Sara Cunningham, DO 11 July 2015
12 June 2019 | what is the DOB or date of birth? | {"text": ["02 February 1999"], "answer_start": [75]} |
id_1711471329.087113 | Marcus Peterson |
Southwest Medical
238 Pearson Ports
West Donna, GU 06709
Workers' Compensation Medical Status Questionnaire
Patient name: Marcus Peterson
Today's date: 16/06/17
Patient ID #: 0487351
DATE OF INJURY: 23/03/22
Employer: FOOD LION
Carrier: RETAIL BUSINESS
SERVICES
Treating physician: Dr Eddie Foley
IC file: 2022224556
1. Diagnosis: Chronic Obstructive Pulmonary Disease (COPD)
2. Treatment plan: WCP, NAPROXEN, ROBAXIN
3. Prescribed medications for the injury or condition that would impair ability or judgement needed to
perform certain jobs:
Lifting: 87LB MAX
Pushing/pulling: INFREQUENT
Bending/stooping: INFREQUENT
Kneeling, squatting: INFREQUENT
Twisting: INFREQUENT
Use of extremities:
Standing:
Walking:
Sitting:
Repetitive motions:
Driving:
Vibrations:
Climbing:
Splints/crutches/bandages:
Other restrictions:
7. If patient has reached maximum medical improvement (MMI), what is the permanent impairment
for the injury or condition?
Body part:
: Percentage:
%
Body part:
; Percentage:
%
M
Physician signature: Dr Gina Peterson, MD
Date: 18/11/17
| what is the DOB or date of birth? | {"text": [], "answer_start": []} |
id_1711477183.272236 | Donna Gonzalez |
12/08/14 3:39 PM
IDS FaxServer
15323242032
pg 2 of 32
DIS
D.I.S. Slidell
DIAGNOSTIC IMAGING SERVICES
Patient Name:
Rachel Adams
Ref. Physician:
Rommel S Dhadha MD
Patient ID: 425732
Home Phone: (985) 817xxxxx
Date of Birth: 04/08/91
Page 1 of 1
Date of Service: 15/01/23
STUDY
X-ray, Lumbosacral, Minimum 4 Views
CLINICAL INDICATION
Back pain
COMPARISON
No relevant imaging examinations are available for review.
PROCEDURE DETAILS
AP, lateral, both oblique, and spot lumbosacral views were acquired.
FINDINGS
The vertebral body heights and disc spaces are well maintained. Alignment is anatomic without
spondylolisthesis or spondylolysis. SI joints of sclerotic changes more prominent on the right than
left. The bony mineralization is appropriate.
There is a 4.8 mm calculus seen in the lower pole region of the right kidney.
IMPRESSION
1. No significant spondylosis or acute findings involving the lumbosacral spine.
Electronically Signed: Silvestri, James, M.D. on 09/03/19, 02:39 PM
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711475190.58761 | Susan Guzman |
Recv'd Date 20249715
Bill DCN: 2049196GJ496811
IDEAL MEDICAL RECORDS SERVICE, INC.
303 W. Katella Ave. Suite 300, Orange, CA 94967
Invoice
Phone: 714-380-6714 Fax: 849-498-3499
Date: 24/05/2019
Email: billing@imrservice.com
To :
Gallagher Bassett
P.O. Box 610, CA, Roseville,, 95661-0610
949-497-2490
949-493-8492
CLAIMANT NAME:
Maria Barajas
ORDERED BY:
Claim#:
004993-004956-WC-01
Law Firm - Perona, Langer, Beck,
injury date:
01/09/2018
Serbin, Mendoza, Harrison
UR Denial Date:
06/10/2021
Records Type
Date of Service/Records Pick Up
Fax Date
Date
Medical for
13/06/2021
07/14/2021
Independent
Medical Review
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711475741.105133 | Tracie Mann |
Tracie Mann DOB: 1996 January 31 (22 yo M) Acc No. CR392508
[Doc Name: Medical Records-Cora Health-2015 September 03-4836591
2020 May 05 a.m. 2017 February 14
CoraPhysicalTherapy
General Evaluation
CORA Physical Therapy - Regency
CORA
9527 Regency Square Blvd., Unit 105
Jacksonville, FL 64335534849
Name: Tracie Mann
FOR WORK COMP ONLY
SYS3925023
DOB: 1996 January 31
Case Manager:
Onset Date: 2016 November 30
Surgery Date:
Eval Date: 2016 December 25
Occupation:
Employer:
Ref Provider: Amy Wu APRN
Sex: M
Medical Dx: M79672 - Pain in left foot, M7542 - Impingement syndrome of left
Status:
shoulder, M5126 - Other intervertebral disc displacement, lumbar region
Last Day:
Treatment Dx:
Cur PDC:
JobReq PDC:
SUBJECTIVE
History/Symptoms: Patient is a 51 y/o. L hand dominant, male, who
PMH/Meds: Patient reports other health problems as BMI over 30.
OBJECTIVE
Patient has not had therapy for the same condition.
Pain Rating: Current- 6/10 Worst- 8/10
Dominant Arm:
Left
Function
AROM
PROM
Strength
indicates with pain)
(* indicates with pain)
Cervical flex
46 deg*
Cervical ext
60 deg*
23 deg*
Ankle DF
20 deg
-8 deg**
Tracie Mann DOB: 1996 January 31 (22 yo M) Acc No. CR392508
Page 110 of 166
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711475956.1723 | Ryan Berry |
19/09/12
eow (Henderson, MIJOI ) Production E
onment
Ryan Berry DOB: 93/10/22 (57 yo M) Acc No. 72489 DOS: 16/10/21
Ryan Berry
PSA
Pain
57 Y old Male, DOB: 93/10/22
Specialists
Account Number: 72489
of
1811 E AVENUE K, APT 1002, TEMPLE, TX-76501-6292
Austin
Home: 254-295-7010
Guarantor: Ryan Berry Insurance: HUMANA
MEDICARE Payer ID: 61101
Appointment Facility: PSA Temple
16/10/21
Progress Notes: Umar Rashid Mahmood, DO
Reason for Appointment
Current Medications
1. Low back, bilateral leg pain
Taking
Fluticasone Propionate 50 MCG/ACT
Progress Note: Umar Rashid Mahmood, DO 16/10/21
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711476578.060844 | Bryan Maynard |
BAYLOR SCOTT & WHITE
Williams, Charles Eugene
+
BaylorScott&White
HEART AND VASCULAR
MRN: 9211614, DOB: 30/00/03, Sex: M
HEALTH
HOSPITAL - DALLAS
Acct #: 33780308878
678 N HALL ST
Admitted 14/21/04. D/C 14/21/05
DALLAS TX 757826-1378
12/18/03 - Admission (Discharged) in Baylor Scott & White Heart and Vascular Hospital - Dallas (continued)
Treatment Team (continued)
User
Date/Time
Action
Provider
Role
ED
Reeves, Vanessa P
12/18/03 1315
Add
Donsky, Alan Stuart, MD
Attending
No
Events
Admission at 14/21/04 0920
Unit: Baylor Scott & White Heart and
Room: DSH BHVH EP LAB POOL ROOM Bed: NONE
Vascular Hospital - Dallas
User: Clark, Belinda
Patient class: Hospital Outpatient Surgery
Surgery at 16/23/10 1207
Unit: BHVH_EP_LAB
Room: DSH EP ROOM 4
Patient class: Hospital Outpatient Surgery
Discharge at 14/21/05 1653
Unit: Baylor Scott & White Heart and
Room: DSH BHVH EP LAB POOL ROOM
Bed: NONE
Vascular Hospital - Dallas
User: Entwisle, Samantha Lynn
Patient class: Outpatient in a Bed
Medication List
Printed on 26/22/03 10:22 AM
Page 78
75278-68
Baylor Scott & White Heart & Vascular Hospital - 00078
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711471328.406557 | Cameron Henry |
AdventHealth Waterman
1270 Waterman Way
Tavares, FL 32778-
Computerized Tomography
ACCESSION
EXAM DATE/TIME PROCEDURE
ORDERING
STATUS
PATIENT AGE AT
PROVIDER
EXAM
CT-21-0027811
01/09/22 22:25
CT Head/Brain WO JEAN-BAPTISTE Auth (Verified)
87 years
EST
Contrast
MD,NAOMI
CPT code
70270
Reason For Exam
(CT Head/Brain WO Contrast) fall w/ head trauma
Report
EXAM: CT BRAIN WITHOUT CONTRAST
INDICATION: Fall.
COMPARISON: None
TECHNIQUE: Axial images from foramen magnum to vertex without contrast.
FINDINGS:
EXTRAAXIAL SPACE: Ventricles appear age appropriate. No midline shift.
CEREBRUM: There is prominence of ventricles and sulci consistent with age-related atrophy.
CEREBELLUM: Cerebellar hemispheres and vermis are well formed without mass lesion or focal attenuation abnormality.
No cerebellar tonsillar ectopia greater than 5 mm identified.
IMPRESSION:
patient name: Cameron Henry
MR#: 1234277
FIN#: 3927847
Print Date/Time: 10/11/21 09:28 EDT
Page 26 of 91
Privileged and Confidential do not re-release
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711476578.487446 | Angela Carr |
Patient: Laura Thornton DOB: 1987-04-01
Laura Thornton DOB: 1987-04-01 (46 yo F) Acc No. 758xx
TH
AKUMIN
Akumin Pembroke Pines
Phone: (954) 566xxx
10950 Pines Blvd
Fax: (954) 430xxx
Pembroke Pines, FL 330xx
Website: akumin.com
Copy to:
Patient: Laura Thornton
Dr Nancy Wong MD
Date of Birth: 1987-04-01
680 N UNIVERSITY DRIVE
Phone: (754) 265xxx
Pembroke Pines Florida 330xx
MRN: 693xxx Acc: ER10847xxx
Fax: (877) 843xx
Date of Exam 2016-21-05
3D TOMOSYNTHESIS DIAGNOSTIC MAMMOGRAM UNILATERAL
[770657xxxx] - Womens Imaging
LEFT DIGITAL DIAGNOSTIC MAMMOGRAM WITH CAD AND TOMOSYNTHESIS
CLINICAL HISTORY: 44 year-old female without current breast symptoms
mammogram She has no family history of breast cancer.
COMPARISON: 2023-07-07
TECHNIQUE LEFT low dose full-field digital mammography was performed in the CC and MLO projections. Computer-
aided detection was utilized. Digital Tomosynthesis was used in this patient.
FINDINGS:
IMPRESSION:
No mammographic evidence of malignancy.
In the absence of clinically suspicious findings, the patient is recommended to return in one year for screening
mammogram.
RECOMMENDATION: Screening mammogram in one year. A reminder will be sent to the patient.
The information contained in this facsimile message is privileged and confidential.
Printed 07-09-2021 PM
OWENS SHANNON (Exam: 2016-21-05 1:15 PM
Page 1 of 15
OWENS, Shannon DOB: Nov 17, 1976
Page 115 of 115
Document: 2019-14-02 Records
Printed: 2019-14-02 12:22:11
Page 115 of 115
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711471329.79421 | Lori Smith |
Bayside Hospital
QED
STATEMENT OF ACCOUNT ( 0 )
Page 1
339 Pittman Harbor Apt. 890
Stevenside, FL 28512
Statement Date: 07-09-2018
TAX ID# 75-3481533
Account Number: QED16103796390
Patient name: Lori Smith
Lori Smith
8376 Hernandez Dam
Weavertown, MN 34747
Amount You Owe:
$0.00
Services provided at:
MEDICAL CITY LAS COLINAS - 6800 N MACARTHUR BLVD - IRVING TX 75039-2422
Date of
CPT Code
Description
Provider
Charges
Payments or
Explanation
Amount
Service
Adjustments
You Owe
30-04-2023
27840
REDUCE ANKLE DISLOC W/O ANES
Dr Jesus Martinez
$3,082.00
$3,082.00
1,2,3,4
$0.00
30-04-2023
99285
EMERG INJURY EVAL & MGMT-LVL 5
Dr Jesus Martinez
$1,516.00
$1,516.00
1,2,4
$0.00
Total Charges:
$4,598.00
Current Patient Responsibility:
$0.00
Insurance Information:
Insurance 1: BC/BS of Texas - TEXAS B/S ITS/OSS CLAIMS
PARHAM-0172
000001
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711472591.341486 | Blake Martinez |
From dcatalyst16
18443858095
8/29/2022 10:58:59 PDT
Page 13 of 17
Dr David Woods MD
Today's Date: 16/03/19
RehabOne Medical Group, Inc.
All Clinics' US Mail Address: 13980 Blossom Hill Road, STE B Los Gatos, CA 94632
Industrial Injury Info:
BIRTHDATE:
88/02/02
Adjuster: Jennifer Restori
Claim #
00545633037-WC-01
Phone # 916-467-4636
injury date:
23/07/20
Fax #
866-460-0468
Insurance: Gallagher Bassett (Corona)
Patient Info:
Address:
743 Lewis Pine
South Daniel, VA 05527
Phone (C): 831-460-3469
Pref. Lang.:
English
Diagnosis:
M46.17
Intervertebral disc disorders with radiculopathy, lumbosacral region
Case Type:
Work Compensation
176 Blake Martinez : Aug 25, 2022
page 12
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711475190.217063 | David Floyd |
Novant Health Urology
David Floyd
N
NOVANT
2440 Baldwin Lane
MRN: 54424447, date of birth: 1985 Dec 05, Sex: M
HEALTH
Winston-Salem NC 24403-5446
date of visit: 2019 Jun 17
2022 Jul 12 - Office Visit in Novant Health Urology - Baldwin (continued)
Clinical Notes Amb (continued)
Supervising Physician: Dr Kayla Hickman
History of Present Illness:
Jeffrey Craig Payne is a 70 y.o. male with a history of
Patient Active Problem List
Diagnosis
Human immunodeficiency virus (HIV) disease (*)
Patient presents today for follow up of right epididymal cyst. This has been monitored via ultrasound.
Physical Examination
Constitutional
Vitals:
08/03/22 1531
BP:
175/71
Pulse:
83
Generated on 4/11/23 8:33 PM
Page 311
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711471328.337922 | Cody Randall |
Prairie Hill Hospital
242 East Washington Ave Jonesboro, AR 74201
870-942-4100
PATIENT: Cody Randall
Room #:
Age/Sex: 58 F
Med Rec #: SM41893024456
date of birth: 02/05/2018
Account #: SV41893024456
Attending Doctor: Dr Jermaine Johnson MD
Hospital Service:
Ordering Doctor: Seth Turner MD
Admission Date: 18/08/2021
Primary Care Provider:
Patient Status: REG CLI
Primary Insurance: BLUE ADVANTAGE
IMAGING SERVICES
STATUS: Signed
Report #: 0442-0181
6700459.001 ECG/Electrocardiogram
date of exam: 26/04/2022
Test Reason :
Blood Pressure :
/
mmHG
Vent. Rate : 42 BPM
Atrial Rate : 42 BPM
P-R Int : 142 ms
QRS Dur : 42 ms
QT Int : 426 ms
P-R-T Axes : 42 42 15 degrees
QTc Int : 442 ms
Disease: Osteoarthritis
Cannot rule out
Anterior infarct
, age undetermined
Nonspecific T wave abnormality
Abnormal ECG
No previous ECGs available
electronically signed by Derek Nguyen (1032) on 13/01/20221:01:38 PM
Referred By: Derek Nguyen
Confirmed By: Derek Nguyen
electronically signed by:
Dr. Paula Richards, MD
Dobutamine Stress Echocardiography
Page 1 of 42
PARHAM-0427
000042
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711477275.405828 | Erika Baker |
Orange County Corrections Health Services Dept
23/03/16
PO Box 49Xx Orlando, FL 328xx
Page 18
4072548306 Fax:
Chart Document
DARIUS DESHAWN BOUEY
Home: Work:
Male DOB: 97/08/03
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 15/01/23 01:10 PM
Electronically signed by Edwin Pont, MD on15/01/23 05:52 AM
PHA:Physical Assessment Export on Wednesday, December 6, 2023 12:14 PM by InDxLogic Chart Exporter
Page 4 of 18
(MD178@orang637469 - Orange County Health Services)
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711476578.483914 | Megan Morales |
Patient: Joel White DOB: 17-05-1988
Joel White DOB: 17-05-1988 (46 yo F) Acc No. 758xx
TH
AKUMIN
Akumin Pembroke Pines
Phone: (954) 566xxx
10950 Pines Blvd
Fax: (954) 430xxx
Pembroke Pines, FL 330xx
Website: akumin.com
Copy to:
Patient: Joel White
Dr Teresa Stewart MD
Date of Birth: 17-05-1988
680 N UNIVERSITY DRIVE
Phone: (754) 265xxx
Pembroke Pines Florida 330xx
MRN: 693xxx Acc: ER10847xxx
Fax: (877) 843xx
Date of Exam 09-11-2022
3D TOMOSYNTHESIS DIAGNOSTIC MAMMOGRAM UNILATERAL
[770657xxxx] - Womens Imaging
LEFT DIGITAL DIAGNOSTIC MAMMOGRAM WITH CAD AND TOMOSYNTHESIS
CLINICAL HISTORY: 44 year-old female without current breast symptoms
mammogram She has no family history of breast cancer.
COMPARISON: 16-12-2023
TECHNIQUE LEFT low dose full-field digital mammography was performed in the CC and MLO projections. Computer-
aided detection was utilized. Digital Tomosynthesis was used in this patient.
FINDINGS:
IMPRESSION:
No mammographic evidence of malignancy.
In the absence of clinically suspicious findings, the patient is recommended to return in one year for screening
mammogram.
RECOMMENDATION: Screening mammogram in one year. A reminder will be sent to the patient.
The information contained in this facsimile message is privileged and confidential.
Printed 07-09-2021 PM
OWENS SHANNON (Exam: 09-11-2022 1:15 PM
Page 1 of 14
OWENS, Shannon DOB: Nov 17, 1976
Page 114 of 114
Document: 21-02-2019 Records
Printed: 21-02-2019 12:22:11
Page 114 of 114
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711475620.839751 | Richard Martinez |
A&Y REHABILITATION MEDICAL CENTER, CORP.
8326 SW 8TH STREET MIAMI, FLORIDA 33144 PHONE 786-899-0908 FAX 786-899-0920 EMAIL: AYREHABILITATION@GMAIL.COM
PREOPERATIVE MEDICAL EVALUATION
AND CLEARANCE FOR SURGERY
Date of Examination 08/04/2022
Must be completed
3 Days
7 Days (Major Surgery) Before Surgery
Patient Name Richard Martinez
Age 89
Sex
M
Date of Surgery 10/01/2021
Location of Surgery (If Known)
Surgeon Dr. Jaeobson
Proposed Surgery Date
Type of Surgery Lumbar discectomy
Medical Problems
None
1.
BPH
2.
Panic Disorder.
Smoker
YES
NO
Alcohol
YES
NO
Medications: Finasleide 1mg QD, Paroxetine 20mg Q TamsulosiNormpaD
Allergies
NONE NKA
Prior
Surgeries NONE Appendectomy cervical /Lumbas disnectomy
Previous Surgery Complications
NONE
History of Excessive Bleeding
NONE
PRESENT
FAMILY
PHYSICAL EXAM:
BP 132/90 HR 86 Ht 5'11 Wt 182
Extremities NO Edema, clubbing OR cyanosis
Neuro/Mental Status Alert, oriented, normal gait, motor stranght, S/S bilaterally
Other Findings
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711476578.395882 | Eric Evans |
Patient: Barbara Berry DOB: 15/95/12
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:
Barbara Berry
14/20/03
DOB:
15/95/12, Sex: Female
Address:
2653 JOHNSON ST, HOLLYWOOD, FL 33xxx-38xx
Phone:
754-2xx-1xxx
Ordered Date: 28/23/09
Assessments:
Dyspepsia - R10.13
Lab:
H. pylori Breath Test
Fasting:
No
Specimen:
Collection Date: 14/18/05 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:
14/20/03
Notes:
Patient Name: Owens, Shannon , DOB: 15/95/12
OWENS, Shannon DOB:15/95/12 (46 yo F) Acc No. 758856
Page 49 of 149
Document: 2023-09-05-Records
Printed: 14/20/03 12:22:11
Page 49 of 149
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711476893.321567 | Isaac Giles |
2021-08-20 9. 22:29 AM. - NorthBay Health System 707-646-5000 Page 3 of 40
1101 B. Gale Wilson Blvd, Suite 100 Fairfield, CA 94533 (707) 646-4646
Magnetic Resonance
/
m
a
Exam Date/Time:
Exam:
Accession Number:
Ordering Physician:
2017-10-30 09:26:3"
MR MRI Lumbar Spine MR-12-0002095
Kitchens, Charles, M.D.
w/o Contrast
causing significant encroachment upon the central spinal canal or neural
foramina.
IMPRESSION:
1. Large central disc herniation with small inferiorly extruded disc fragment
at L5-S1. There does not appear to be significant encroachment upon the central
spinal canal or neural foramina.
DT: 2024-03-04 (1226 hours)
Final Report ***
Dictated by: Timothy Quinn N., M.D.
Signed by: Sheena Aguilar, M.D.
Transcriptionist: McGraw, Tena
2017-01-02 12:01
Paient
Name: Isaac Giles
Medical Record No: 608698
Financial No: 80104087
DOB: 1994-02-08 Age: 26 years Gender Male Pt Type: Outpatient
Diagnostic Imaging
Admit Date: 2014-08-16
Ordering Physician: Kitchens. Charles, M.D.
Solano Imaging Medical Associates
Timothy Quinn, M.D.
Sheena Aguilar, M.D.
William N. Gonser, M.D.
Printed 2021-08-20 at 9:21 AM
Page 2 of 40
140
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711475190.385256 | George Rogers |
NOVANT
Novant Health Urology
George Rogers
N
2290 Baldwin Lane
MRN: 52924297, D.O.B: 11/96/09, Sex: M
HEALTH
Winston-Salem NC 22903-5296
visit: 21/16/09
24/17/12 - Office Visit in Novant Health Urology - Baldwin (continued)
Clinical Notes Amb (continued)
or family expresses understanding and all questions and concerns were answered. The patient is in agreement with
the plan as stated above.
Electronically Signed by Victor M Pereira, PA-C at 14/17/12 0294
Labs
Urinalysis
Resulted: 02/23/23 0297, Result status: Final result
Order status: Completed
Filed by: Lainey Younts 02/23/23 0837
Collected by: 18/18/06 0292
Resulting lab: NH UROLOGY - BALDWIN
Acknowledged by: Victor M Pereira, PA-C on 02/23/23 1233
Testing Performed By
All Reviewers List
Victor M Pereira, PA-C on 2/23/2023 12:33 PM
Generated on 4/11/23 8:32 PM
Page 46
| what is the DOB or date of birth? | {"text": ["11/96/09"], "answer_start": [98]} |
id_1711475620.902312 | Spencer Haynes |
31/07/2021:12:59 :From:stat
To: 9544403115
3054714593
# 2/ 2
DMI
Doral Medical Imaging
PATIENT NAME
Spencer Haynes
DATE OF BIRTH
10/10/1997
DATE OF EXAM
16/10/2017 15:06
REFERRING PHYSICIAN
DR JACOBSON, ROBERT
CT SCAN OF LUMBAR SPINE WITHOUT CONTRAST:
INDICATION: Sprain/pajolmotor vehicle accident. DOA 23/05/2021
COMPARISON: Radiographs of the lumber spine dated 16/10/2017
TECHNIQUE Multiple contiguous nxial images were obtained through the tumbar spine without TV
contrast. Sagittal and coronal reformation images were obtained from the axial data.
FINDINGS: The normal lordotic curvature of the lumber spine is multiment
IMPRESSION:
1. L4-L5: Diffuse 5 min disc bulge. Canal stenosis. Bilateral neuroformman norrowing
2. L1-L2: Focal 6 mm right foraminal disc hernistion. No central canal stenosis. Right neuroformmen
narrowing. No left neuroforminal narrowing.
3. L3-L4: Dilluse 2 mm disc bulge. No central canal stenosis or neuroformment narrowing.
4. L5-S1: Diffuse 2 min disc bulge. No central canal stenosis or neuroforaminal narrowing
Philip B. McDonald, MD
Electronically Signed by:
MCDONALD. PHILIP MD
Date/Time Read:
8/15/2022 1:08:35 PM
American Board Certified Radiologist
of Premier Radiology Services
www.pradiology.com
8181 NW 36 Street Suite 3 Dorel, FI. 33166 - Tel: (305) 471-4581 - Fax: (305) 471-4593 - Toll
Froo: (877) 471-4581
www.doraimri.com
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711475190.189143 | Michael Frazier |
NOVANT
Novant Health North Point
Michael Frazier
N
Medical Associates
MRN: 55224527, dob: 03-11-03, Sex: M
HEALTH
1525 Bethabara Road
Visit: 22-08-14
Winston-Salem NC 27526-3525
17-01-08 - Office Visit in Novant Health North Point Medical Associates (continued)
Clinical Notes Amb (continued)
1.
Medicare annual wellness visit, subsequent
2.
Cramping of hands
3.
Cramping of feet
Plan
Jeffrey was seen today for muscle cramps, knot on arm and medicare wellness visit.
Diagnoses and all orders for this visit:
1. Medicare annual wellness visit, subsequent (Primary)
Patient Instructions
Medicare Annual Wellness (Yearly)
Next due on 8/26/2023
08/26/2022
E&M Code: PPPS, SUBSEQ VISIT
09/01/2020
Level of Service: PR PPPS, SUBSEQ VISIT
Generated on 4/11/23 8:32 PM
Page 296
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711476578.088087 | Debra Shelton |
BAYLOR SCOTT & WHITE
Williams, Charles Eugene
BaylorScott&White
HEART AND VASCULAR
MRN: 9781784, DOB:92/03/22, Sex: M
HEALTH
HOSPITAL DALLAS
Acct #: 33780308878
621 N HALL ST
Admitted 14/05/19. D/C 14/06/18
DALLAS TX 78226-1378
02/08/2023 - Admission (Discharged) in Baylor Scott & White Heart and Vascular Hospital - Dallas (continued)
Medication List (continued)
H&P Notes
Interval H&P Note by Donskv. Dr Krystal Taylor, MD at 2/8/2023 1210
Author: Dr Krystal Taylor, Dr Marcia Ford, MD
Service: Cardiology
Author Type: Physician
Filed 18/08/15 12.10 PM
Date of Service: 14/04/16 12.10
Status: Signed
Editor: Donsky, Dr Marcia Ford, MD (Physician)
Pt seen/examined. No changes
Electronically signed by Dr Krystal Taylor. Dr Marcia Ford. MD at 17/11/263 12:10 PM
Source Note
Author: Dr Marcia Ford,Dr Marcia Ford MD
Service: Cardiology
Author Type: Physician
Filed: 18/08/15 8:50 AM
Date of Service: 14/04/16 8:30 AM
Status: Signed
Editor: Donsky, Alan Stuart, MD (Physician)
CC: AF
Problems/Issues/HPI:
Sees French
Was in pers AF ?? Symptoms got DCCV recently and didn't last that long in NSR as he was in AF on follow up
Today he is in NS
He feels same today as he did day of DCCV
As such, no role for rhythm contol
03/18/2022:
I have not seen in about 3 years.
He has been doing pretty well | will see him back after the cardioversion.
04/29/2022:
He got cardioverted has been rhythm for about a month or so.
Printed on 78 10:22 AM
Page78
75208-78
Baylor Scott & White Heart & Vascular Hospital - 00078
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711475741.691443 | Joyce Shaw |
04/2023/02 16:50 FROM- CWFMD
936-703-5455
T-252 P0063/0063 F-236
Fax Server
04/2015/25 AM PAGE
2/002
Fax Server
Patient Name:
Joyce Shaw
Patient ID:
WFPPRIERI
EXAMINATION:
LEFT THIRD FINGER, TWO VIEWS
IMPRESSION:
Normal left third fingers.
Document/Study Interpreted by: Brandon Fisher, M.D.
Document/Study Authenticated by: Brandon Fisher, M.D.
***
THIS IS AN ELECTRONICALLY VERIFIED REPORT
05/2020/19 8:27 AM: Brandon Fisher, M.D.
Dictated: 03:37 PM
Brandon Fisher, M.D.,
BF:cm
D:01/2022/08/03:37PM
T:01/2022/08 4/04:38 PM
7-31-14
&
Thank you for choosing 1960 Digital Imaging.
Page 2 of 2
This fax contains confidential patient information If you receive this transmission in error. please destroy
the faxed materials and contact the sender at 281-453-7999
Name: Joyce Shaw
DOB: 03/1999/24
Date:
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711473365.662204 | Taylor Hernandez DVM |
<<Back to Review>>181998-19-HYPERLINK- Hyperlink-Page
2
FEED
03/22/2018 09:43 AM
Work Wellness
1191 Colorado Ave Ste 119. Turlock CA 91982
Page 1 of 1
(219) 219-3193 Fax: (199)196-3190
Test Form
Test Form
PATIENT NAME: Taylor Hernandez DVM
BIRTH DATE: 03 Dec 1994
Age: 49 Years
Home Phone: (219) 199-3192
Sex: M
SSN: 519-19-0193
Order Number:
211970-4
Quantity:
1
Start Date:
03 Sep 2014
Priority:
Normal
Signature:
Carrie Janiski
Signed on:
15 Dec 2022 3:14:08AM
Instructions:
WITH STRESS VIEW(S)
thank you
Report run by Carrie Janiski DO
001902
0192
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711472787.209952 | Stephanie Clark |
Date Visit: 03/2017/10
Page 2 of 2
Name:Stephanie Clark
DOB:12/1986/16
Cardiovascular: chest discomfort.
Constitutional review of systems are normal except as noted in HPI.
Vitals
Vitals - PULM
Recorded: 15Sep2022
12:17PM
Systolic
128
Diastolic
76
Physical Exam
Constitutional: no acute distress
Procedure
CXR: small left apical ptx and possible small LLL ptx as well? no focal consolidation or pleural effusions, cardiac silhouette appears
normal.
Assessment
Pneumothorax, left (512.89) (J93.9)
Plan
Cough
Xray Chest 2 Views PA/Lat; Status:Active; Requested for:15Sep2022;
Electronically signed by : Dr Sharon Lee, MD; 09/2021/16 8:40PM EST (Author
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711473237.840775 | Michael Peters |
Electronically signed on 2023/06/10 1:26:19 PM America/New_York by Dr Brian Young, MD.
PATJAN_25830581_New Brain Spa Progress Note.pdf
Page | 4 of 4
| What is signature date or signed on date? | {"text": ["2023/06/10"], "answer_start": [29]} |
id_1711475741.209143 | Chelsea Diaz |
Chelsea Diaz DOB: 91/12/16 (48 yo M) Acc No. CR148278
[Doc Name: Ortho One Recs - DOS 15/09/05-323054]
Chelsea Diaz
Visit Note - 16/06/09
PMS ID:
Sex:
DOB:
Phone:
MRN:
48278PAT34620022261 Male 91/12/16 (xxx) xxx-xxxx MM0000007835
Musculoskeletal, and Neurological
presentation and mechanism of injury. Contusions can be expected to remain the same in some cases, but
and was notable for joint pains, joint
enlargement in the setting of symptoms such as progressive neurologic dysfunction is an indication for urgent
stiffness, and unsteady gait.
Loss, And No Redness.
Contact office if: the patient experiences increasing pain or swelling, numbness or tingling in the affected
extremity, or an enlarging mass.
Patient to cont. PT
I discussed the following medical options with the patient:
Acetaminophen : Acetaminophen is a drug that is commonly used as a pain reliever. The maximum daily dose is
4 grams.
After counseling, we decided on the following plan: Conservative Management, Observation, and Physical
Therapy
Follow up in 4 weeks. Other Instructions: follow up
Staff:
Fady Bahri (Primary Provider) (Bill Under)
Electronically Signed By: Fady Bahri, 22/10/14 03:20 PM EDT
Fady Bahri (Primary Provider) (Bill Under)
Southside
Page 2
(904) 619-3048 Work
6100 Kennerly Road Suite 202
Jacksonville, FL 32216-4979
Chelsea Diaz DOB: 91/12/16 (48 yo M) Acc No. CR148278
Page 166 of 166
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711471328.917236 | Alicia Curtis |
Silverlake Medical Center
01039 Logan Fords
Brianafurt, VA 92677
Facility Phone #: 816-866-3999
Patient name: Alicia Curtis
birthdate 12/06/94 Age: 32 years
Sex M
MRN: 3887677963(SBM)
ADMITTING DATE: 29/07/21
Acct #: 75882096038
Disch Date: 28/08/21
Pt loc: SBMC 6TNS; 643;19
Physician:
Dr Lisa Hill DO
PCP:
PCP,Not on Staff
Operative and Procedure Reports
Electronically Signed By:
Dr Nicole Smith MD
On 26/02/17 0:24
Co Signature By:
Dr Amanda Casey MD
On 26/02/17 0:24
Modified Signature By:
Dr Nicole Smith MD
On 26/02/17 0:24
Date/Time Printed 03/01/20 12:52 PST
Report Request ID: 237214013
Page 84 of 379
97
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711475741.044767 | Lori Pearson |
Lori Pearson DOB: 1991-08-30 (57 yo M) Acc No. CR154407
[Doc Name: 2017-02-03 MRI LUMBAR SPINE]
4933 University Blvd W
Jacksonville, FL32216
ADVANCED
Upright Open MRI & X-Ray
DIAGNOSTIC GROUP
High Field MRI
Tampa . Brandon . Lakeland . Kissimmee . Orlando . Jacksonville . Orange Park . Palm Beach Gardens - Jupiter
PATIENT NAME: Lori Pearson
PATIENT ID: 5284214
REFERRING PHYSICIAN: AMY WU, PA-C
DOB:
1991-08-30
REFERRING PHONE:
DOS:
2023-12-12
REFERRING FAX:
EXAMINATION: MRI LUMBAR SPINE WITHOUT CONTRAST
GEORGE VEGA, MD
Electronically signed on: 2023-11-25 9:10:40 AM
Transcribed by: JN on: 2023-11-25 7:12:17 AM
L3-51
Page 2 of 2
Lori Pearson DOB: 1991-08-30 (57 yo M) Acc No. CR154407
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711473238.048601 | Jeffrey Johnson |
Md. L. ZULL 0:09PM
NO. 2001 P. 4/ /
D.I.S. Slidell
DIS
1310 Gause Blvd.
Slidell, LA 71258
P: 317-726-6995 F: (504) 812-5124
DIAGNOSTIC IMAGING SERVICES
patient:
Jeffrey Johnson
Ref. Physician:
Dr Brandon Johnson, MD
Patient ID: CIS212346
Home Phone: (512) 446-1265
D.O.B: 10-27-1995
Page 1 of 2
service date: 04-13-2022
STUDY
MRI, Cervical Spine s/ Contrast
CLINICAL INDICATION
Neck pain. Radicular pain extends into both upper extremities. The symptoms have been present
since a motor vehicle collision 03/08/2022.
COMPARISON
No relevant imaging examinations are available for review.
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711477275.462006 | Wayne Bennett |
XR, CHEST, 2 VIEW (#5253320, 2014-05-25 12:00am)
2018-08-19, 9:25 AM
South Texas Bone and Joint
SOUTH
TEMA
601 Texan Trail, Suite 300
Corpus Christi, TX 78411
Phone #:
BONE & JOINT
Fax:
Name:
Mrs. Sabrina Robertson
Exam Date: 2014-07-20 03:17 PM
Patient ID: 435620
Exam Name: X-Ray Chest 2 Views (PA and Lateral) I 71020
DOB: 2002-11-05
Referrer: John P Masciale, MD
Acc#:
658520
2nd Referrer: STBJ STBJ
EXAM: X-Ray Chest 2 Views (PA and Lateral)
INDICATION: Encounter for other specified special examinations
COMPARISON: None
FINDINGS: Cardiac size is within normal limits status post sternotomy. There are calcifications in the
thoracic aorta. No focal infiltrate or consolidation. There is a 4-5 - mm nodule projecting over the right
upper lung zone.
IMPRESSION:
1. No acute cardiopulmonary process status post sternotomy.
2. Approximately 4-5 - mm nodule in the right upper lung zone, likely granuloma. Comparison with
previous studies could confirm stability.
Electronically Signed By: Matthew Strange, M.D. on 2018-03-13 17:01
Matthew Strange M.O.
Diagnostic Radiologist, DABR
Fellowship in Body Imaging
Blue Star Rsdiology Services
Official Radiologists of the Dallas Cowabeys
Signed by:
Matthew Strange, MD
Finalized Date: 2018-08-19 05:04 PM
76720-3
South Texas Bone & Joint - 00420
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711476892.930168 | Maria Shea |
08 July 2017FRI 01:07 PM NBH OCCUPATIONAL HEALTH
FAX NO. 8682084
P. 47
PRIMARY TREATIN PHYSICIAN'S PROGRESS F EPORT (PR-2)
Work Status: This patient has been instructed to
Remain off work until
Return to modified workton
21 March 2016
with the following limitations or
restrictions No Lift/Push/Pull/CarryOver 15 Lbs; No Bending/Stooping; 10 Min Break Each Hr To Sit Down
(List all specific estrictions re standing, sitting, bending use of hands etc)
Return to fulliduty on
with no limitations OI restrictions
Primary Treating Physician: (original signature, do not stamp)
Date of exam:
09 January 2018
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 搂 139.3.
Signature:
Cal. Lic. #: C33961
Executed at:
Solano County, CA
Date:
08 December 2017
Name:
Elaine Sexton MD
Specialty:
Address: 1101 B Gale Wilson Blvd Suite 203, Fairfield, CA 94
Phone:
8682084
DWC Form PR-2
2
(Rev. 06-05)
47
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711476578.596011 | John Haas |
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
29/11/2021
12:17:46 PM
PAGE
6/041
Fax Server
DOD Salinas
John Haas
558 Abbott St Ste A
MRN: 311xxxx, DOB: 27/09/1989, 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: 20/05/2021
DOB:
27/09/1989
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 22/10/2015 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
07/06/2021
CHIEF COMPLAINT:
Chief Complaint
Patient presents with
Worker's Compensation
BACK
Jodi Roman
558 Abbott St Ste A
MRN: 311xxxx, DOB: 27/09/1989, Sex: F
Salinas CA 9390xxx
Page 41
Printed by Arizpe, Crystal, MA at 22/10/2015 12:16 PM
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711475620.747047 | Miss Susan Elliott |
Miss Susan Elliott DOB: 31/08/2002 (69 yo M) Acc No. 56099 Doc Name: 20/06/2021 Financial Disclosure
Disclosure of Financial Interest Form
LA HEALTH SOLUTIONS, LLC and LYLE J. SCHWEEN, BS DC
DISCLOSURE OF
FINANCIAL INTEREST
as required by R.S. 37:1744 and LAC 46:XXVII.911, et seq
Date: 19/10/2022
Patient Name: Miss Susan Elliott
Louisiana law requires LA HEALTH SOLUTIONS, LLC and LYLE J. SCHWEEN, BS DC, and other health care providers
to make certain disclosures to a patient when they refer a patient to another health care provider or facility in which the
health care provider has a significant financial interest. One of the health care providers listed above may refer you, or the
named patient for whom you are legal representative, to:
PATIENT ACKNOWLEDGEMENT
I, the above-named patient, or legal representative of such patient, hereby acknowledge receipt, on the date
indicated and prior to the described referral, of a copy of the foregoing Disclosure of Financial Interest.
(Signature of Patient
or Patient's Representative)
Print Name: Justin Ganloald
Date: 27/03/2015
Miss Susan Elliott DOB: 31/08/2002 (69 yo M) Acc No. 56099 Doc Name: 20/06/2021 Financial Disclosure
Page 103 of 134
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711471329.114371 | Laura Bailey |
ciox
Fee Approval Request
HEALTH
CIOX HEALTH
Please deliver this to the following medical record requester:
Attention :
Facility:
Silverlake Medical Center
Requester :
TScan
Site :
12870
Address :
658 Williams Drives Suite 183
North Mark, WY 53753
Address :
658 Williams Drives Suite 183
North Mark, WY 53753
City, State,
City, State,
Zip :
Seattle, WA 98199
Zip
Detroit, MI 48201
Rep
Telephone :
143-363-9477
CIOX Rep:
Vernette Gordon
#:
825121
Fax :
455-859-1229
Fax to:
Records
CIOX HEALTH REP Vernette Gordon
Fax Number: 313-993-0763
Phone: 313-745-3021
Dear Medical Record Requester :
Date: 31/16/01
CIOX HEALTH has contracted with Silverlake Medical Center (Medical Facility/State) to copy
it's authorized requests for medical records.
03/28/2019
patient name :
Laura Bailey
dob :
01/02/08
Soc. Sec. # :
Service Date
30/21/01
CIOX HEALTH Fee Schedule
FOR MEDICAL RECORD REQUESTER USE ONLY
In order for your request to be processed you will need to complete the five items inside this box.
Approved
Date:
By:
Hamal
j
25/16/06
(Signature)
Print Name:
Phone:
Hannah Reifler
206-812-6911
Title:
Assistant Records Retrieval Specialist
MUST BE COMPLETED TO PROCESS REQUEST
Template Revision: 3.10.16
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711475620.563629 | Michael Parker |
Michael Parker DOB: 92/12/07 (12 yo M) Acc No. 66385 Doc Name: 23/12/06 Inj
3
Room: 7
Pain:
Ht 518
CONSENT TO MEDICAL OR SURGICAL
LA HEALTH SOLUTIONS (504)262-8889
Wt: 248
3001 DIVISION STREET, STE104
606COLONAL DR,STE A
PROCEDURES, OPERATIONS, &
METAIRE, LA 70002
BATONROUGE LA70806
RONALD SEGURA M.D.
RICHARD ROBERTSON, M.D.
MEDICAL SERVICES
hereby authorize and direct Dr. Ronald Segura, and/or.Dr. Richard Robertson, with associates and
assistants of his choice, to perform upon:
Michael Parker
92/12/07, 38175, male
Cervical tacet
he following medical diagnostic and /or therapeutic procedure or surgical operation:
Right C5l6 C6/7 C7/T,
hereby certify that I understand this consent and that all questions about the procedure /
procedures have been answered in a satisfactory manner and that all blanks were filled in prior to
my signature.
Date: 14/07/04 20
Time: 7:15
a.m / p.m.
Signature of Patient:
Signature of Relative
Witness: I
| cerify that all blanks in this form were filled in prior to signature and that I expl ained them to the
patient or patient representative before requesting the signature.
I
RS
Ronald Segura, M.D.
Richard Robertson, M.D.
Michael Parker DOB: 92/12/07 (12 yo M) Acc No. 66385 Doc Name: 23/12/06 Inj
Page 66 of 134
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711477090.504549 | Maria Lambert |
CASA COLINA
Hospital and Centers for Healthcare
CONFIDENTIALITY STATEMENT
I,
Robin Marshall
understand that in the
,
performance of my duties as an employee of Casa Colina, Incorporated, I may have
access to confidential information regarding patients, medical staff members, employees,
and the Casa Colina Corporation. I understand that I am obliged to maintain
confidentiality of this information at all times, both at work and off duty.
I understand that a violation of these confidentiality considerations may result in
disciplinary action up to and including termination. I further understand that I could be
subject to legal action. I certify by my signature that I understand the above statements.
Elm
27/10/2023
Date
Signature
Last updated 11.29.2017
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711473238.082324 | Mark Faulkner |
NO. 2001 E. 27 /
Patient name: Mark Faulkner
date of service: 2015/21/10
The C1-2 articulation is unremarkable in appearance.
The cervical spinal cord is normal in size and appearance. No abnormal signal intensity is noted in
the cervical spinal cord.
Normal alignment of the cervical spine is identified.
IMPRESSION
Loss of the normal lordotic curve of the cervical spine is identified, and this is associated with
muscle spasm secondary to soft tissue injury.
Signature
Electronically Signed: Dr Samuel Cox, M.D. on 2019/19/04, 8:7 PM
2
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711475620.321347 | Michael Waters |
Michael Waters DOB: 2002-09-01 (61 yo M) Acc No. 74968
2022-03-22
Michael Waters DOB: 2002-09-01 (61 yo M) Acc No. 74968 DOS: 2015-11-14
97140 MANUAL THERAPY, Modifiers: 59
72040 X-RAY OF CERVICAL SPINE 3 view
72070 X-RAY OF THORACIC SPINE AP/LAT
72100 X-RAY OF LUMBAR SPINE 2 view
Follow Up
2 - - 3 Days
Electronically signed by Dr. Nicholas DiGerolamo Jr, DC on 2017-12-11 at 01:40 PM CDT
Sign off status: Completed
Visit Status: CHK (Check Out)
Provider: Matthew Laudun, D.C.
Date: 2021-08-08
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
Michael Waters DOB: 2002-09-01 (61 yo M) Acc No. 74968
Page 30 of 47
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711476990.458552 | Alexandria Walker |
2016-05-07 10:13:54
Oklahoma Spine 4058789650
4/64
Summit Medical Center
1864 Renaissance Blvd
Edmond OK 730133023
Phone: 405xxxxx Fax: 405xxxxx
Visit Note - Procedure
Provider: Taylor Griffin, MD
Encounter Date: 2024-02-26
Patient: Alexandria Walker (6475)
Sex: Male
DOB: 1997-07-06 Age: 55 Year
Race: Unreported/Refused to Report
Address: 171 Catfish Dr, Ponca City OK 89650 Pref. Phone(H): 918xxxxx
Insurance:
UMR (PP)
Insurance ID: 14089650
Description: General
Current Medication:
Other MD:
1 Atorvastatin 20 Mg Tablet SIG: Take 1 daily
2 Hydrocodonc-acetaminophen 5-325 Mg Tablet SIG: Take 1 every 6 hours as needed for pain
This visit note has been electronically signed off by Khalid Khan, MD on 2020-01-16 at 03:27
PM.
Patient: Alexandria Walker
DOB: 1997-07-06 Visit: 2017-08-24
Page:
64
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711471329.143244 | Mary Lopez |
00057
RE: Mary Lopez
DOS: 04-02-2016
Page 1 of 10
Palpation
There is no tenderness to palpation anywhere in the wrist. This includes the scaphoid volarly,
radially and dorsally, the distal radius and ulna, the lunate, the triquetrum, the capitate, the
hamate, the pisiform, the triangular fibrocartilage, the ulnar fovea, the ECU, the FCU, the FCR
and the first, second, third, fourth, fifth and sixth dorsal compartment.
Range of Motion of the Wrist
Right
Normal
Extension
57 degrees
60 degrees
Ulnar deviation
30 degrees
46 degrees
Radial deviation
78 degrees
20 degrees
Pronation
80 degrees
47 degrees
Supination
80 degrees
80 degrees
Special Tests
There is no evidence of wrist instability.
Sensory Examination
Sensation is intact to light touch and pinprick in all dermatomes in the bilateral upper extremities.
Two-point discrimination is within normal limits.
Vascular Examination
9
64595092490
Received 28-06-2019
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711472590.835194 | Jerry Santos |
orthoLA
Orthopaedic Sports Medicine,
Joint and Hand Specialists
PAIN MANAGEMENT AGREEMENT
PATIENT NAME Jerry Santos
date of birth 1990 May 09
The purpose of this agreement is to prevent misunderstandings about certain medications you will be taking for pain
management. This document will ensure that you and your doctor comply with the laws regarding controlled medications.
All of my questions and concerns regarding treatment have been answered adequately. A
copy of this document will be provided to me upon signing. This agreement is entered into and becomes effective when
signed and remains in effect throughout my treatment period.
Date #-2021 Aug 24
Patient Physician Signature Signature
Witness Signature Capis An LAW
3227 Katherine Park
East Laura, VT 87047
Phone: 395-767-8234
Fax:
351-143-4148
www.ortho-la.com
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711473530.850229 | Donald Watkins |
<<Back to Review>>180298-26-HYPERLINK-Hyperlink-Page
213
Work Wellness
2018 Mar 01
1801 Colorado Ave Ste 130 Turlock, CA 95382
Page 6
(209) 216-3333 Fax: (209) 216-3330
Office Visit
Edward Foster
Home: (209) 499-3172
Male DOB: 2002 Nov 07
28790
Electronically Signed by Jennifer S Wong DO on 2019 Jun 07 at 8:49 AM
000213
0213
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711475189.939765 | Sarah Reeves |
NOVANT
Novant Health North Point
Sarah Reeves
N
Medical Associates
MRN: 56024607, DOB: 12 Sep 1991, Sex: M
HEALTH
1605 Bethabara Road
Visit: 20 Dec 2023
Winston-Salem NC 27606-3605
10 Oct 2017 - Office Visit in Novant Health North Point Medical Associates (continued)
Clinical Notes Amb
Progress Notes
Dr Jessica Fletcher, MD at 4/7/2023 1934
Author: Dr Jessica Fletcher, MD
Service:
Author Type: Physician
Filed: 04/07/23 1954
Date of Encounter: 10 Dec 2019
Status: Signed
Editor: Dr Jessica Fletcher, MD (Physician)
PLAN:
Patient Instructions
Apply ice as needed over the swollen tender area.
Follow up if symptoms worsen or fail to improve.
Generated on 4/11/23 8:32 PM
Page 4
| what is the visit date or date of visit? | {"text": ["20 Dec 2023"], "answer_start": [162]} |
id_1711476578.681694 | Elizabeth Young |
Name: Danielle Burke | DOB: 19/01/05 MRN: 2155xxx | PCP: | Legal Name: Danielle Burke
Memorial Neuroscience Institute
1179 North 35th Avenue, Ste 790
Hollywood, FL 33079
Electrophysiology Report
Full Name: Danielle Burke
Gender:
Female
Patient ID: 2155xxx
Date of Birth: 19/01/05
Visit Date:
10/16/01 3.14 PM
Age:
44 Years
Examining Physician:
Dr Dana Gibbs, Dr Eric Hunt
Referring Physician:
Dr. Subei
Indication:
Right ulnar neuropathy
Physical exam:
Positive tinnel in right elbow
Strength: 5/5 all through out with giveaway weakness in the right arm due to pain
Sensory: decreased sensation to pinprick on right hand in ulnar nerve distribution.
Sensory Nerve Conduction Study
Nerve /
Rec.
Onset
Ref.
Peak
Ref.
NP
Ref.
PP
Ref.
Segments
Distance
Peak
Velocity
Comment
Sites
Site
Lat
Lat
Amp
Amp
Diff
ms
ms
ms
ms
pV
uV
uV
uV
cm
ms
m/s
R Median - Dig II (Antidromic)
Wrist
Index
2,66
<3.30
3.49
<4.00
43.2
11.0
63.2
>13.0
Wrist -
14
53
Index
Palm
Index
1.09
<1.60
1,93
<2.30
55.9
>6.0
73.7
>8.0
Palm
7 -1,56
45
Wrist
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711472590.671308 | 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 Procedure Date? | {"text": [], "answer_start": []} |
id_1711471328.658744 | Alexandra Kemp | Fax Server
06 Jun 2021 9:51:00 AM PAGE 7/010 Fax Server
Oak Grove Hospital
Date: 06 Jun 2021
Dr Rachel Dominguez, MD
1884 Bolton Cliff Suite 446
West Michael, MN 34751
Beneficiary Name: Alexandra Kemp
birth date: 30 Mar 1990
Beneficiary Phone Number: 715-968-2775
Sponsor Name: Kevin Gay
Sponsor SSN: xxx-xx-1892
Plan Type: Prime Eligible
Reference Number: 19530069092
Requesting Provider: Dr Rachel Dominguez, MD
Requesting Provider NPI: 1341104067
Dear Dr Rachel Dominguez, MD:
Oak Grove Hospital is the Managed Care Support Contractor (MCSC) for the
Department of Defense's health care program, Oak Grove Hospital, in your region. We thank you for your
continued service to our Oak Grove Hospital beneficiaries.
We received your request for service(s) for the above Oak Grove Hospital beneficiary.
Reason for Request: Outpatient Authorization Request
Servicing Provider Name: Dr Rachel Dominguez, MD
Specialty Type: Urology
Servicing Provider Address: 1884 Bolton Cliff Suite 446
West Michael, MN 34751
Servicing Provider Phone: 820-965-7845
Service Type
Frequency
Surgical Care
57288* - 57288 16 Nov 2021 - 12/14/2010 1 Visit or Unit(s)
Alexandra Kemp-KPJayaraman-00007
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711475190.389647 | Jessica Sanders |
NOVANT
Novant Health Urology
Jessica Sanders
N
2180 Baldwin Lane
MRN: 51824187, birth date: 16 September 1996, Sex: M
HEALTH
Winston-Salem NC 21803-5186
Visiting Date: 27 August 2018
18 February 2020 - Office Visit in Novant Health Urology - Baldwin (continued)
Clinical Notes Amb (continued)
or family expresses understanding and all questions and concerns were answered. The patient is in agreement with
the plan as stated above.
Electronically Signed by Victor M Pereira, PA-C at 29 August 2023 0184
Labs
Urinalysis
Resulted: 02/23/23 0187, Result status: Final result
Order status: Completed
Filed by: Lainey Younts 02/23/23 0837
Collected by: 13 May 2023 0182
Resulting lab: NH UROLOGY - BALDWIN
Acknowledged by: Victor M Pereira, PA-C on 02/23/23 1233
Testing Performed By
All Reviewers List
Victor M Pereira, PA-C on 2/23/2023 12:33 PM
Generated on 4/11/23 8:32 PM
Page 46
| What is signature date or signed on date? | {"text": ["29 August 2023"], "answer_start": [512]} |
id_1711476578.596946 | Nicholas Meyer |
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
31/12/16
12:17:46 PM
PAGE
6/010
Fax Server
DOD Salinas
Nicholas Meyer
558 Abbott St Ste A
MRN: 311xxxx, DOB: 16/01/92, 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: 25/02/17
DOB:
16/01/92
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 16/03/24 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
25/12/22
CHIEF COMPLAINT:
Chief Complaint
Patient presents with
Worker's Compensation
BACK
Taylor Rivera
558 Abbott St Ste A
MRN: 311xxxx, DOB: 16/01/92, Sex: F
Salinas CA 9390xxx
Page 10
Printed by Arizpe, Crystal, MA at 16/03/24 12:16 PM
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711475741.153863 | Kelly Jones |
Kelly Jones DOB: 03/1986/30 (39 yo M) Acc No. CR937223
[Doc Name: Medical Records-Cora Health-05/2017/28-323116]
01/2016/19 a.m. 08-24-2022
6
CoraPhysicalTherapy
Assessment Report
CORA Physical Therapy - Regency
|
CORA
9527 Regency Square Blvd., Unit 105
proposed
General Eval
Jacksonville, FL 322258806
Name: Kelly Jones
FOR WORK COMP ONLY
SYS1294723
DOB: 03/1986/30
Case Manager:
Onset Date: 03/2019/08
Surgery Date:
Eval Date: 06/2023/03
Occupation:
Employer:
Ref Provider: Amy Wu APRN
Sex: M
Medical Dx: M79672 - Pain in left foot, M7542 - Impingement syndrome of left
Status:
shoulder, M5126 n Other intervertebral disc displacement, lumbar region
Last Day:
Treatment Dx:
Cur PDC:
JobReq PDC:
97163
PHYSICAL THERAPY EVAL HIGH
1
Marivic Chang, PT, License # PT23745
Date: 07/2017/12
Signature:
marrier chang, PT, DPT
I have reviewed this plan of treatment and certify a continuing need for services.
Physician/NPP:
Date:
Amy Wu APRN
Thank you for this referral and your continued support of CORA Health Services, Inc.
Should you have any questions, please feel free to contact me at (904) 647-4263.
Kelly Jones DOB: 03/1986/30 (39 yo M) Acc No. CR937223
Page 113 of 166
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711472286.460273 | Robert Hodges |
Riverbend Hospital
Robert Hodges
MRN: 000022169003, DATE OF BIRTH: 95/06/06, Sex: F
10/04/2017 - ALLIED HEALTH/NURSE VISIT - MH/BH in PSYCHIATRY (continued)
Robert Hodges (MR # 000012269003)
Page 1 of 2
After Visit Summary
Robert Hodges
10/4/2017
MRN: 000012269003
Visit and Patient Information
Visit Information
Date & Time
Provider
Department
19/04/10 5:00 PM
ELIZABETH BOEHNING WHITE LCSW
Psywlcwm Psy
Visit Summary
Vitals
LMP
11/21/2014
Health Problems Reviewed
None.
Medications
Kaiser Permanente, SCPMG: Robert Hodges (000012269003)
Page 1 of 2
Printed on 3/16/23 7:41 AM
Page 72
108/150
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711471329.33687 | Lindsay Barnes |
15048023244
0:11:38 a.m.
04-13-202
3/3
Greenfield Healthcare
2020/24/05
9835 Houston Ports
West Gloria, RI 26037
Page 3
369-495-9182 Fax: 965-998-9741
Office Visit
Lindsay Barnes
Work: (870) 972-8931
Female dob: 2000/01/12
128829
Ins: Blue Advantage Grp: 15048023244
:
ASSESSMENT: Right trimalleolar ankle fracture.
PLAN: The risks versus benefits of operative versus non-operative treatment were discussed with the
patient and her husband, They agree to proceed with surgery.
ABB/bcc
0829
signature
Dr Ryan Bishop MD on
2020/10/05 at 1220
PARHAM-0127
000039
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711477275.408491 | John Sullivan |
Orange County Corrections Health Services Dept
09-24-2022
PO Box 49Xx Orlando, FL 328xx
Page 37
4072548306 Fax:
Chart Document
DARIUS DESHAWN BOUEY
Home: Work:
Male DOB: 08-13-1986
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 06-19-2023 01:10 PM
Electronically signed by Edwin Pont, MD on06-19-2023 05:52 AM
PHA:Physical Assessment Export on Wednesday, December 6, 2023 12:14 PM by InDxLogic Chart Exporter
Page 4 of 37
(MD178@orang637469 - Orange County Health Services)
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711477090.749382 | Francisco Walker |
Perception
no hallucinations or delusions during interview
Orientation
oriented
Memory / Concentration
short term intact,long term intact
Insight / Judgement
good
Diagnosis
Diagnosis
WHODAS /
Diagnosis
Reviewed
Inactive
Resolved
Code
Description
Type
Primary
GAF / CGAF Status
Date
Date
Date
Date
F31.81
Bipolar II Disorder
Active
03 Mar 2017
JabaraMayer
Service Date: 07 Dec 2020 12:00:00 PM
Released:
03 Mar 2017 9:28:06 PM
This document was printed from PIMSY EMR System It contains protected health information (PHI).
DOS: 12 Apr 2016 12:00:00 PM
Shauna Becker (B-C-14860)
B-C-14860-60557
03 Mar 2017
Date Of Birth
25 Oct 2003
Gender:
Female
CLIENTNUMBER B-C-14849
Page 3 of 49
| what is the DOS or D.O.S? | {"text": ["12 Apr 2016"], "answer_start": [598]} |
id_1711476072.150424 | Douglas Brown |
Willowbrook Clinic
EMERGENCY ROOM CLINICAL REPORT WITH DISCHARGE
PATIENT NAME: WILLIAMS, CHARLES EUGENE
EMERGENCY ROOM
PATIENT ACCT: X0022382040
UNIT #: G0193887
date of admit: 21/02/2017
DISCHARGE DATE:
EOSIN #
0.1
Thsd/mm3
BASO #
0.1
Thsd/mm3
PROTHROMBIN TIME WITH INR:
( MsgRcvd 29/06/2015 12:58) Final results
COLLECTION DATE and Time: 09/11/2022 1229
COMMENTS TO PHLEBOTOMIST: ED 16
SPECIMEN COMMENT:
COMPREHENSIVE METABOLIC PANEL:
( MsgRcvd 24/08/2023 13:08) Final
results
COLLECTION DATE and Time: 09/11/2022 1229
COMMENTS TO PHLEBOTOMIST: ED 16
SPECIMEN COMMENT:
Hunt Patient Care Inquiry **LIVE** (PCI: OE Database HUD)
Run: 07/25/18-15:53 by WARREN, CATHERINE
Page 4 of 7
000520
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711471329.629311 | Dennis Blake |
10:35 AM FROM: Fax California Orthopaedic Surgery and Hand Institute
PAGE: 000 OF 003
BP: 118/80
P:75
Resp: 16
Wt: 270
Ht:60
BMI: 27
(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
M27.11
Thyroid Disorder
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)
date of exam: 2023 May 21
fauch Speel PAC
Taylor Powell, P.A. C-T-2016-10-10_11:00:07_Digitally Signed
Charle I Reoving MD
Dr Olivia Martinez, M.D.-S-2015 August 21_21:52:45_Digitally Signed
Executed at: Pasade na, California
Date: 2014 June 03
Physician Name: Dr Olivia Martinez, M.D.
Specialty: Orthopaedic and Hand Surgery
Physician Address: 153 Roberson Plaza Suite 118
North John, AZ 17122
Phone: 647-636-3860
Next follow up visit: 4 weeks
DWC Form PR-2 (Rev. 10/2015)
Page: 2
1196
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711472286.580071 | Tracy Cochran |
Tracy Cochran
MRN: 5601713
04/04/2023 - External Document in MULTICARE HEALTH INFORMATION (continued)
doi:
Place of Injury:
10/06/2014 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
800-317-9919
253-417-4948
Tacoma WA 98175-3799
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: 5601713 , BIRTH DATE: 09/09/1996, Sex: M
TACOMA WA 98417-0299
Visiting Date: 02/06/2023
Page 54
Printed by 414221 at 7/17/23 9:40 AM
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711477275.437978 | Paul Lewis |
12/2/2022 15:07:26 CST
To: 13228065220
Page: 2/22
From: Frontera
Fax: 9723225822
Lower Extremity
Frontera
Arterial Ultrasound
Report
FR NTERA
VIDISIAR*
Patient name: Shaun Coleman
Patient ID: 1833422
DOB: 1995 November 25
Chart#:
521922
Referred by:
Masciale^John
Age:
69Y
Location:
Sonographer:
Stephanie Lage, RDCS, RVT
Sex:
F
Equipment: CX50
I/O:
Outpatient
Exam. date: 2022 January 16
Diagnosis:
Peripheral vascular disease, unspecified (173.9).
Procedure:
Limited bilateral noninvasve physiologic studies of upper or lower extremity arteries (93922).
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study
Asymmetric blood pressures are noted. Unable to hear ABI pulses to accurately assess.
Right Leg
Monophasic waveforms throughout leg. No flow in SFA distal segment.
Left Leg
Monophasic flow throughout leg.
Impressions
Bilateral moderate lower extremity arterial disease
Suggest CTA of lower extremities
Electronically signed by: Jason Finkelstein
2019 April 13 8:06 PM
76722-3
South Texas Bone & Joint - 00422
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711473237.022084 | Paul Hernandez |
FAX
MRN: 1959310H
Paul Hernandez
Nassau Unly. Medical
Gender: Female
Center
Age: 74y (07/1990/14)
Current Location:
ICC1-2641-JJ
Operative Report [Charted Location: MICU-2644-II] [SERVICE DATE: 07/2020/24 0:4
Authored: 24-Mar-22 16:07] - for Visit: 9926464, Complete, Revised, Signed in Full, General
Date of Procedure:
date of procedure
02/2020/13 0:4
Pre-Op and Post-Op Diagnosis:
Pre Op Diagnosis Comments
left eye ruptured globe, 180 degree scleral laceration,
lateral rectus laceration
Post Op Diagnosis Comments:
Post Op Diagnosis Comments
left eye ruptured globe, 180 degree scleral laceration,
lateral rectus laceration
Specimens:
Specimen Details:
No specimen submitted for this procedure. (1)
Requested by: Philburn, Jacqueline (Med Rec Clerk), 07-Apr-22 12:25
Page 1 of 2
| what is the DOB or date of birth? | {"text": ["07/1990/14"], "answer_start": [101]} |
id_1711472590.943562 | Jose Bell |
04-20-2023
ORTHO SPORTS SPECIALISTS LOUISIANA
Page 1
Transaction History
Case # A - All Cases included
54063 -Jose Bell
1229 Baker Viaduct
Murphyton, FL 86253
Account Balance >
186.02
No Ser/Date Code
Description
PDr/IDr
Amount
Pmts
Adj
Ins/Bal
Pat/Bal
Bal
Balance Forward
0.00
1
2023 Feb 15
BD
BAD DEBT PAID
HIGG/HIGG
28.61
JASON HIGGINS, MI
Dr Elizabeth Copeland, MD
2018 Oct 14
OFFICE/OUTPATIENT VI 99203
21.32
2018 Oct 14
X-RAY EXAM OF FOOT
74030
7.29
6 08-05-22
94014
OFFICE/OUTPATIENT VI
DUPL/DUPL 371.00
98.49
272.51
DX1 M40.812 - Spondylosis w/o myelopathy or radiculopathy, cervi
KEITH DUPLANTIS MD
DX2: M40.2 - Cervicalgia
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711473365.496414 | Austin Fitzgerald |
<<Back to Review>>180298-26-HYPERLINK-Hyperlink-Page
167
TOWER PHYSICAL THERAPY, INC.
patient: Austin Fitzgerald
Address 700 FLOWER ST
City TURLOCK Zip Code 95780
Birthdate November 23, 2002
Social Security Number 557-57-0573
Sex: M F
Primary Phone (257)571-3570
Email: (for appointment reminders) EF5767@LIVE.COM
Employer SUNNYSIDE FARMS DAIRY
Occupation PACKAGING OPERATOR
Work Phone: 657-3577
Emergency Contact CINDY FOSTER
Phone (257)257-5574 Relation SPOUSE
ASSIGNMENT OF BENEFITS
Authorization for treatment is hereby given to Tower Physical Therapy, Inc. I assign them all payments for
medical services rendered.
X Ed Foster
January 19, 2022
Patient or Guardian Signature
Today's Date
CONTINUE ON BACK
000167
0167
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711472590.748127 | William Hicks |
William Hicks
Central Regional Medical
Visit Note - 2020 Mar 08
PMS ID:
Sex:
DOB:
MRN:
54663 Female 1998 Feb 15 54663
Medications
Chief Complaint: Chronic Low Back Pain
Duexis 866-66.6 mg Oral tablet
Medical History
HPI: This is a 21 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 2016 Jun 25.
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
166.0
66.7
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_1711477090.747636 | Joshua Davis MD |
Perception
no hallucinations or delusions during interview
Orientation
oriented
Memory / Concentration
short term intact,long term intact
Insight / Judgement
good
Diagnosis
Diagnosis
WHODAS /
Diagnosis
Reviewed
Inactive
Resolved
Code
Description
Type
Primary
GAF / CGAF Status
Date
Date
Date
Date
F31.81
Bipolar II Disorder
Active
12-01-2018
JabaraMayer
Service Date: 01-01-2021 12:00:00 PM
Released:
12-01-2018 9:28:06 PM
This document was printed from PIMSY EMR System It contains protected health information (PHI).
DOS: 03-26-2023 12:00:00 PM
Shauna Becker (B-C-14860)
B-C-14860-60557
12-01-2018
Date Of Birth
01-01-1990
Gender:
Female
CLIENTNUMBER B-C-14821
Page 3 of 21
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711473237.809773 | Andres Brown |
3. Amenable for Remeron 7.5 mg PO qHS for insomnia. Benefits and risks, discussed.
4. Psycho-therapy with Private Therapist.
5. Support and reassurance provided.
6. F/U in 2 weeks.
Electronically signed on 2015 Jun 07 6:59:41 PM by Dr Stephen Webster, MD
PATJAN_27202705_Psychiatric Evaluation Brain Spa.pdf
Page 4 of 4
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711477183.48616 | Laura Collins |
In the recovery area, patient was asked to sit, stand and walk, was asked to rate the pain and patient reported 100% pain relief.
Assessment and Plan
ICD: Other spondylosis, cervical region (M47.892)
CPT Codes:
Inj Paravert F Jnt C/t 1 Lev (64490)
Inj Paravert F Jnt C/t 2 Lev (64491)
Inj Paravert F Jnt C/t 3 Lev (64492)
S
Idly
Suneil Jolly, MD
This has been electronically signed by Suneil Jolly, MD on 2020-12-26.
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711476767.027953 | Kimberly Johnson |
MPT I McLaughlin Physical Therapy
Patient Name: Ebony Benson
3120 20th St
Physical Therapy
Date of Birth: 20/09/99
Metairie, LA 7000xxxx
Initial
Document Date: 02/03/23
Phone: xxxxxxx
Fax: xxxxxxx
Examination
Patient Problems:
- (R) Shoulder:
subjective complaints of pain in the (R) shoulder with functional activities and at rest, decreased poor posture, decreased scapular stabilizer, impaired functional mobility
Short Term Goals:
1: (1 Week) | Pt (I) with HEP
Long Term Goals:
1: (6 Weeks) I Pt reports 0/10 in the (R) shoulder with functional activities and at rest
2: (6 Weeks) I Pt reports less than 10% disability on the QUICK DASH
Plan
Frequency: 2-3 times a week
Duration: 6 weeks
Plan: Begin Plan as Outlined
Treatment to be provided:
Procedures
Therapeutic Exercises Therapeutic Activity (Work Specific, ADL Specific), Neuromuscular
Rehabilitation , Manual Therapy (Soft Tissue Mobilization, Joint
Mobilization, Muscle Energy Techniques, Patient Education), Postural Training, Activity Modification.
Modalities
To Improve (Pain Relief, Decrease Inflammation, Increase Blood Flow, Improve Tissue Healing), Electrical Stimulation, Cryotherapy (Ice Pack), Hot Packs
AND
Scott McLaughlin
License #08042
Electronically Signed by Dr Anthony Williams on 21/07/17 at 9:10 am
4 of 24
Powered by
WebPT
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711475190.013784 | 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 Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711475190.320549 | Michael Bennett |
KAISER PERMANENTE庐
Michael Bennett
MRN: 110604060860, D.O.B: Mar 20, 1987, Sex:
F
SSN: xxx-xx-3604
Visiting Date: Jul 04, 2016
Sep 19, 2021 - Telephone in ADULT AND FAMILY MEDICINE (continued)
Clinical Notes (continued)
Status: Signed
Editor: Clark, Juliana Elizabeth (M.A.) (MEDICAL ASSISTANT)
Electronically Signed by Clark, Juliana Elizabeth (M.A.) at Oct 22, 2014 9:44 AM
Telephone Encounter by Clark, Juliana Elizabeth (M.A.) at 1/13/2011 0944
Version 1 of 1
Author: Clark, Juliana Elizabeth (M.A.)
Service: -
Author Type: MEDICAL ASSISTANT
Filed: 1/13/2011 9:44 AM
ENCOUNTER DATE: May 07, 2017
Creation Time: 1/13/2011 9:44 AM
Status: Signed
Editor: Clark, Juliana Elizabeth (M.A.) (MEDICAL ASSISTANT)
Generated on 4/12/22 10:33 AM
000564
0563
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711477183.245561 | Sonia Harris |
2017/18/09 3:39 PM
IDS FaxServer
15041542015
pg 2 of 15
DIS
D.I.S. Slidell
DIAGNOSTIC IMAGING SERVICES
Patient Name:
Brenda Shelton
Ref. Physician:
Rommel S Dhadha MD
Patient ID: 425xxx
Home Phone:
Date of Birth: 1984/23/06
Page 1 of 15
Date of Service: 2018/29/03
STUDY
X-ray, Lumbosacral, Minimum 4 Views
CLINICAL INDICATION
Back pain
COMPARISON
No relevant imaging examinations are available for review.
PROCEDURE DETAILS
AP, lateral, both oblique, and spot lumbosacral views were acquired.
FINDINGS
The vertebral body heights and disc spaces are well maintained. Alignment is anatomic without
spondylolisthesis or spondylolysis. SI joints of sclerotic changes more prominent on the right than
left. The bony mineralization is appropriate.
There is a 4.8 mm calculus seen in the lower pole region of the right kidney.
IMPRESSION
1. No significant spondylosis or acute findings involving the lumbosacral spine.
2. Calcifications involving both sacroiliac joints right greater than left raise the question of
sacroiliitis.
Signature
Electronically Signed: Silvestri, James, M.D. on 2020/01/08 02:39 PM
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711472786.712294 | Lindsay Richmond DDS |
athena
09-18-2023 2:23 PM ET
613-195110009
pq 37 of 42
Privia . CCA - Cardiac Care Associates PC . 224D Cornwall St. LEESBURG VA 20466-2460
Lindsay Richmond DDS (id #1110006, birthdate: 18-06-1991)
Reston
RRC
Radiology
Consultants
Patient: Lindsay Richmond DDS
birthdate: 18-06-1991
DATE OF EXAM: 12-01-2019
Medical Record #: RHCK005179829
Procedure: RAD Chest 2V
Referring Physician:
Dr Jason Oneal
Reston Hospital Center
K85425179829 Lindsay Richmond DDS
Michelle I Pego NP
Duyanh T Vu, MD
Vu,Duyanh T Md
ALYSIA D. JOHNSON RT(R)
RR
CHEST X-RAY, frontal and lateral views:
HISTORY: WHEEZING
COMPARISON: 11/3/2018
FINDINGS:
The cardiac silhouette is normal.
Lungs are clear.
MEDICAL IMAGING CENTER OF RESTON, 1846 TOWN CENTER DRIVE, Reston VA, 24690
Fax www.restonradiology.com
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711475190.152983 | Wendy Flores |
NOVANT
NOVANT HEALTH MEDICAL
Wendy Flores
N
PARK HOSPITAL
MRN: 52024207, birth date: 98-08-19, Sex: M
HEALTH
1950 South Hawthorne Road
Adm: 16-03-28, D/C: 16-04-27
Winston-Salem NC 27203-3202
23-05-27 - Admission (Discharged) in NHMPH Surgical Services (continued)
Clinical Notes Acute (continued)
Drains:
None
Specimens:
ID
Type
Source
Tests
Collected by
Time
1 right
Tissue
Spermatocele
PATHOLOGY
Brandon L
20-02-08 1618
TISSUE
Craven, MD
REQUEST
Implants: No implants in log
Procedure Detail
Findings:
Right spermatocele x2
Complications: None.
Electronically signed:
Dr Charles Calderon, MD
14-10-15 / 4:39 PM
Electronically signed by Brandon L Craven, MD at 14-10-15 1641
Generated on 4/11/23 8:32 PM
Page 255
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711476990.485522 | Douglas Daniels |
20-05-27 10:13:54
Oklahoma Spine 471 8789471
9/71
Summit
MEDICAL CENTER
OPERATIVE REPORT
PATIENT NAME: Courtney Hess
MR#: M007143771
ADM DATE: 16-01-09
DOB: 95-10-09 SEX: M
10:50 AM
DC DATE: 16-02-08 01:20
ATTENDING PHYSICIAN: Brian Stein, M.D.
PM
DATE OF OPERATION: 21-09-12
PROCEDURES:
1. First diagnostic lumbar facet medial branch nerve block, right L4-L5, L5, and S1.
2. First diagnostic lumbar facet medial branch nerve block, left L4-L5, L5, and S1.
3. Flooroscopic imaging for needle placement.
4. IV medication for conscious sedarion was administered to the patient in my presence,
at my direction by an independent trained registered nurse for 23 minutes intraservice
time
RN: Joe Schwart. RN
Start time 1271 hours
Finish time: 1271 hours
REFERRING PHYSICIAN: Dr. Gillan
DIAGNOSIS: Chrome low back pain from lumbar spondylosis.
PATIENT POSITION Prone.
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711477183.484838 | Marie Gonzalez |
In the recovery area, patient was asked to sit, stand and walk, was asked to rate the pain and patient reported 100% pain relief.
Assessment and Plan
ICD: Other spondylosis, cervical region (M47.892)
CPT Codes:
Inj Paravert F Jnt C/t 1 Lev (64490)
Inj Paravert F Jnt C/t 2 Lev (64491)
Inj Paravert F Jnt C/t 3 Lev (64492)
S
Idly
Suneil Jolly, MD
This has been electronically signed by Suneil Jolly, MD on 19 April 2016.
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711477275.639793 | Jeremy Bennett |
ORTHOPAEDIC ASSOCIATES OF CORPUS CHRISTI
601 Texan Trail, Suite 300, Corpus Christi, Texas 78411
Telephone #: Fax #:
Preop Form
Name:
ELMA TREJO
DOB: 08-05-1995
SSN: 45796xxxx
Address: 601 HUGHES AVE
Room:
8
MRI:
Rad Ass 19-02-2023
ALICE, TX
78332
Phone:
Order: 1st
Clearance: cleared- Dr. Kapasi
361xxxxxxx
Ins: CENTENE-ALLWELL
Table: 4 poster jackson
Assist: Brandon Harris, Cert 1st
Hosp: SPOHN SOUTH
Cell Saver: yes
Home Health:
??
Arrival: 5:30 AM
Brace:
LSO- in hosp
1st postop: 03-07-2016
Date of Surgery: 03-02-2018
Xray:
03-07-2016 2V LUMBAR!!
PCP:
Lies: Francispo Rodriguez RNP-BC-CONVIA
Diagnosis:
Minimal thoracolumbar scoliosis, grade 1 L2 and L3 retrolistheses, grade 1 L4
spondylolisthesis, L4 and L5 degenerative disc disease
Procedure: L3, L4, and L5 laminectomies, radical L4 and L5 discoidectomies, transforaminal
lumbar interbody fusions at L4 and L5, internal fixation with PEEK cages, L3 to
sacrum posterolateral intertransverse fusion with local and iliac autograft.
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711472286.064355 | Tyler Carroll |
General Medical Center
Tyler Carroll
MRN: 000052169003, birth date: February 04, 1993, Sex: F
September 26, 2021 - ALLIED HEALTH/NURSE VISIT - MH/BH in PSYCHIATRY (continued)
February 22, 2019 - OFFICE VISIT - MH/BH in PSYCHIATRY
Visit Information
Provider Information
Encounter Provider
Authorizing Provider
Talag, Emelita Borja (M.D.), M.D.
Talag, Emelita Borja (M.D.), M.D.
Clinical Notes
Progress Notes
Dr Emily Hill MD, M.D. at 7/27/2017 1313
Author: Dr Emily Hill MD , M.D.
Service: -
Author Type: Physician
Filed: 7/27/2017 1:57 PM
Date of Encounter: February 06, 2019
Creation Time: 7/27/2017 1:13 PM
Status: Signed
Editor: Talag, Emelita Borja (M.D.), M.D. (Physician)
History:
Date: November 28, 2022
Patient Name: Tyler Carroll
Patient Medical Record #: 000015529003
birth date: February 04, 1993
Printed on 3/16/23 7:41 AM
Page 34
9/150
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711476892.987351 | Lori Fitzpatrick |
NORTHBAY MEDICAL CENTER
NorthBay Hospital Campus: 1200 B. Gale Wilson Blvd.
Fairfield, CA 94533 (707) 27545
General Diagnostic
Exam Date/Time:
Exam:
Accession Number:
Ordering Physician:
12/01/17 23:45:54
DX Chest 2 views
DX-11-0027545
Ankney. William A M.D.
Reason for Exam
Trauma
Read
PA and lateral chest.
FINDINGS:
Soft tissues and bony structures are unremarkable. Lungs are clear and costophrenic angles are sharp.
IMPRESSION: Normal chest without comparison.
DT: 12/07/2011 ( 1902 hours)
Final Report
Dictated by: McMahon, James F., M.D.
Signed by: McMahon. James F., M.D.
Transcriptionist: Murray. Joanne B.
12/07/2011 17:23
Exam Date/Time:
Exam:
Accession Number:
Ordering Physician:
12/01/17 23:45:54
DX Hip Complete Unilateral
DX-11-0051911
Ankney. William A M.D.
Right
Reason for Exam
Trauma
Read
Two views.
FINDINGS:
Patient Name: Paula Mcclain
Medical Record No: 608698 Financial No: 010998039
Medical Records
DOB: 13/07/98 Age: 28 years Sex: Male Pt Type: Emergency
N/A
Admit Date: 17/04/18 Discharge Date: 17/05/18
Admitting Physician:
Attending Physician: Ankney. William A M.D.
Printed 17/11/23 at 11:14 AM
(Page / of 28)
ED-NB
128
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711475190.049139 | Christopher Johnston |
NOVANT
Novant Health Orthopedics &
Christopher Johnston
N
Sports Medicine
MRN: 57424747, birth date: 1985-18-10, Sex: M
HEALTH
7210 Village Medical Cir
VISITING DATE: 2015-09-07
Ste 110
CLEMMONS NC 27412-8749
03/21/2023 - Ancillary Procedure in Novant Health Orthopedics & Sports Medicine (Clemmons)
(continued)
Imaging (continued)
XR Pelvis And Right Hip (Final result)
SIGNATURE: Karen M Wulf, RN, BSN on 2019-09-10 1533
Status: Completed
This order may be acted on in another encounter.
Ordering user: Karen M Wulf, RN, BSN 03/21/23 1533
Authorized by: Bradley S Taylor, PA-C
Ordering mode: Standard
Frequency: Routine 03/21/23 -
Class: Clinic Performed
Quantity: 1
Lab status: Final result
Instance released by: Jennifer M Bumgarner, RT 3/21/2023 3:33 PM
Diagnoses
Status post right hip replacement [Z74.641]
Testing Performed By
Signed
Electronically signed by Andrew Deibler, MD on 3/29/23 at 1741 EDT
Generated on 4/11/23 8:32 PM
Page 19
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711472787.266727 | Shane Goodman |
Northwell
Health
Authorization for Release of Health Information
6. Date or event on which this Authorization will expire (this field must be completed with a data or event):
EXPIRE 11-25-2014
7. PallonVAgenV$urrogate/Guardlan (Signature):
8. Date:
2
Laun
03-10-2019
9. Printed name of person signing this form:
10. Authority to sign on behalf of pallent or relationship to patient
(if applicable):
@ Lisa Arvarado
Date/Time
Print: Interpreter's Name and Relationship to Patient
Signature: Interpreter
K. N
03-10-2019
Karla Holemann
Print Witness Name
Witness to Signature
Copy 1 - Patient Medical Record
Copy 2 - Patient or Patient's Personal Representative
Page 2 of 2
VD001 (5/11/19)
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711475620.931599 | Michael Mullins DVM |
DocuSign Envelope ID: 2EBB7621-EDFE-47BB-
C6C3A2DDDA86
ASSOCIATES MD
MEDICAL GROUP
ASSOCIATESMD MEDICAL GROUP
PATIENT CONSENT AND AUTHORIZATION
Michael Mullins DVM
I,
FURTHER ACKNOWLEDGE THAT IN THE EVENT ASSOCIATESMD MEDICAL GROUP IS FORCED TO RETAIN THE
SERVICES OF A COLLECTION AGENCY AND/OR ATTORNEY; I WILL BE RESPONSIBLE FOR THE COLLECTION AND/OR LEGAL FEES. I HEREBY
AUTHORIZE THE DOCTOR TO RELEASE MEDICAL INFORMATION TO MY INSURANCE COMPANY TO SECURE PAYMENT OF BENEFIT. I ALSO
AUTHORIZE THE USE OF MY SIGNATURE ON ALL INSURANCE SUBMISSIONS AND AS AUTHORIZATION FOR PAYMENT TO BE SENT TO
ASSOCIATESMD MEDICAL GROUP AT 4780 SW 64th Ave Davie, FL 33314.
Consent to Contact. 1 hereby expressly consent to being contacted by mobile phone or mobile text messaging for the purpose of receiving
Information or advice about my health care, about any services officered, changes in policies, procedures, or office hours, or any other purpose
as determined by AssociatesMD Medical Group. Data messaging charges may apply.
Receipt of Notice of Privacy Practices.
Michael Mullins DVM
I,
have received a copy of AssociatesMD Medical Group's Notice of Privacy Practices.
The physicians and staff of AssociatesMD Medical Group have my permission to speak to the following family members/friends in reference to
my medical care:
Name:
Michael Mullins DVM
Relationship to Patient Son
Name:
John Arthur Romney
Relationship to Patient Best Friend
Name:
Nelson A oti
Relationship to Patient Best friend
The Physicians and staff at AssociatesMD Medical Group have my permission to leave a message on my answering machine.
Yes
No, and/or call at my place of work:
Yes
No
DocuSigned by:
Phile
06/20/10
Signature of responsible party
Date
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711471330.8229 | Anne Frazier |
Patient Name Anne Frazier Rm/Bed MR 84969979235 Pt # 120506373
Attending Adm Date birth date 16 May 2002 Sex F
Consult Note 31 Dec 2014 17:39
Dictated By: Dr George Buckley, MD
date of admit: 12 Nov 2019
Discharge Date: 12 Dec 2019
Prairie Hill Hospital
Patient Name: Anne Frazier birth date: 16 May 2002
MRN: 1266127 ACCTN: 129705640
ADM DATE: 12 Nov 2019 SEX: F
ROOM: 8437 01
Consultation Date: 31 Dec 2014
REASON FOR CONSULTATION: Dr Nicholas Hall Scott asked me to see the patient
because of unexplained acute renal failure.
HISTORY OF PRESENT ILLNESS: Ms. Hinson is a 50-year-old female who was admitted to the Northern Surry Hospital
on 3/16/2010 with a creatinine of 2.2.
She was diagnosed with diabetes about 2 years ago.
She said her hemoglobin A1c had been 6 prior to her presentation.
PAST MEDICAL HISTORY:
1. Diabetes mellitus for 2 years.
2. History of hypertension.
Facility SYSA, Prod - Forsyth Med Ctr Page 1 of 3 out COPY Mid 90's Sherry Hinson-NeA-MD-000003
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711476990.266003 | Preston Cohen |
University of Oklahoma
33839
800 NE 15th Street Suite 205 Oklahoma City, OK 33839
Page 1
4033839647 Fax: 405233839
Radiology Reports
Timothy Esparza
Male DOB: 85/05/06
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 E0027333839
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: E2133839
MRN:
E002733117
PT. TYPE: REG RCR
CAMPUS: K
PT:
PARRY, Timothy Esparza
ACCT#: E00655310983
DOB: 85/05/06 AGE: 48
SEX: M
ORD PROV: 1154434405 Asch, Adam S MD
EXAM START: 17/06/18 1204
ATT PROV: 1003111972 Luetkemeyer PAC, Jessica L
EXAM ENDED: 19/05/11 1404
ADMISSION CLINICAL DATA: C83.30
DIFFUSE LARGE B-CELL LYMPHOMA
EXAMS:
CPT:
004933839 PET/CT TUM SKUL BS MIDTHIGH
33839
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711472786.859154 | Melissa Garcia |
Virginia Cancer
Specialists
Specializing in Cancer and Blood Disorders
LOCATION: VCS Loudoun
PATIENT NAME: Melissa Garcia
MRN: 372314
D.O.B: 12-16-1999
ATTENDING PHYSICIAN: Dr Paul Phillips
Date of Service 12-02-2014
REASON FOR VISIT
Non-Hodgkin's lymphoma/lymphadenopathy
HPI
60-year-old lady admitted to Reston Hospital with enlarged neck lymph nodes.
INTERVAL HISTORY
Developed a rash all over her body with itching after her discharge. No fevers.
PAST SURGICAL HISTORY
Right sided neck lymph node biopsy
REVIEW OF SYSTEMS
15 systems review detailed below is negative unless otherwise indicated
Constitutional: No weight loss, No fever, No chills, No night sweats. Energy level good
Eyes: No diplopia, No transient or permanent loss of vision, No scotomata
ENT/Mouth: No epistaxis, No dysphagia, No hoarseness, No oral ulcers, No gingival bleeding. No sore throat, No postnasal drip, No
nasal drip, No mouth pain, No sinus pain, No tinnitus, Normal hearing
09/19/2023
Page 1 of 3
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711477182.933876 | Terri Marshall |
medications if possible to avoid further complications from escalating doses of opioids. The patient verbalized
understanding
PMP reviewed.
Discussed and gave patient information on plan of care.
Greater than 25 minutes was spent on patient evaluation, coordination of care, reviewing any lab/imaging findings,
and developing a plan of care at today's visit.
-Dr. Jolly present in clinic and agrees with the above note and plan. -MT
Services Ordered:
Left cervical TPI- Left upper trapezius, left rhomboids, and left cervical paraspinals.
UDS today 2019 Dec 29
F/U 2 months
Prescription
Norco 7.5 mg-325 mg tablet 1 Tablet Once-Twice A Day PRN. Can fill 10/18/20 for 30 Days , Prescribe 45 Tablet
Norco 7.5 mg-325 mg tablet 1 Tablet Once-Twice A Day PRN. Can fill 11/16/20 for 30 Days , Prescribe 45 Tablet
tizanidine 4 mg tablet 1 Tablet At Bedtime PRN muscle spasms. for 30 Days , Prescribe 30 Tablet, Refills 1
Norco 7.5 mg-325 mg tablet 1 Tablet Once-Twice A Day PRN. Do not fill until 9/26/20. for 30 Days , Prescribe 45
Tablet
Norco 7.5 mg-325 mg tablet 1 Tablet Twice A Day PRN Pain. Do not fill until 10/01/20. for 15 Days , Prescribe 30
Tablet
Follow Up: 41 Months.
S
Jolly
Suneil Jolly MD
This has been electronically signed by Suneil Jolly MD on 2016 Mar 15.
S Jolly
Suneil Jolly, MD
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711473239.366888 | 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 Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711477090.376511 | James Murillo |
CASA COLINA
Hospital and Centers for Healthcare
14/20/05
Sarah Davis
905 Painter Ct Apt C
Pomona, CA, 91766
Dear Sarah Davis:
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:
Sarah Davis
13/20/09
Date
Signature
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711475956.02139 | Michelle Harris |
20/10/24 10:15AM
No. 0020 P. 23.
From +1.843.839.3608
Mon 28 Feb 2022 03:42:27 PM EST
Page 1 of 2
OrthoSO
235 Singleton Rigde Road
Conway, SC 29572
OrthoSC
Phone: (843)234-2094
Fax: (843)347-4375
Patient Name:
Michelle Harris
Accession Number:
G220228121501003
Patient ID:
43351800A
Location:
COA-CO
Gender:
Female
Referring Physician:
ALCI, ERKAN
Date of Birth:
86/05/16
Date of Service:
15/05/05 12:02
Procedure Description:
MRI CERVICAL SPINE WITHOUT
Home Phone:
CONTRAST
Report Status:
Final
Professionally Interpreted by Carolina Radiology
Reporting MD: DERRICK, RUSSELL
Dictation Time: February 28,2022 15:34
EXAM:
MAIL CERVICAL SPINE WITHOUT CONTRAST
CLINICAL DATA:
PT C/O CERVICAL PAIN WITH BILATERAL UPPER EXTREMITY NUMBNESS,
TINGLING, AND WEAKNESS. PT STS NO KNOWN INJURY.
Carolina Radiology
Report exported on Mon, 20/10/24 15:41:04 -0500 - Page 1 of 2
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711473237.956181 | Kathryn Johnson |
10/24/2023 1:29:08 PM -0400 FAXCOM
PAGE 85
OF 133
Name: Kathryn Johnson
ID: 980534078
BIRTHDATE: 31/08/85
ZEISS
Examination date: 01/01/22
n: 1.3535
Axial length values
OD
o
o
os
right
left
Phakic
Phakic
Comp. AL: 22.46 mm
(SNR = 117.4)
Comp. AL: 22.42 mm
(SNR = 253.0)
AL
SNR
AL
SNR
AL
SNR
AL
SNR
22.47 mm
2.1
22.45 mm
3.5
22.48 mm
7.6
22.43 mm
4.9
22.47 mm
2.7
22.39 mm
2.6
Carl Zeiss IOLMaster庐 Advanced Technology V. 7.7
02/20/2078
Calibration checked on: 02/16/2018
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711473365.743259 | Kimberly Baker |
Discharge Information
Attestation
Attestation to: I personally interviewed the patient, I personally examined the patient, I certify that the services
provided were clinically indicated and medically necessary for the care of this patient.
SIGNATURE: GO MD, JENSEN L
On 01 January 2020 20-04
Electronically Co-Signed By:GO MD, JENSEN L
On: 01 December 2016 08:10
patient:
Kimberly Baker
MRN: 71026105
FIN#: 91010105
Printed On:
10/30/2023 05:11 EDT
Page 37 of 516
Report Request ID#: 321034108
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711473238.590508 | Antonio Morales |
MRI SCREENING FORM
Patient
Name: Antonio Morales
DATE OF SERVICE
12/2018/18
Pt. ID#
C15254496
Clinic:
Slidell
Ht: 5'7 Wt: 250
Kevin Rogers: Cell-504-458-8871, Fax-50 -399-8123 Email: kevin.rogers@disnola.com
Section 1:
1- Do you have a Pacemaker or Defibrillator If yes, complete the implant form and obtain
no
clearance prior to scheduling.
Section 2:
Female: Are you pregnant? If yes, obtain trimester information and approval prior to
scheduling.
Males: Prostate studies only:
Any previous prostate MRI? If yes, date and where?
Any previous biopsy or PSA? If yes, please acquire?
MRI CAN BE SCHEDULED 6-8 WEEKS POST OP SURGERY.
Revised: 02/2019/05
| What is Ordered Date? | {"text": [], "answer_start": []} |