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id_1711476767.61594
Mark Saunders
26/20/04 08:30 1 12 >> unknown P 3/29 Assessment (1) Myofascial pain 729.1/M79.1 (2) Cervical myofascial strain, subsequent encounter Strain of muscle, fascia and tendon at neck level, subsequent encounter V58.89/516.1XXD Plan Orders Lidocaine 10mg (J2001) - 729.1/M79.1, - 847.0/S16.1XXD - 10/23/2023 - Hold lab results until reviewed :No Ultrasound guidance for needle placement (76942) - - 10/23/2023 - Hold lab results until reviewed :No Tendon origin/insertion injection (20551) - 729.1/M79.1, 847.0/S16.1XXD - 10/23/2023 - Hold lab results until reviewed :No Trigger point(s), 3 or more muscles (20553) - 729.1/M79.1, 847.0/516.1XXD - 10/23/2023 - Hold lab results until reviewed :No Instructions Please refer to discharge sheet. The supervising physician is on site to provide direct personal supervision involing the patient's care during their office visit today. This document is prepared by automatic population of appropriate fields, typed and or formatted entry. The reader is encouraged to contact me directly with any issue or questions. Electronically Signed by: David Brooks, PA -Author on 21/18/04 02:16:58 PM [Digital Signature Validated]
What is the Date of operation?
{"text": [], "answer_start": []}
id_1711475620.537323
Peter Fernandez
Peter Fernandez DOB: Jan 07, 1993 (26 yo M) Acc No. 48370 Doc Name: Dec 11, 2018 NP Forms I do 00 /do not authorize the release of information pertaining to HIV/AIDS Purpose of the Requested Disclosure I am authorizing the release of my Protected Health Information for the following purposes: Medical Care Insurance At the request of patient Other (specify) Request by Attorney Time Period for this Authorization This Authorization will expire five years from the date of its execution. Revocation of This Authorization | understand that I have the right to revoke this Authorization at any time to prohibit future release of my information. To revoke this Authorization, 1 must send written notice to LA Health Solutions, to the attention of LA Health Solutions Medical Records Division at the address indicated above. I understand that my revocation of this Authorization applies to future disclosures only and will not have any effect on any disclosures of Protected Health Information made before receiving the revocation. Redisclosure I understand that my Protected Health Information disclosed pursuant to this Authorization may be redisclosed by the recipient identified above and may no longer be protected from disclosure to others by federal or state law. Waiver I hereby expressly waive any claim of privilege or privacy with respect to the released information. 1 release and forever discharge LA Health Solutions and its agents, servants, or employees from all liability or claims, of any kind or character, in any way arising out of the disclosure of the requested information, including disclosures made in good faith. Voluntary 1 understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for benefits will not be conditioned upon my authorization of this disclosure. Signature of Patient/Patient's Representative: Date: Jabbith Dec 15, 2016 Printed Name of Patient's Representative: Relationship to Patient: Peter Fernandez DOB: Jan 07, 1993 (26 yo M) Acc No. 48370 Doc Name: Dec 11, 2018 NP Forms Page 100 of 123
what is the service date or date of service?
{"text": [], "answer_start": []}
id_1711475620.535537
Dale Miller
Dale Miller DOB: 1987/06/12 (43 yo M) Acc No. 47046 Doc Name: 2016/30/05 NP Forms I do 00 /do not authorize the release of information pertaining to HIV/AIDS Purpose of the Requested Disclosure I am authorizing the release of my Protected Health Information for the following purposes: Medical Care Insurance At the request of patient Other (specify) Request by Attorney Time Period for this Authorization This Authorization will expire five years from the date of its execution. Revocation of This Authorization | understand that I have the right to revoke this Authorization at any time to prohibit future release of my information. To revoke this Authorization, 1 must send written notice to LA Health Solutions, to the attention of LA Health Solutions Medical Records Division at the address indicated above. I understand that my revocation of this Authorization applies to future disclosures only and will not have any effect on any disclosures of Protected Health Information made before receiving the revocation. Redisclosure I understand that my Protected Health Information disclosed pursuant to this Authorization may be redisclosed by the recipient identified above and may no longer be protected from disclosure to others by federal or state law. Waiver I hereby expressly waive any claim of privilege or privacy with respect to the released information. 1 release and forever discharge LA Health Solutions and its agents, servants, or employees from all liability or claims, of any kind or character, in any way arising out of the disclosure of the requested information, including disclosures made in good faith. Voluntary 1 understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for benefits will not be conditioned upon my authorization of this disclosure. Signature of Patient/Patient's Representative: Date: Jabbith 2019/30/04 Printed Name of Patient's Representative: Relationship to Patient: Dale Miller DOB: 1987/06/12 (43 yo M) Acc No. 47046 Doc Name: 2016/30/05 NP Forms Page 100 of 123
what is the DOB or date of birth?
{"text": ["1987/06/12"], "answer_start": [21]}
id_1711475444.903435
Kathryn Levine
Kathryn Levine DOB: 16/87/09 (59 yo M) Acc No. 74940 11/16/10 Kathryn Levine DOB: 16/87/09 (59 yo M) Acc No. 74940 DOS: 08/21/07 LA Health Solutions Initial Visit Chiro-MVA Patient: Kathryn Levine Provider: Matthew Laudun, D.C. DOB: 16/87/09 Age: 59 Y Sex: Male Date: 16/15/04 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: 26/21/11 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. Kathryn Levine DOB: 16/87/09 (59 yo M) Acc No. 74940 Page 25 of 47
What is the Date of Consultation?
{"text": [], "answer_start": []}
id_1711476990.669153
Jennifer Tran
24/01/09, 11:51 AM Print Preview SWANN, Lisa A DOB: 86/03/28 (64 yo F) Acc No. 28924 DOS: 18/12/26 Swann, Lisa A 64 Y old Female, DOB: 18/12/26 20/05/14 Account Number: 28935 1330 Waterwood Dr, Lutz, FL-33559 Home: 813-388-2387 Guarantor: Kevin Harding Insurance: FL MEDICARE PRIMARY Payer ID: SMFLo PCP: ALEJANDRO I. MICHEL Referring: ALEJANDRO I. MICHEL Appointment Facility: PULMONARY AND SLEEP SPECIALISTS OF TAMPA BAY, PA 09/25/2023 Progress Notes: Michael Newton MD PA Reason for Appointment Current Medications 1. Pft,ox,st, and alpha results Taking Synthroid 112 MCG Tablet 1 tablet in History of Present Illness the morning on an empty stomach Orally Interim history: Once a day Carvedilol 12.5 MG Tablet 1 tablet AM, 9/25/2023. In office visit. Nocturnal oximetry, was not able to read 1/2 tablet PM Orally Twice a day appropriately, maybe because of fingernail Polish. Will try the ring next. Ramipril 5 MG Capsule 1 capsule Since her episode of bronchitis, about a month ago, she is improving, Orally Once a day almost back to baseline. Still has cough and still brings up some phlegm. patient is awake, alert, and oriented, able to answer all questions, and Progress Note: Michael Newton MD PA 24/01/09 Note generated by 漏ClinicalWorks EMPSM Software (www.eClinicalWorks.com) 1/24
What is signature date or signed on date?
{"text": [], "answer_start": []}
id_1711472590.863471
Travis Stewart
orthoLA CONFIDENTIAL PATIENT MEDICAL HISTORY FOR OFFICE USE ONLY HIGGINS ELIAS ELLENDER HILDENBRAND GREBER BORNE JOHNSON DUPLANTIS HEIGHT 5.6 " WEIGHT 764 lbs AGE 65 BP / PULSE TEMP PATIENT NAME Nadine Buggage BIRTHDATE 1995 October 03 SS# 769-76-1761 REASON FOR PRESENT VISIT Fall AFFECTED SIDE: DECET RIGHT DISATERAL DATE OF INJURY 2018 May 28 ARE YOU DRIGHT-HANDED LEFT-HANDED ARE YOU CURRENTLY PREGNANT YES NO OCCUPATION How did Injury occur? Where did injury occur? PAST SURGICAL/HOSPITALIZATION HISTORY (Please Include: Date, Surgery/Illness, Doctor, Facility) Sinus - 2015 May 30 Dr. Justin Tenney Unit 9742 Box 9223 DPO AE 01991 Phone: 250-764-5226 Fax: 497-630-4265 www.ortho-la.com
What is the Date of Encounter or Enc?
{"text": [], "answer_start": []}
id_1711476767.58818
Jessica Morrow
2014 June 09 08:36 1 12 unknown P 8/32 Brandon Lewis Coastal Neurology Page: 7 610 Trenia Ann I 725 W Granada Blvd. Ste 22 Date: 2014 June 09 Orange City FL 32763 Time: Ormond Beach, FI 32174 7:50 AM Patient: Patient ID is equal to 23632 Date: Service date of the Charge: 2019 March 16 CPT: Description: Charge Primary Primary Secndry Non Primary Pt Account Amount Pmnt Adj Pmnt Adj Pmnt Balance 20551 Injection(s); single tendon $350.00 $0.00 $0.00 $0.00 $0.00 $0.00 $350.00 20553 Injection(s): single or multiple $380.00 $0.00 $0.00 $0.00 $0.00 $0.00 $380.00 Total Outstanding Balance for Date of Service: $1,270.00 Date: Service date of the Charge: 2022 August 10 CPT: Description: Charge Primary Primary Secndry Non Primary Pt Account Amount Pmnt Adj Pmnt Adj Pmnt Balance 20553 Injection(s): single or multiple $380.00 $0.00 $0.00 $0.00 $0.00 $0.00 $380.00 Total Outstanding Balance for Date of Service: $920.00 Date: Service date of the Charge: 10/24/2023 CPT: Description: Charge Primary Primary Secndry Non Primary Pt Account Amount Pmnt Adj Pmnt Adj Pmnt Balance
What is the Date of Encounter or Enc?
{"text": [], "answer_start": []}
id_1711471328.557941
Jesse Chang
Valley View Hospital DISCHARGE SUMMARY PATIENT: Jesse Chang Medical Rec #: 24082535947 Account #: 0069827621 Location: CN4A Sex: F DOB: 02-26-2002 Age: 66 admission date: 11-19-2022 Date of Discharge: 12-19-2022 Primary Care Physician: Dr Kirk Lyons M.D. PRIMARY CARE PHYSICIAN: Dr Kirk Lyons, MD. The patient is being discharged to New Bedford Rehab. DISCHARGE DIAGNOSES: Ulcerative Colitis OTHER PAST MEDICAL HISTORY: High Blood Pressure PAST SURGICAL HISTORY: Knee replacement in 2001 BRIEF HISTORY OF PRESENTING ILLNESS AND HOSPITAL COURSE: This is an unfortunate 66-year-old female who has had a tumultuous. Additional copy Page 88 of 99
What is the Date of Encounter or Enc?
{"text": [], "answer_start": []}
id_1711476893.376416
James Barton
2233 Post St., Suite 233 Integrated Pain Care 3133 Garrity Way San Francisco, CA 94115 Tel (510) 32887 A Pain Management Clinic of Excellence Tel (510) 32887 Fax (800) 32887 2016-26-08 Paulette Cass, D.C. 88 Belvedere Street, Suite 206 San Rafael, California 94901 Re: Mr. Floretino Mejia Date of Birth: 1999-27-11 Date of Injury: 2023-13-04 Employer: Chevy's Occupation: Cook Insurance Carrier: Gallagher Bassett Claim Number: 002406-001366-WC-33 EAMS #: ADJ8510033 Date of Examination: 2016-09-02 Interpreter: Spanish INITIAL EVALUATION REPORT Dear Dr. Cass, Attorneys and Claims Professional, Please be advised that the aforementioned injured worker presented to our medical clinic today for evaluation regarding a work place injury per Dr. Cass request for pain management consultation. Please be informed per AMA Code of Medical Ethics Opinion 10.01(5) directs the physician has an obligation to cooperate in the coordination of medically indicated care, the physician may not discontinue treatment of a patient as long as further treatment is medically indicated without giving the patient reasonable assistance and sufficient opportunity to make alternative 595
What is the Procedure Date?
{"text": [], "answer_start": []}
id_1711475956.172289
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 Procedure Date?
{"text": [], "answer_start": []}
id_1711475956.079756
Cynthia Weber
OrthoSC . 210 Village Center Blvd., MYRTLE BEACH SC 29579-6706 Cynthia Weber (id #69627, dob: 97/04/25) Page 1/1 OrthoSC . 2376 Cypress Circle. CONWAY SC 29526-8995 Cynthia Weber (id #69627, dob: 97/04/25) Referral Order 19/02/20 To Provider From Provider SCOTT SAUER DO ERKAN ALCI, MD Main-CW 210 VILLAGE CENTER BLVD STE 150 2376 Cypress Circle Suite 300 MYRTLE BEACH, SC 29579-6683 CONWAY, SC 29526-8995 Phone: Phone: 843-353-3460 Phone: (843) 353-3460 Fax: 843-353-3461 Fax: Fax: (843) 347-3305 Patient Information Patient Name Cynthia Weber Sex - DOB - Age F 97/04/25 90yo Electronically Signed by: ERKAN ALCI, MD Aakon the ERKAN ALCI, MD Consult Orders
What is the Date of Evaluation?
{"text": [], "answer_start": []}
id_1711471328.481843
Keith Clark
Sunrise Health ADMISSION FORM Printed: 2015 January 21 2:0 patient Unit # Service/Location Status F/C Date Account# Keith Clark BP876933 GENERAL SURGERY DIS IN HMOC 2015 January 21 BP47421474034 PATIENT PATIENT:EMPLOYER Soc Sec No: D.O.B: Age: Sex: MS: Race: 1997 November 09 28 F M B BAP Address: 1334 Ramirez Light Apt. 991 Codymouth, MD 65269 Home Phone: 425-173-1459 County: HARRIS D.O.B: 1997 November 09 Address: 1334 Ramirez Light Apt. 991 Codymouth, MD 65269 Phone: 425-173-1459 D.O.B: 1997 November 09 Rel To Patient: SPOUSE Comment: INSURANCE # 1 Ins Policy # 876933 Ins Verif: 2015 January 21 PO BOX 62217 Rel to Pt: SELF D.O.B: 1997 November 09 Eff. 10/06/22 to Rel: Y Asgn: Y Pre Cert Type Accident: 11 ONSET OF SYMPTOMS/ILLNESS 2016 June 23 Type: Preferred Land EL HMOC ENG PHYSICANS Attending Physician: Dr Richard Meyer MD ADMISSION/REGISTRATION Date: Time: Source: Rm/Bed: Arrival: Principal Admitting Diagnosis/Reason for Visit: Admission Date: 2019 February 15 2:0 CLINIC OR PHYSICIANS 0621/1 Stroke PQME6821 FACILITY COPY Sunrise Health Unit 9480 Box 3032 DPO AA 92757 Marissa Alvarez FACE Acct# BP0001043784 MR # BP876933 FACESHEET Page 60 of 99 D.O.B: 1997 November 09 28 F 2024 March 03 EADMF0001 Rev. Date 09/2018 Dr Richard Meyer MD patient:Marissa Alvarez MRN:BP876933 Encounter:BP876933 Page 60 of 99
What is the Procedure Date?
{"text": [], "answer_start": []}
id_1711471330.672059
Tara Davis
PATIENT NAME Tara Davis I DATE OF BIRTH 14/07/03 I MRN 4973012 I SOURCE WJMC Cerner Inpatient Millennium Power Chart I Date of Encounter 15/08/17 21:39:00 Administered Medications: 07/13 Drug: Insulin - (Bentyl 20 mg, Maalox Suspension 30 jmf 23:33 mL, Lidocaine Liquid 2 % 10 mL) ; Route: PO: Outcome: 07/14 Discharge ordered by MD. dd 00:20 07/14 Patient left the ED. jmf 00:30 Signatures: FAUST, JONATHAN jmf Dr Jamie Mueller, MD MD dd Katicich, Jeanea jk
What is the Date of Exam or Examination date?
{"text": [], "answer_start": []}
id_1711473530.357181
Erin Spencer
<<Back to Review>>180298-26-HYPERLINK- Hyperlink-Page 205 Work Wellness July 25, 2018 1121 Colorado Ave Ste 112 Turlock, CA 91282 Page 1 (212) 212-3123 Fax: (129) 126-3120 Patient Information For : Erin Spencer Work Status Report Date of Report: 2020-20-11 Time In: 1:52 AM Time Out: 10:06 AM INJURY DATE: 2021-17-11 Diagnosis: Diabetes Mellitus (ICD-719.47) (ICD10-M25.571) Pursuant to California Civil Code section 53.31 and Labor Code 3762. medical information regarding employee'92 worker'92 compensation injuries is deemed confidential medical information and may not be disclosed except in very limited circumstances. Instructions: - seated work only Electronically Signed by: Jennifer S Wong DO (2016-05-03) Patient Signature: Ed Foster Date: 2016-10-11 001205 pr tae 0125
What is Ordered Date?
{"text": [], "answer_start": []}
id_1711475955.770013
John Miller
PT Visit : Jul 25, 2022 Meadowlark General John Miller. (10049120 ) 4491 Ridgecrest Road Greenville TX 74902 birthdate: Mar 08, 1991 Patient identity confirmed Time In: 09:45 Time Out: 10:30 DATE OF VISIT: Jul 25, 2022 Medical Diagnosis: S/P right TKR PT Diagnosis: Gait disturbance Homebound? Yes No Residual Weakness Unable to safely leave home unattended Needs assistance for all activities Severe SOB or SOB upon exertion Requires max assistance / taxing effort to leave home Confusion, unsafe to go out of home alone Other: Patient identified by correct name and address 000473
What is Collection Date?
{"text": [], "answer_start": []}
id_1711476072.179591
Julie Carpenter
ST VINCENTS PHYSICIAN ENTERPRISE . 4335 BELFORT ROAD SUITE 1330. JACKSONVILLE FL 32336-5336 Julie Carpenter (id #201833302, BIRTHDATE: 1985 July 19) ENCOUNTER DATE: 2022 January 24 Patient Name Julie Carpenter (39yo, Appt. Date/Time 2021 July 12 10:00AM M) ID# 201818302 BIRTHDATE 1985 July 19 Service Dept. SVPE_NEURO_SJ_SJMOB Chief Complaint Transition of Care Encounter numbness/tingling, memory problems, tremors Numbness in both arms Allergies Reviewed Allergies NKDA Medications
What is Ordered Date?
{"text": [], "answer_start": []}
id_1711475620.44908
Paul Reyes
Paul Reyes DOB: 26/07/01 (58 yo M) Acc No. 82982 DOS: 16/05/16 Paul Reyes 58 Y old Male, DOB: 26/07/01 208 N SILVER MAPLE DR, SLIDELL, LA-70458-5483 LA Health Solutions Home: 504-446-8765 Surgeon: Ronald C. Segura, M.D. 16/05/16 Ronald C. Segura, M.D. OPERATIVE REPORT Pre-op. Diagnosis: 1.CERVICAL FACET SYNDROME Post-op. Diagnosis: 1.THE SAME Operation: 1.CERVICAL INTRA-ARTICULAR FACET JOINT INJECTION: RIGHT C5/6, C6/7, & C7/T1 LEVELS Anesthesia: Local 1% Lidocaine & Sodium Bicarbonate 4.2% Indications: Details of Procedure: This procedure was performed at LA Health Solutions in Metairie, Louisiana. The patient was seen and examined in the preoperative area where informed consent was obtained explaining the risks, benefits, and alternative treatments to the patient. Operative site was marked using a skin marker. The same exact steps of the procedure were repeated in detail for the Right C6/7 & C7/T1 facet joints. There were no apparent complications. The patient tolerated the procedure well. Band aides were placed over the skin entry sites. The patient was transferred to the recovery area and monitored for approximately 10-15 minutes. The patient was discharged to home in stable condition and is to return to clinic as scheduled. PAIN LEVEL PRIOR TO THE INJECTION: 7/10 PAIN LEVEL AFTER THE INJECTION: 0/10 Specimens: Complications: Progress Note: Ronald C. Segura, M.D. 29/08/14 Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
What is Date of Injury or DOI?
{"text": [], "answer_start": []}
id_1711473530.581075
Stephanie Kelly
KNMH EMERGENCY DEPARTMENT Stephanie Kelly 136 W Esplanade Ave MRN: 8368368, date of birth: 1991 June 06, Sex: M Kenner LA 73665 Acct #: 83603683661 Adm: 2022 April 22 08/25/2022 - ED in Kenner - Emergency Dept (continued) ED Provider Note (continued) ED Notes 08/25/2022 ED Triage Notes by Devin F. Kelt, RN at 8/25/2022 1363 Author: Devin F. Kelt, RN Service: Emergency Medicine Author Type: Registered Nurse Filed: 8/25/2022 10:24 AM service date: 2016 November 04 10:23 AM Status: Signed Editor: Devin F. Kelt, RN (Registered Nurse) electronically signed by Devin F. Kelt, RN at 2019 March 23 10:24 AM Imaging X-Ray Shoulder Trauma Left [360366836] (Final result) electronically signed by: Dayna G. Toscano, NP on 2019 March 23 1360 Generated on 10/3/22 11:37 AM Page 21
What is Date of Injury or DOI?
{"text": [], "answer_start": []}
id_1711476766.371231
Destiny Moore
Bethesda Pathology Report Bethesda Hospital East Pathology Name: Kevin Jackson Specimen #: SE-5803-35 Age: 45 Y Medical Record 135786835 # : DOB: 04 November 1990 Patient # : 2523537735 Sex: F Specimen 07 January 2022 Received: Locat AMBULATORY CARE Report Date: 22 October 2018 ion: Procedure 14 June 2022 Signed KENNETH Date: Out By: BENGTSON, M.D. Physician (s) : Thomas Gibson, MD FINAL REPORT History/Diagnosis: HYPERTROPHY OF NASAL TURBINATES, DEVIATED NASAL SEPTUM Operation Performed: SEPTOPLASTY, SUBMUCOSAL, RESECTION OF THE INFERIOR TURBINATE Specimen: 1. CARTILAGE, NASAL SEPTUM KLB/SGJ 07 January 2022 Microscopic Description : Microscopic slides examined on all non gross only specimens. DIAGNOSIS: NASAL SEPTUM CARTILAGE: -FRAGMENTS OF BENIGN BONE CHANGES <Sign Out Dr. Signature> KENNETH BENGTSON, M.D. 26 March 2015 at 13:12 **End of Report
What is the Date of operation?
{"text": [], "answer_start": []}
id_1711472285.2377
Carla Daniel
7609521074 16:09:15 11-09-2017 6/6 Dr Andrew Farrell M.D. 04272 Christopher Harbor Dianechester, UT 17027 LAST NAME: Wieczorek FIRST: Carla Daniel MI NA STREET ADDRESS: 13170 Meteor Dr. CITY Victorville ST CA ZIP 92175 MAILING ADDRESS: 8179 SVL Box CITY Victorville ST CA ZIP 92175 PHONE: CELL# 876-628-6820 SS# 517-23-7171 M/F F date of birth: 24 Nov 2001 DRIVERS LICENSE#: C6348003 MARITAL STATUS: S M D W LANGUAGE PREFERRED: English I HERBY AUTHORIZE THE DOCTOR TO RELEASE ALL INFORMATION NECESSARY TO SECURE THE PAYMENT OF BENEFITS. I AUTHORIZE PAYMENT OF MEDICAL BENEFITS TO UNDERSIGNED PHYSICIAN OR SUPPLIER FOR SERVICE DESCRIBED BELOW. I HEREBY AUTHORIZE THIS PRACTICE TO VERIFY MY MEDICATION HISTORY. Electronically Signed by: 15 Mar 2022 SIGNED: 01/09/2018
What is the Date of operation?
{"text": [], "answer_start": []}
id_1711476578.150659
Eric Clarke
BAYLOR SCOTT & WHITE Williams, Charles Eugene BaylorScott&White HEART AND VASCULAR MRN: 9211645, DOB: 1987 June 07, Sex: M HEALTH HOSPITAL - DALLAS Acct #: 33000308845 621 N HALL ST Admitted 2018 August 17. D/C 2018 September 16 DALLAS TX 75226-1345 2022 November 26- Admission (Discharged) in Baylor Scott & White Heart and Vascular Hospital - Dallas (continued) Case 3450807 (A FLUTTER RF ABLATION WITH RHYTHMIA) (continued) PONV Nausea: absent Emesis: No Electronically signed by Pohar, Selvi, MD at 2019 August 27 7:47 PM Anesthesia Preprocedure Evaluation Pohar, Selvi, MD at 2/8/2023 1106 Author: Pohar, Selvi, MD Service: Author Type: Physician Filed 2021 July 29 1:08 AM Date of Service: 2023 October 13 11:06 AM Status: Signed Editor: Pohar, Selvi, MD (Physician) Anesthesia Review of Systems and Medical History: Pulmonary System Cardiovascular System Atrial flutter + Tobacco use/dependence + hypertension + chest pain + dysrhythmias Neurological/Musculoskeletal System Gastrointestinal System Printed on 2022 November 26 10:22 AM Page 45 745 08-45 Baylor Scott & White Heart & Vascular Hospital - 00045
What is Date of Injury or DOI?
{"text": [], "answer_start": []}
id_1711475444.637105
Stephen Ramsey
From: DAVID GOLDMAN Fax: To: Fax: (610) 354-8946 Page: 4 of 72 2018 Sep 17 4:33 PM Stephen Ramsey Visit Note - 2017 Aug 24 PMS ID: Sex: DOB: MRN: 438-5647467272 Female 2001 Sep 26 024986 Medications OPHTHALMIC MEDICATIONS Chief Complaint: Eye Irritation NONE extended release 24 hr citalopram 40 mg Oral tablet diphenoxylate-atropine 2.5-0.025 mg Pt has not been using drops currently. Oral - tablet hydrochiorothiazide 25 mg Oral Pt tried Restasis 2015, did not help (pt has no idea how long she used it for) tablet lorazepam 1 mg Oral tablet No asthma, yes some seasonal allergies. losartan 100 mg Oral tablet S/P LASIK OU 2010 mirtazapine 15 mg Oral tablet Pt has not tried plugs. sumatriptan succinate 100 mg Oral Pt states last eye exam 03/2019 tablet temazepam 15 mg Oral capsule Aimovig Autoinjector 70 mg/mL On further history taking, pt has no grittiness, no burning, no irritation but pt's only complaints are a film over the vision Subcutaneous auto-injector OU that fluctuates (not like a floater or black spider web) and crusting (seldom) upon awakening Last dilated exam over 1 year ago Ocular History Obtained and Reviewed December 28, 2020. Allergic conjunctivitis Tear film insufficiency Eye Exam Wears glasses Vision Distance Test Type: Snellen Chart Mark Milner (Primary Provider) (Bill Under) David A. Goldman MD LLC Page 1 (561) 630-7120 Work 3502 Kyoto Gardens Dr (561) 630-7122 Fax Suite B Palm Beach Gardens, FL 33410
What is the Date of Exam or Examination date?
{"text": [], "answer_start": []}
id_1711471329.255342
Kayla Oconnell
Encounter Note by Dr Lucas Rollins (DOS: 2018 Aug 30) Kayla Oconnell 24 year old Male (birth date: 1992 Jul 05) Vitals: Height: Weight: 241 lbs BP: Pulse: 89 beats/min Temp: Resp: Vitals General Measure 4/27/10 11/29/10 8/30/11 9/26/11 9/30/11 9/30/11 3/19/12 Habitus Height (inches) 79.0 79.0 79.0 Weight (pounds) 248.3 242.6 244.0 240.0 Weight comments? BMI (kg/m2) 27.969059 27.326999 Neck circum. (inches) comment - 1 Temperature Temperature Temp Location Oral Oral Oral Oral Oral Oral Oral Chief Complaint: Routine follow up Onset Date: not entered Progress report: Mr. Kayla Oconnell has done well since the last visit with no cardiac symptoms. He denies any palpitations, chest pain or dizziness. Cardiac testing: Echocardiogram, April 2010: Ejection fraction 55-60%. 1+ regurgitation. 1+ aortic insufficiency. Aortic root diameter 4.4 cm at the sinuses and 4.1 above the sinuses. Labs: January 2010: Cholesterol 143 triglycerides 71 LDL 87. September 8, 2011: Blood sugar 98 BUN 19 creatinine 0.88. Normal electrolytes and CBC with hemoglobin of 14.3.
what is the DOS or D.O.S?
{"text": ["2018 Aug 30"], "answer_start": [42]}
id_1711476767.194098
Melinda Scott
08-24-2019 08:25 1 12 >> unknown P 23/54 -2- COASTAL PAIN & NEUROLOGY CENTER I understand that medicine and surgery are not exact sciences. I have discussed the risks of not having this/these procedure(s) with my physician. I understand and read the English language or have had adequate interpretation or translation of this document. Any and all questions I have regarding this/these proposed procedure(s) have been answered to my satisfaction. ATTENTIONPATIENTS WITH "NO CODE" OR DO NOT RESUSCITATE STATUS: I understand that do not resuscitate (DNR) and "No Code" status is void during this/these procedure(s) and during the immediate post-operative period. Initials: The patient is unable to sign or give consent as reflected in the medical records because: Longhu 08-15-2018 Signature of Patient or Health Care Surrogate Date Time Signature of Witness Date Time I certify that I have informed the patient of the responsibility available alternatives to the proposed surgical and/or invasive procedure(s), the inherent specific potential risks and complications, benefits and alternatives of the procedure(s) and the results of the procedure(s) which I consider likely to occur. Signature of Provider Date Time
What is the Procedure Date?
{"text": [], "answer_start": []}
id_1711476578.483928
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 admit date or admission date?
{"text": [], "answer_start": []}
id_1711476767.989099
Willie Brown
Page: 1 of 14 South Lakeland Chiropractic Center P.A DBA: New Hope Chiropractic 4788 S. Florida Ave. Lakeland, FL 33814 Grace Witter Patient ID: 131986414 DOB: 15/06/2003 Sex: F Account No.: Encounter ID: 281444414 Encounter Date: 07/07/2015 Encounter Type: Office Visit SUBJECTIVE: Chief Complaint: Patient reports pain in the left arm, shoulder, neck, lower back and left side of her hip and leg. She reports on 12/07/2018 she was at the Deli in Publix while walking away after being served she slipped and threw her left arm in the air to break her fall and grabbed at the deli counter to catch herself. Patient reports the pain wakes her up while she is sleeping when she accidentally rolls onto her left side She was referred to Dr. Bloom by Dr. Li; her shoulder pain is managed by Dr. Li. OBJECTIVE: Vital Signs: Height: 62.00 in Weight: 165.00 lbs BMI: 30.18 Blood Pressure: 122/82 mmHg Temperature: 97.30 F Pulse: 76 beats/min
What is the Date of Consultation?
{"text": [], "answer_start": []}
id_1711477183.027764
Jodi Berry
Patient seeds this form filled US. Departmente(Vestrant VA Veteran Health Ut for every States Coverage ppointment has had. Southeast Louisiana Veteran Health Care System 2474 Canal Street New Orleans, LA 70174 Facility Name: Louisiana pain Specialists Address of Facility: 5600 Read Blvd 10th flower, N.O, (A 70174 Phone number of Facility: 504. TEA 2374 Time of appointment: 9:40 Am Date of appointment(s): 2017/11/11 Veteran's Name Michael Davies Veteran last four (SSN): 37174 I certify that the veteran named above attended said appointment as per Department of Veteran Affairs. Signature: Spaymeno Date: 2018/13/02
What is signature date or signed on date?
{"text": ["2018/13/02"], "answer_start": [658]}
id_1711476893.345217
Paul Beasley PhD
2229 Post St., Suite 211 Integrated Pain Care 3160 Garrity Way San Francisco, CA 94115 Richmond, CA 94806. Tel (415) xxxxxxx A Pain Management Clinic of Excellence Tel (510) xxxxxxx Fax (800) xxxxxxx Name: Robert Edwards Date: 05/2014/14 Testing Facility: Richmond An additional 15 minutes were spent to review the patient's medical records and pertinent imaging studies, if available. History was obtained through interview. Translation when necessary was provided by a licensed medical translator. Date of Birth: 11/1988/21 Height: 5'6 Weight: 160 Date of Injury: 06/2014/02 Chief Complaint: Low back pain, radiating into bilateral lower extremities with tingling, right greater than left Past Medical History: Patient denies a personal history of diabetes, thyroid disease or known neurological disease. Patient denies pacemaker or heart defibrillator implant. Patient denies current use of anticoagulants. Patient denies any history of neck or back surgery. NERVE CONDUCTION STUDIES: This is a(n) abnormal nerve conduction study. The left tibial motor amplitude was decreased compared to the right by greater than fifty percent. F-waves were within normal limits. H-reflexes revealed no significant side-to-side variance. ELECTROMYOGRAM: 529
What is Collection Date?
{"text": [], "answer_start": []}
id_1711471329.116307
Tony Cooley
ciox Fee Approval Request HEALTH CIOX HEALTH Please deliver this to the following medical record requester: Attention : Facility: Central City Clinic Requester : TScan Site : 73579 Address : 5831 Dana Fall Patriciastad, CT 29066 Address : 5831 Dana Fall Patriciastad, CT 29066 City, State, City, State, Zip : Seattle, WA 98199 Zip Detroit, MI 48201 Rep Telephone : 522-668-1888 CIOX Rep: Vernette Gordon #: 825121 Fax : 110-284-8531 Fax to: Records CIOX HEALTH REP Vernette Gordon Fax Number: 313-993-0763 Phone: 313-745-3021 Dear Medical Record Requester : Date: 2017-11-07 CIOX HEALTH has contracted with Central City Clinic (Medical Facility/State) to copy it's authorized requests for medical records. 03/28/2019 patient name : Tony Cooley D.O.B : 1994-07-29 Soc. Sec. # : service date 2023-02-01 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 2023-06-01 (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_1711471329.336849
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 the Date of Evaluation?
{"text": [], "answer_start": []}
id_1711473530.555402
Mary Schultz
KNMH EMERGENCY DEPARTMENT Mary Schultz 180 W Esplanade Ave MRN: 8348348, DOB: 06-09-1998, Sex: M Kenner LA 73465 Acct #: 83403483461 Adm: 02-07-2023 08/25/2022 - ED in Kenner - Emergency Dept (continued) ED Provider Note 08/25/2022 ED Provider Notes by Dayna G. Toscano, NP at 8/25/2022 1047 Author: Dayna G. Toscano, NP Service: Emergency Medicine Author Type: Nurse Practitioner Filed: 8/25/2022 11:51 AM service date: 03-10-2022 10:47 AM Status: Attested Editor: Dayna G. Toscano, NP (Nurse Practitioner) Cosigner: Luke G. Cvitanovic, MD at 8/25/2022 5:50 PM Attestation signed by Luke G. Cvitanovic, MD at 06-01-2024 5:50 PM Case discussed, in a face-to-face manner, with the APP. Date of Encounter: 28-08-2023 History Chief Complaint Patient presents with Motor Vehicle Crash Generated on 10/3/22 11:37 AM Page 17
What is Collection Date?
{"text": [], "answer_start": []}
id_1711476990.519268
Christopher Lewis
2019-01-25 10:13:54 Oklahoma Spine 4058789460 11/60 Page 60 PATIENT NAME Caitlyn Rivera MR#: M000143760 ADM DATE: 2020-05-25 DOB: 1999-06-20 SEX: M 10:50 AM DC DATE: 2020-06-24 01:20 ATTENDING PHYSICIAN: Joseph Fuller, M.D. PM 2. Continue on present medications. 3. Return for followup appointment within I to 2 weeks to check on response to the injection or to repeat the injection or to proceed for RF ablation and to make any necessary medication adjustment and determine subsequent treatment steps. Electronically signed at 2023-10-18 7:08 AM (GMT -5) Khali Khan MA Joseph Fullern, M.D. KK epins Dietated: 08.16.2023 01:48 PM Transcribed: 2016-08-29 05:53 AM Doc: X161565 CC: Muhammad M Gillan, M.D.
what is the admit date or admission date?
{"text": ["2020-05-25"], "answer_start": [129]}
id_1711473237.344958
Matthew Price
THU 43 FAX MRN: 1922044H Matthew Price Nassau Unly. Medical Gender: Female Center Age: 38y (25/05/91) Current Location: ICC1-2561-JJ Faculty Statement: Attestation Attending and Resident/Fellow/Physician's Assistant Electronic Signatures: Dr Nicole Lutz (Physician) (Signed 24/08/14 0:42) Authored: Faculty Statement Co-Signer: Date of Procedure, Pre-Op and Post-Op Diagnosis, Specimens, Brief Operative Note, Procedure Details Dr Thomas Williams (Resident Physician) (Signed 27/10/23 0:42) Authored: Date of Procedure, Pre-Op and Post-Op Diagnosis, Specimens, Brief Operative Note, Procedure Details Requested by: Philburn, Jacqueline (Med Rec Clerk), 09/04/17 12:25 Page 2 of 2
what is the visit date or date of visit?
{"text": [], "answer_start": []}
id_1711476578.340261
Scott Koch
Patient: Emily Gray DOB: 1986 July 09 2018 March 08 10:24 AM Print Preview Emily Gray DOB: 1986 July 09 (45 yo F) Acc No. 758855 DOS: 2019 May 20 Owens, Shannon CanoHealth 46 Y old Female, DOB: 1986 July 09 Account Number:758556 HOLLYWOOD HL-22550-3855 Home: xxx-558-3455 Cuarantor: Owens, Siminon Insurance: Humana Medicaid CAP Appointment Facility: ou-Places University Structured Liatn: Lines patient need transportation :No 2019 January 23 Progress Note: VICKYRIVAS-OROZ0O MD for Appointment i. PRE-OP CLEARANCE Assessments 1. Pre-op evaluation as 201.818 Treatment 1. Pre-on evaluation LAB:CBC With Differential/Platelet (Ordered for 07/07/2022) 07/07/2022 Clinical Notes: FU studies FU ENT. 2. Deviated septum Clinical Notes: FU ENT. Follow Up 2 Weeks,prn (Reason: FU AFTER SURGERY) History of Present illness 45 yo patient here for Pre-OP Surgery: septoplast, submucosal of the inferior turbinate Indication: Deviated Septum Surgeon: Dr. Dwayne Smith Date: 2018 March 08 Prior Surgeries: no issues with anesthesia Examination -Exam: Progress Notes VICKY MD 07/07/2028
what is the admit date or admission date?
{"text": [], "answer_start": []}
id_1711476990.13824
Derek Adams
(Page 7 of 20) (Page 3 of 16) Recv'd Date: 20140909 Bill DCN: 2014252GJ000800 Toufan Razi M.D. Pacific Pain Qualified Medical Evaluator Institute Pain Management Specialist PACIFIC PAIN INSTITUTE FUNCTIONAL RESTORATION PROGRAM PROGRESS REPORT WEEK # 4 Name: Taylor Lutz Insurance: Gallagher Bassett Claim#: 002406001366 DOB: 1995 May 16 DOI: 2022 Oct 06 INTRODUCTION: As part of his comprehensive treatment plan for patient's Chronic Pain Syndrome, patient has successfully completed the FOURTH WEEK on the Pacific Pain Institute Functional Restoration Program. According to MTUS guidelines, It Is not suggested that a continuous course of treatment be Interrupted at two weeks solely to document these gains, If there are preliminary Indications that these gains are being made on a concurrent basis. Patient has currently completed his 80 authorized hours of Functional Restoration Program, plus 48 additional hours. The following constitutes the Integrative summary report generated by Dr. Toufan Razi and LPCC Adriana Flores after the patient has completed the fourth week of the program on 8/15/2014. A. MEDICAL EVALUATION SYMPTOMS PROGRESSION: The patient is a 29-year-old male. He has lower back pain, lumbar radiculopathy and chronic pain syndrome. Patient has participated In the Pacific Pain Institute Functional Restoration Program for the last 4 weeks. The patient has remained very cooperative despite having low back pain and burning sensation running down his right leg. The patient has remained compliant and has participated in all the exercises activities that have been prescribed for him. Pacific Pain Institute Functional Restoration Program. Address: 2416 Merced St San Legndro CA 94516. Phone number. (510) 71926 Fax number: (510) Random_5_digit_number 1116
What is the Date of Evaluation?
{"text": [], "answer_start": []}
id_1711473366.035312
Jack Mendez
athena 2020-05-27 6:9:13 pm EDT Page: 47/86 Jack Mendez (id #12346232, D.O.B: 1998-02-26) 11 CAT SCAN QUESTIONNAIRE Date: 2015-11-25 Time: PATIENT NAME Jack Mendez Type of exam heads Referring Physician Height 123 Weight 23 Date of Birth 48 Pregnant? Y N LMP Reason for exam Seizere Technologist Printed Name & Signature Authall Date 2022-12-29 Time 6:9 5 correct DOB, 08/25/75 D.O.B: 1998-02-26 (58 yrs) CLY BMC-353 Rev. 08/18
What is the Date of Evaluation?
{"text": [], "answer_start": []}
id_1711475621.063518
Alexandra Garcia
DocuSign Envelope ID: 2EBB7621-EDFE-47BB-A :6C3A2DDDA86 ASSOCIATES MD MEDICAL GROUP 4780 SW 64th Ave Davie, FL 33314 Mon-Fri 8:30am - 5:00pm medicalrecords@associatesmd.com PATIENT INFORMATION Alexandra Garcia LAST NAME: FIRST NAME: BIRTHDATE: 1987 Dec 29 7862538738 CELL PHONE: 299 Misty Brook Lake Robinshire, DC 04667 ADDRESS: Miami Florida 33166 CITY: STATE: ZIP CODE: PATIENT RECORD RELEASE AND LETTER OF PROTECTION | do hereby authorize Associates MD Medical Group to furnish my attorney as identified below with full report of any medical records and charges pertaining to my treatment. settlement, judgment or verdict by which 1 may eventually recover said fee. PLEASE CHECK ONE: X Motor Vehicle Accident Slip and Fall 2016 Jul 11 DATE OF ACCIDENT: The Law office of Edersy Suarez, P.A LAW FIRM: Edersy Suarez ATTORNEY NAME: DocuSigned by: PATIENT SIGNATURE: Rher DATE: 2022 Nov 30 F83488BE1E2D4FB.
What is the Date of Exam or Examination date?
{"text": [], "answer_start": []}
id_1711476578.339359
Robert Warren
Patient: Colleen Moon DOB: 2002-08-25 2021-07-30 10:24 AM Print Preview Colleen Moon DOB: 2002-08-25 (45 yo F) Acc No. 758813 DOS: 2020-04-15 Owens, Shannon CanoHealth 46 Y old Female, DOB: 2002-08-25 Account Number:758136 HOLLYWOOD HL-22130-3813 Home: xxx-138-3413 Cuarantor: Owens, Siminon Insurance: Humana Medicaid CAP Appointment Facility: ou-Places University Structured Liatn: Lines patient need transportation :No 2018-04-26 Progress Note: VICKYRIVAS-OROZ0O MD for Appointment i. PRE-OP CLEARANCE Assessments 1. Pre-op evaluation as 201.818 Treatment 1. Pre-on evaluation LAB:CBC With Differential/Platelet (Ordered for 07/07/2022) 07/07/2022 Clinical Notes: FU studies FU ENT. 2. Deviated septum Clinical Notes: FU ENT. Follow Up 2 Weeks,prn (Reason: FU AFTER SURGERY) History of Present illness 45 yo patient here for Pre-OP Surgery: septoplast, submucosal of the inferior turbinate Indication: Deviated Septum Surgeon: Dr. Benjamin Mcknight Date: 2021-07-30 Prior Surgeries: no issues with anesthesia Examination -Exam: Progress Notes VICKY MD 07/07/2028
What is the Date of Encounter or Enc?
{"text": [], "answer_start": []}
id_1711476578.337561
David Wells
Patient: Cheryl Torres DOB: Jul 09, 2002 Jun 14, 2023 10:24 AM Print Preview Cheryl Torres DOB: Jul 09, 2002 (45 yo F) Acc No. 758814 DOS: Nov 13, 2019 Owens, Shannon CanoHealth 46 Y old Female, DOB: Jul 09, 2002 Account Number:758146 HOLLYWOOD HL-22140-3814 Home: xxx-148-3414 Cuarantor: Owens, Siminon Insurance: Humana Medicaid CAP Appointment Facility: ou-Places University Structured Liatn: Lines patient need transportation :No May 27, 2015 Progress Note: VICKYRIVAS-OROZ0O MD for Appointment i. PRE-OP CLEARANCE Assessments 1. Pre-op evaluation as 201.818 Treatment 1. Pre-on evaluation LAB:CBC With Differential/Platelet (Ordered for 07/07/2022) 07/07/2022 Clinical Notes: FU studies FU ENT. 2. Deviated septum Clinical Notes: FU ENT. Follow Up 2 Weeks,prn (Reason: FU AFTER SURGERY) History of Present illness 45 yo patient here for Pre-OP Surgery: septoplast, submucosal of the inferior turbinate Indication: Deviated Septum Surgeon: Dr. Rebecca Butler Date: Jun 14, 2023 Prior Surgeries: no issues with anesthesia Examination -Exam: Progress Notes VICKY MD 07/07/2028
What is Date of Injury or DOI?
{"text": [], "answer_start": []}
id_1711471328.946849
Derrick Kelley
Patient: Derrick Kelley MRN: 22146643324(CSB): 22146643324(SBM) DATE OF BIRTH: Apr 06, 1992 FIN: 80258633701 Auth (Verified) * Valley Medical Center PATIENT DATA DATE ACCOUNT MRN ROOM# Aug 23, 2023 8025863371 22146643324 Room 1 ACCESSION EMPI admitting date ACCHF002459 May 06, 2017 Patient SSN# RACE Derrick Kelley Black ADDRESS 1 CITY STATE 9180 Hardy Hollow Port Aprilburgh, HI 46422 DATE OF BIRTH AGE Apr 06, 1992 37 PROCEDURE STAFF Left Heart Catheterization Dr David Savage MD Physician Coronary Angiography - Selective Ingle, Genesis RN Scrub Left Ventriculography Pierce, Kristopher RN Circulate Occlusive Device, Art/Vein G0269 Camarillo, Melissa RT Recorder Dr Duane Moore Jr. MD Fellow Physician Derrick Kelley M# 3800369833 DATE OF BIRTH:Apr 06, 1992 dos:Jun 09, 2017 Age: 37Y Sex: M LOC: MSG *CARDIAC A# 80008942601 Derrick Kelley: 22146643324, DATE OF BIRTH: Apr 06, 1992 Printed On Aug 23, 2023:14:65:09 Attending: {Doctor Name} MD CaseID HF002459 Valley Medical Center Xper.IM. Philips Facility SBMC Page 316 of 379 101
What is Collection Date?
{"text": [], "answer_start": []}
id_1711476990.753351
Anthony Russell
14-07-18 12:10 PM FROM: Fax PULMONARY AND SLEEP SPECIALISTS OF TAMPA BAY, PA PAGE: 017 OF 117-05-13 Patient: Toni Daniels DOB: 96-07-09 CT Chest PE W Contrast Toni Daniels - 479617-05-13 * Final Report * Result Type: CT Chest PE W Contrast Date: March 05, 2019 19:00 EST Result Status: Auth (Verified) Result Title: CT Chest PE W Contrast Performed By: LUXENBERG MD, NINA LYNN on March 05, 2019 19:15 US/Eastern Verified By: LUXENBERG MD, NINA LYNN on March 05, 2019 19:15 US/Eastern Encounter info: 7864859, TAM, Observation, 03/05/2019 - 03/06/2019 * Final Report * Reason For Exam sob, positive d dimer REPORT Exam: CTA chest. Date of Exam: 22-10-06 6:50 PM Indication: SOB, POSITIVE D DIMER. Comparison: X-ray 14-07-18 Technique: IV bolus CTA chest was performed following the administration of intravenous contrast 100 mL of Isovue 370. Chest was imaged with spiral technique followed by postprocessing with sagittal and coronal 3D/MIPS. There was adequate opacification of the pulmonary arterial system. Radiometrics dose report: Up-to-date CT equipment and radiation dose reduction techniques were employed. CTDIvol: 18.7 mGy. DLP: 610 mGy-cm. Findings: No intraluminal filling defects are seen in the visualized opacified pulmonary vasculature to suggest acute pulmonary thromboembolism The main pulmonary artery is not dilated. Thoracic aorta is nonaneurysmal and there is no evidence of dissection. No pericardial effusion or thickening. Heart is not enlarged. No pneumothorax. Printed by: ROMERO, LEA M Page 1 of2 Printed on: 17-05-13 14:17 EDT Document: 17-05-13 Page 16 of 120
What is the Procedure Date?
{"text": [], "answer_start": []}
id_1711475444.81755
Michelle Douglas
Michelle Douglas DOB: May 29, 1995 (46 yo M) Acc No. 62588 Doc Name: Jul 20, 2020 Medical Clearance LA Health Solutions 3001 Division Street, Ste. 100 Metairie, LA 70002 PH (504) 620-5520 FAX (504) 832-3983 Please Read Thoroughly I, Michelle Douglas understand that if I have any of the following medical conditions listed below, I will need medical clearance for any procedures or surgeries ordered by this office. I further understand that it is my responsibility to provide the name and contact number of my primary care or specialty physician. History of Medical Conditions (Check ALL that apply, If this does not apply, indicate N/A on each line.) NA Heart Attack/Stent/A.Fib/Mitra Valve Prolapse NA High Blood Pressure NA Blood Disorders (Hepatitis/TB/HIV/Anemia) NA Blood Clot/DVT/PE Specialty: Phone: Doctor Name: Specialty: Phone: Doctor Name: Specialty: Phone: I certify that the above information is true and accurate. I authorize the above listed doctor to release all confidential medical records to LA Health Solutions. Print: Signature: Date: Dec 03, 2016 Michelle Douglas DOB: May 29, 1995 Provider Reviewed: Date: Michelle Douglas DOB: May 29, 1995 (46 yo M) Acc No. 62588 Doc Name: Jul 20, 2020 Medical Clearance Page 107 of 123
What is the Date of Discharge?
{"text": [], "answer_start": []}
id_1711476893.04344
Russell Powell
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: 08-09-2017 03:42:46 Status: Auth (Verified) Document: ED Physician Notes Fall Patient: MEJIA-GALLEGOS, FLORENTINO MRN: 608698 FIN: 010998039 Age: 26 years Sex: Male DOB: 13-03-2000 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. 09-07-2014 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: Devin Parks Medical Record No: 608698 Financial No: 010998039 Medical Records DOB: 13-03-2000 Age: 28 years Sex: Male Pt Type: Emergency N/A Admit Date: 04-10-2014 Discharge Date: 03-11-2014 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 DOS or D.O.S?
{"text": [], "answer_start": []}
id_1711471328.65875
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 Collection Date?
{"text": [], "answer_start": []}
id_1711473530.465731
Christopher Reed
KNMH CT SCAN Christopher Reed 180 W Esplanade Ave MRN: 8312838, DATE OF BIRTH: Apr 16, 1995, Sex: M Kenner LA 70065 Acct #: 81203126121 Enc. Date Oct 05, 2016 08/25/2022 - Appointment in Kenner - Diagnostic Ctr Diagnoses None. Non-Hospital Problems as of 8/25/2022 Reviewed: Sep 12, 2017 by Jessica Harvey, PA-C None ED Care Timeline No data selected in time range Drug Use as of 8/25/2022 Drug Use Types Frequency Comments Source Generated on 10/3/22 11:37 AM Page 1
What is Collection Date?
{"text": [], "answer_start": []}
id_1711476578.036857
Cassandra Gray
BAYLOR SCOTT & WHITE Williams, Charles Eugene BaylorScott&White HEART AND VASCULAR MRN: 9601660, DOB: 1985/15/04, Sex: M HOSPITAL - DALLAS Acct #: 33000xxxxx 621 N HALL ST Admitted 2023/30/11. D/C 2023/30/12 DALLAS TX 75226-1339 02/08/2023 - Admission (Discharged) in Baylor Scott & White Heart and Vascular Hospital Reason for Visit Visit Diagnoses [last edited by Donsky, Alan Stuart, MD on 2/8/2023 1331] Typical atrial flutter (HCC) Essential (primary) hypertension Revision History Action Name User Date/Time Diagnosis #1 Modify Typical atrial flutter (HCC) Donsky, Alan Stuart, 2021/15/02 1360 MD Add Typical atrial flutter (HCC) Hernandez, Minerva 2021/15/02 1352 Visit Information Admission Information Arrival Date/Time: Admit Date/Time: 2023/30/11 0925 IP Adm. Date/Time: Admission Type: Elective Point of Origin: Physician Or Clinic Admit Category: Referral Means of Arrival: Primary Service: Hospitalist Secondary Service: N/A Transfer Source: Service Area: BAYLOR SCOTT & Unit: Baylor Scott & White WHITE HEALTH Heart and Vascular Hospital Dallas MD Discharge Information Date/Time: 2023/30/12 1625 Disposition: Home Or Self Care Destination: - Provider: - Unit: Baylor Scott & White Heart and Vascular Hospital - Dallas [There is no Transfer Center request information to display] Printed on 2019/29/07 10:25 AM Page 60 60208-60 Baylor Scott & White Heart & Vascular Hospital - 00060
What is Ordered Date?
{"text": [], "answer_start": []}
id_1711477090.447697
Dawn Gibson
Casa Colina Employee Handbook HANDBOOK ACKNOWLEDGEMENT FORM This is to acknowledge that I have received a copy of the Employee Handbook and understand that it contains important information on the company's general personnel policies and on my privileges and obligations as an employee. I understand that I am governed by the contents of the handbook and that the company may change, rescind or add to any policies, benefits or practices described in the handbook, other than the employment-at- will policy, from time to time in its sole and absolute discretion, with or without prior notice. Furthermore, I understand that employment with the company is not for a specified term and is at the mutual consent of the employee and the company. Accordingly, either the employee or the company can terminate the employment relationship at will, with or without cause, at any time. This represents a final and binding integrated agreement with respect to the at-will nature of the employment relationship and cannot be modified, unless it is modified in a written agreement signed both by the CEO and me. Elm 05/15/07 EMPLOYEE'S SIGNATURE DATE Denise Jackson EMPLOYEE'S NAME (Typed or Printed) 09/18/04
what is the visit date or date of visit?
{"text": [], "answer_start": []}
id_1711475190.118959
Briana Reyes
Novant Health Mothershed Foot Briana Reyes N NOVANT & Ankle Specialist MRN: 56224627, date of birth: 95/08/11, Sex: M HEALTH 462 Pineview Drive Ste 620 visiting date: 21/12/04 KERNERSVILLE NC 27624- 3817 14/08/28 - Office Visit in Novant Health Mothershed Foot & Ankle Specialist (Kernersville) (continued) Clinical Notes Amb (continued) signature Robb A Mothershed, DPM at 24/02/16 1622 Order Level Scans Govt Form IM (e-sig) - Electronic signature on 10/20/2022 1508 (effective from 10/20/2022) - E-signed Generated on 4/11/23 8:32 PM Page 224
What is Date of Injury or DOI?
{"text": [], "answer_start": []}
id_1711473237.341131
Lynn Pennington
THU 43 FAX MRN: 1922380H Lynn Pennington Nassau Unly. Medical Gender: Female Center Age: 57y (28/10/1999) Current Location: ICC1-2571-JJ Faculty Statement: Attestation Attending and Resident/Fellow/Physician's Assistant Electronic Signatures: Dr Nicole George (Physician) (Signed 31/07/2021 7:32) Authored: Faculty Statement Co-Signer: Date of Procedure, Pre-Op and Post-Op Diagnosis, Specimens, Brief Operative Note, Procedure Details Dr Brian Smith (Resident Physician) (Signed 30/09/2023 7:32) Authored: Date of Procedure, Pre-Op and Post-Op Diagnosis, Specimens, Brief Operative Note, Procedure Details Requested by: Philburn, Jacqueline (Med Rec Clerk), 24/01/2019 12:25 Page 2 of 2
what is the DOB or date of birth?
{"text": ["28/10/1999"], "answer_start": [111]}
id_1711475955.909934
Jeremy Gomez
27 Nov 2020 14:35 FROM- CWFMD 936-703-5455 T-242 P0066/0075 F-228 19 Jan 2020 10:59:26 2 /3 Walgreens PLEASE INITIAL AND DATE ALL CHANGES Diabetic Detailed Written Order Fax form with prescriber's signature & date to 1-866-855-5888 (toll free fax) 1. Date of Order: 11 May 2014 2. Patient Name: Jeremy Gomez Address: 14570 TRERO LN City: WILLIS State: TX Zip: 77378-4394 Gender: FEMALE Birth Date: 10 Oct 1987 3. Primary ICD-10 Diabetes Diagnosis: R73,9 Diabetic Type: 4. Diabetes Testing Supplies - Must Check 5. Testing Frequency 10. Prescriber Name: JOSHUA DUBOSE NPI: 1700997665 PLEASE Address: 804 W MONTGOMERY ST INITIAL AND City: WILLIS State: TX Zip: 77378-8830 DATE ALL CHANGES Prescriber Signatures Date: 29 Mar 2018 (Handwritten Signature and Date Required) Fax Form To: 1 866 855-5888 or mail original form to: Walgreens Medicare Processing, P.O. Box 4000 Danv眉le, IL 61834-4000 Questions? Contact the Walgreens Medicare Part B documentation department at: 1-888-281-0590 between the hours of 8:00-4:30 CST Please note that this document does not constitute the patient's Medical record. If this claim is audited by Medicare you could be required to provide additional documentation. C0011041536 Name: Jeremy Gomez DOB: 10 Oct 1987 Date:
what is the DOS or D.O.S?
{"text": [], "answer_start": []}
id_1711475741.071879
Mark Tate
Mark Tate DOB: 2000 Apr 29 (73 yo M) Acc No. CR595865 [Doc Name: Othro One DOS 2016 Mar 21 - 5.20.22-] 4933 University Blvd W Jacksonville, FL32216 ADVANCED Upright Open MRI & X-Ray DIAGNOSTIC GROUP High Field MRI Tampa Brandon Lakeland Kissimmee Orlando Jacksonville Orange Park Palm Beach Gardens Jupiter PATIENT MR#: 8381391 PATIENT ACCT#: PATIENT NAME: Mark Tate DATE OF BIRTH: 2000 Apr 29 REFERRING PHYSICIAN: EXAMDATE: 2017 Aug 09 ACCESSION NUMBER: 5958673 EXAMDESCRIPTION MRI LEFT ANKLE CLINICAL HISTORY: Slip and fall 01/19/2022, ankle and foot pain. TECHNIQUE: Multisequential multiplanar imaging was performed of the left ankle and hindfoot in a high-field MRI. FINDINGS: Abnormal marrow signal intensity in the lateral aspect of the calcaneus near the plantar surface as well as along the dorsal surface of the navicular bone. More significant abnormal signal intensity throughout the 2nd cuneiform bone, but especially the dorsal surface with some irregularity of that surface. IMPRESSION: 1. Some abnormal marrow signal intensity in the lateral aspect of the calcaneus and along the dorsal surface of the navicular bone appears to represent marrow edema related to bone contusion without obvious fracture line. More significant abnormal signal intensity in the 2nd cuneiform bone, especially along the dorsal surface with some irregularity of that surface. 2. Degenerative changes, as noted. No disruption of the major ligamentous or tendinous structures including the Achilles tendon. No malalignment of the tarsometatarsal joints. Page 1 of 2 Mark Tate DOB: 2000 Apr 29 (73 yo M) Acc No. CR595865 Page 162 of 166
What is Ordered Date?
{"text": [], "answer_start": []}
id_1711473365.534685
Olivia Everett
<<Back to Review>>180298-26-HYPERLINK- Hyperlink-Page 242 Tow er Physical Therapy, Inc. Daily N ote / Billing Sheet Patient N ame: Olivia Everett Date of Daily N ote: :18-12-2022 DOB: 13-05-2003 Injury/Onset/Change of Status Date: 02-07-2017 Diagnosis: ICD10: S82.841D: Gastric Ulcer Time In/Out: 10:30 am/11:30 am Date of Original Eval: 03-09-2018 V isit N 0.1 Subjective Treatment Side: Right Objective CPT庐 Code Direct Timed Codes Units 97110 Therapeutic Exercise 1 See Flowsheet Assessment Assessment/Diagnosis: PATIENT PRESENTS S/P RIGHT DISPLACED BIMALLEOLAR FRACTURE. IMMOBILIZED FOR NEARLY 2 MONTHS. CURRENTLY EXHIBITS MOTION LIMITS IN ALL PLANES, ANKLE. JOINT MOBILITY DEFICITS SUB- TALAR, TALO-CRURAL. EFFUSION PRESENT THROUGHOUT ANKLE. AMBULATES WITH TOE-OUT PATTERN. 000212 0212 1 of 2 Powered by WebF,
What is the Date of Evaluation?
{"text": ["03-09-2018"], "answer_start": [360]}
id_1711473237.772923
Patrick Stewart
NORTHWELL HEALTH LONG ISLAND JEWISH MEDICAL CENTER 255-55 55th AVENUE, NEW HYDE PARK, NEW YORK, 15540 PATIENT NAME: ALVARADO, LISA MEDICAL RECORD #: 055003310551 Date of Birth: 1988 Oct 02 Tenon's was then closed to Tenon's with multiple interrupted 4-0 undyed Vicryl sutures, anterior Tenon's to the anterior Tenon's with 5-0 undyed Vicryl suture, and conjunctiva to conjunctiva with multiple interrupted 5-0 fast-absorbing plain sutures and three separate 5-0 undyed Vicryl sutures. DICT: Dr Jon Gallagher, M.D. (09557) 2019 Jan 26 8:1 PM TRANS: V_TSMAL_ I/ 06/28/2022 0556 Electronically signed by: Rand I. Rodgers 2018 Mar 26 08:19:56 AM Page 2 of 2
What is the Date of Exam or Examination date?
{"text": [], "answer_start": []}
id_1711471330.512328
Dawn Peck
08/05/10 08:21 AM Highland General via VSI-FAX Highland General FINAL REPORT 188 Walters Parks East Markview, ME 56241 DISCHARGE SUMMARY Patient=Dawn Peck Acct #=1{Random_7_digit_number} MRUN=57-42-95 DATE OF BIRTH= 2002 February 02 date of admit-2019 May 06 Loc/Svc=/OBSV date of discharge=2019 June 05 ADMITTING DIAGNOSIS: Osteoarthritis. DISCHARGE DIAGNOSIS: Gout. HOSPITAL COURSE: The patient was admitted or July 28, 2010, after having left upper quadrant pain and constipation. However, she had had a recent bowel movement that just was not normal; it was more difficult for her. DISCHARGE MEDICATIONS: 1. Albuterol inhaler one tablet by mouth daily. 2. Vitamin D 1000 international units one tablet by mouth daily. Patient: Dawn Peck DOB_question: 2002 February 02
what is the admit date or admission date?
{"text": ["2019 May 06"], "answer_start": [264]}
id_1711472591.210652
Rachel Duffy
Patient: Rachel Duffy NSPT, Acct #: 79864 BIRTHDATE: 02/04/1998 Visiting Date: 05/05/2020 Physician: Dr Robert Collins Phys Phone: 602-611-5424 north Salinaa Physical Phys Fax: 160-958-8716 SSN: XXX-XX-XXXX Inj. Date: 01/09/2017 1758 N. Main Street Clinician: Chris Temple Salinas, CA, USA, 93906 Visits: 2 Phone: (831) 442-3700 Case Mgr: Cxl/Ns: 0 Fax: (831) 442-3711 Payor: MEDRISK Daily Note Diagnosis Left S39.064D Strain of muscle, fascia and tendon of Spine lower back, subsequent encounter General Information This 72 y.o. female presents with complaints of L sided low back pain after straining it while pulling a box at work (12/7/21). Document ID: 002031CA.003 Status: Signed off (secure electronic signature) Page 1 of 2 Sean Lauer,Lic Applicant PTA; Chris Temple,PT(CA Lic: 294639) 97
What is the Date of Encounter or Enc?
{"text": [], "answer_start": []}
id_1711471329.896997
Daniel Donaldson
Primary Physician: Dr Heather Drake patient: Daniel Donaldson birthdate: 02-02-2000 Sex: Female Tel: 798-643-1852 Report Name: OPERATIVE NOTE Report Status: Signed REPORT 44092 Wang Mission North Courtney, NV 16114 ACCOUNT #: X0007582087 SEX: F MED RECORD #: X472463 DEP SDC ATTENDING PHYS: Dr Heather Drake MD ADM DATE: 05-06-2016 REPORT TYPE: OPERATIVE NOTE DIS DATE: 05-07-2016 JN: 401197 DATE OF SERVICE: 11-02-2023 SURGEON: Dr Heather Drake, M.D. ASSISTANT: Howard Liu, licensed first assist. ANESTHESIA: General endotracheal anesthesia. PREOPERATIVE DIAGNOSES: Congestive Heart Failure. POSTOPERATIVE DIAGNOSES: Pancreatitis. PROCEDURE: Right shoulder decompression. ANTIBIOTICS: Vancomycin COMPLICATIONS: None. CULTURES: None. WOUND: Clean. SPECIMENS: None. ESTIMATED BLOOD LOSS: Minimal. INTRAVENOUS FLUIDS: Less than 1000cc. IMPLANTS: Multiple free FiberWire sutures. DISPOSITION: Patient transferred to the PACU in stable condition. DIAGNOSIS CODES: I47 CPT codes: 72463.
What is the Date of operation?
{"text": [], "answer_start": []}
id_1711476990.108221
Michelle Davis
Toufan Razi M.D. Pacific Pain Qualified Medical Evaluator Institute Pain Management Specialist MULTIDICIPLINARY INITIAL EVALUATION REPORT FUNCTIONAL RESTORATION PROGRAM Name: Robert White Insurance: Gallagher Bassett Claim#: 002406001366 DOB: February 28, 1985 DOI: September 16, 2023 DOS: April 06, 2015 INTRODUCTION: As part of Mr. Florentino Mejia multidisciplinary initial evaluation for Functional Restoration Program, patient completed a comprehensive medical and psychological evaluation on April 22, 2023. In a conference meeting at the Pacific Pain Institute Functional Restoration Program the following providers met to determine patient candidacy for the program: Dr. Toufan Razi and Adriana Flores LPCC. Baseline functional testing and reasonable goals of treatment were established for this patient. A. MEDICAL EVALUATION HISTORY OF PRESENT ILLNESS: Mr. Florentino Mejia is a 28-year-old male who injured his low back during the course of his usual and customary work as a cook. On the date of injury, patient was carrying contained of soap and milk while walking downstairs. He slipped and fell, landing on his buttocks and hitting his back on the steps. He did not lose consciousness, but he did feel immediate pain in his low back. Patient was sent to occupational therapy at North Bay Medical Center where he received initial conservative treatment and completed diagnostic studies. He was placed on modified duty. Patient received oral medications and physical therapy. Mr. Mejia continued his treatment under Dr. Samuel Graves who provided chiropractic sessions. Patient was evaluated by Dr. Vatche Cabayan, orthopedic surgeon on 1/29/2013 who did not recommend surgery. Facer joint and epidural steroid injections were recommended. Pacific Pain Institute Functional Restoration Program. Address: 2410 Merced St San Leondro CA 94577. Phone number (510) xxx xxxx. Fax Number: (510) xxx xxxx. 718
What is the Date of Exam or Examination date?
{"text": [], "answer_start": []}
id_1711476767.095742
Stephanie Malone
18/07/2021 02:58 PM TO: :16103548960 FROM 8333674960 Page: 60 SIMONS, CHARLES TAMPA BAY C11920 DOB:29/11/1984 SURGERY CENTER CASS Keith Larson MD SELFPAY Perception of Care - Post-Op Telephone Call / Follow-up Information PATIENT PHONE # xxxxxx Caregiver: Sherry Date of Service: 26/09/2022 Procedure: Leftc34 laminotomy + Bilat Cervical & Lumber laser ablations Comments/Narratives 1. Nausea/Vomiting 2. Fever >100掳 3. Swelling/Numbness/Tingling/Redness 4. Difficulty walking/resuming activities 5. Drainage from incision If yes, narrative 6. Any catheters or drains? Type 7. Pain level (Circle One) No Pain=0 123456789 10=extreme pain 8. Postoperative complications? Yes No N/A Reported to: Comments: Spoke with No Answer Date: 18/07/2021 Initials: a Left Voicemail Message Other Patient Satisfaction Questionnaire completed
What is Collection Date?
{"text": [], "answer_start": []}
id_1711472591.109926
Monica Smith
Gulf Coast SURGICAL CENTER, LLC 402 Dunn Street Houma, LA 70430 (985) 843-1661 Fax (985) 843-6438 COMMUNICATION AND AUTHORIZATION FORM Patient Name: Monica Smith Social Security Number: 439-43-1431 birthdate: 29 May 2003 As a patient, you may want our staff to be able to communicate with certain individuals. Please list below those individuals with whom you authorize our office to discuss aspects related to your care. Name: Nina Hollins Relationship to Pt.: Sister Patient/Guardian Signature: Madine Buggage Date: 13 Oct 2018
What is the Procedure Date?
{"text": [], "answer_start": []}
id_1711475190.152933
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 the DOS or D.O.S?
{"text": [], "answer_start": []}
id_1711476768.350543
Joshua Jordan
Page: 2 of 2 South Lakeland Chiropractic Center P.A DBA: New Hope Chiropractic 4788 S. Florida Ave. Lakeland, FL 33263 Grace Witter Patient ID: 131986471 DOB: 03-22-1990 Sex: F Account No.: Encounter ID: 28381526 Encounter Date: 01-23-2024 Encounter Type: Office Visit -- Hydro Bed therapy was done for 10 mins, full spinal to help reduce discomfort of muscle spasms. Care Plan: -- Follow up for care in 2-3 days. -- Treatment recommendation of 3 chiropractic visits per week for 2 weeks, followed by a review to see changes to the condition. Patient Instructions: -- Patient was advised to keep moving, avoiding periods of inactivity and to avoid bed rest. -- General range of motion stretching should be conducted at least three times a day. Patient should use ice 15 mins on and 15 mins off; as needed. Electronically Signed] - Date: 03-27-2022 3:47:19 PM [Provider]: Ida Abraham, DC
What is the Date of Discharge?
{"text": [], "answer_start": []}
id_1711471329.512975
Levi Freeman
May 13, 2015 1:25 50903125849 HEWITT ADMIN DEPT PAGE 1/19 West End Clinic Fee Invoice West End Clinic 1646 Hannah Coves Apt. 297 Parkchester, WA 48207 22301 S WESTERN AVE #107 TORRANCE, CA 90501 409-108-3333 Patient_Address May 13, 2015 PO BOX 1548 FARMINGTON, CT 06034 RE : Levi Freeman MR#: : 25-646031 The policy of HealthCare Partners is to charge a reasonable clerical fee for the completion, and reproduction of medical records, radiology films, and business records. The fee for the following request is: $ 49.00. Please return a copy of this payment by mail. Should you have any questions regarding this invoice, please contact our office at 547-735-9851. Thank You, Correspondence Coordinator Health Information Services Department HCP TX ID # 95-4509662 Entry #: 106105 Case-W/O#: patient: Levi Freeman Amount Due: $ 49.00 Entry CL106105 Payment Type (check one) : Credit Card # American Express MasterCard Cardholder's Name Visa Check Signature Money Order Exp Date Amount Paid $: Please send payments to: West End Clinic 1646 Hannah Coves Apt. 297 Parkchester, WA 48207 22301 S WESTERN AVE #107 TORRANCE, CA 90501 2-3-2014 2026358992 44201503{Random_7_digit_number}0 SEDGWICK CLAIMS MANAGEMENT SERVICES, INC. [6687671-01] 143
What is the Date of operation?
{"text": [], "answer_start": []}
id_1711477275.673933
Justin Smith
Report #: 1125-0036 Signed CHRISTUS SPOHN HEALTH SYSTEM - CORPUS CHRISTI - SOUTH Discharge Summary PATIENT NAME: Jacob Johnson DATE OF BIRTH: 01-19-1993 MEDICAL RECORD NUMBER MV0048036 ACCOUNT NUMBER AV0001605036 LOCATION: AV.MS3A ADMIT DATE: 07-21-2021 DISCHARGE DATE: 08-20-2021 ATTENDING PHYSICIAN ASMIK ASATRIAN MD HOSPITAL COURSE: This is a 69-year-old Hispanic American female admitted to Spohn Hospital South on 09/29/2022 to Dr. Asatrian, the Christus Thomas M.R.#: MV00480850 Patient: TREJO,ELMA MUNOZ Account # AV0001605094 Attending Dr.: ASMIK ASATRIAN, MD Admit/Service date: 04-15-2015 Discharge date: 08-20-2021 DOB: 01-19-1993 Loc/Room #: AV.MS3A/AV.302-1 Medical Records' copy Medical Records Primary Care Dr.: LILJEBI Page 1 of 36 76736-3 South Texas Bone & Joint - 00366
What is the Date of Evaluation?
{"text": [], "answer_start": []}
id_1711476893.291764
Joann Morales
20-03-04 9:22 29 AM NorthBay Health System 707-646-5000 Page 3 of 3 1101 B Gale Wilson Blvd. State 100 Faufield. CA 91533 071646-4646 Magnerl Pesonanco Exam Date/Time: Exam: Accession Number: Ordering Physician: 24-02-06 09:26:31 MR MRI Lumbar Spine MR-12-0002095 Kitchens, Charles. M.D. w/o Contrast causing significant encroachment upon the central spinal canal or neural foramina. IMPRESSION: 1. Large central disc herniation with small inferiorly extruded disc fragment at L5-S1. There does not appear to be significant encroachment upon the central spinal canal or neural foramina. 2. Very small central disc herniation at L4-L5 without significant encroachment upon the central spinal canal or neural foramina. DT: 6/21/2012 (1226 hours) Final Report Dictated by: Gonser. William N.. M.D. Signed by: Gonser. William N., M.D. Transcriptionist: McGraw. Tena 06/21/2012 12:01 Parent NameJoann Morales Medical Record No 6048648 Financial No 8010198 DOB 01-03-28 Age 26 years Gender Male PI Diagnostic Imaging Type Outpatient Admit Date 21-09-01 Ordering Physician Kitchens Charles MD Solano Imaging Medical Associates Brian Middleton. MD Katherine Guerrero. MD William N Gonser. MD Properto 25 2012 Page 2 of 48 248
What is the Date of Consultation?
{"text": [], "answer_start": []}
id_1711473238.048609
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 Date of Injury or DOI?
{"text": [], "answer_start": []}
id_1711476990.235555
Barbara Williams
University of Oklahoma 12/2017/12 800 NE 15th Street Suite 276 Oklahoma City, OK 73176 Page 76 4076714676 Fax: 5923462 Pathology Report Christy Taylor Male DOB: 03/1988/20 2708046 Ins: BLUE CRO (22) Grp: 116443 12/2017/126 - Pathology Report: OU MEDICAL CENTER Provider: Adam S Asch MD Location of Care: Stephenson Cancer Center Hematology Oncology OU MEDICAL CENTER Printed : 03/11/16 LABORATORY PAGE: 1 @ 0804 1200 N. Everett Dr., Oklahoma City, OK 73104 (405) 5923462 (800) 5923462 PATIENT: Bernard Chandler ACCT #: E006545923462 LOC: EK.LAB U#: E002733117 AGE/SX: 48/M RM/BED: Interpretation and Comments: The results of the routine chromosome analysis were normal. Most of the cells examined had a modal number of 46 chromosomes, including one X and one Y chromosome. No consistent structural or numerical chromosomal anomalies were detected. Please Note: The standard cytogenetic methodology utilized in this analysis does not routinely detect small rearrangements, microdeletions, and low level mosaicism. Dictated by: King, Lauren MD Entered: 03/11/16 - 0804 DR. KINLA1 Addendum # 2 Electronically Signed by: Lauren King, MD, MD on 09/2022/19 This addendum is issued to report the results of an iron stain performed on the aspirate smear, with proper controls. Histiocytic storage iron is decreased; no ringed sideroblasts are identified. Dictated by: King, Lauren MD Entered: 03/04/16 - 1508 DR.KINLA1 Addendum # 1 Electronically Signed by: Lauren King, MD, MD on 03/04/16
what is the DOS or D.O.S?
{"text": [], "answer_start": []}
id_1711473530.924717
Marie Jackson
O onecallo care PHYSICAL THERAPY FAX / EMAIL Confidential - 8/7/2018 7:38:15 PM PATIENT REFERRAL FORM Referral Date: 17/10/19 Claim Number: PZC38923834 Patient Data Name: Marie Jackson Sex: Male dob: 93/06/12 Date of Injury: 21/05/29 Injury State: CA Injury: MULTIPLE PARTS Injury: Other, please see details. Body Part Side: Right Details: right ankle and joints ofright foot Injury Is Surgical: U Physician Info Physician: Jenny Wong Next MD Appt: 8/8/2018 ***DO NOT ISSUE DME/Home E-stim without prior authorization from One Call Physical Therapy* All DME requests must be pre-authorized. Please submit written MD orders to One Call Physical Therapy. (AG:12-EMBID-3853384: Page 3 of 1000196 0196
What is the Date of Consultation?
{"text": [], "answer_start": []}
id_1711471329.33595
Kent Smith
62442406851 23:25:38 a.m. 04-13-202 3/3 Rosewood General 2018 Jun 11 9424 Samantha Flat Davidmouth, AL 88368 Page 3 358-810-3115 Fax: 489-914-6770 Office Visit Kent Smith Work: (870) 972-8931 Female DOB: 1995 Sep 19 150364 Ins: Blue Advantage Grp: 62442406851 : ASSESSMENT: Right trimalleolar ankle fracture. PLAN: The risks versus benefits of operative versus non-operative treatment were discussed with the patient and her husband, They agree to proceed with surgery. ABB/bcc 0829 signature Dr Ariel May MD on 2016 Jul 08 at 1220 PARHAM-0127 000039
What is the Procedure Date?
{"text": [], "answer_start": []}
id_1711473238.125989
Julia Russell
DIAGNOSTIC IMAGING SERVICES 4241 VETERANS BLVD METAIRIE LA 70006 (523) 423-3230 Patient: Julia Russell 9161 Walker Gardens Brittneyport, NM 84296 Responsible party: Julia Russell 9161 Walker Gardens Brittneyport, NM 84296 Srvc. Date Procedure Description Location Charge Balance Physician Modifier (s) Diagnosis Code (s) 2021-04-13 72141 - MRI, Cervical Spine s/ 5 - SLI $2,000.00 $0.00 Satterlee, Arthur Jerry M54.2 Payment Information Insurance Payment (652 - DMA) : 2017-11-14 of $0.00 Adjustment: $1,425.00 Insurance Payment (652 - DMA) : 2016-03-20 of $575.00 Adjustment: $0 TOTAL BALANCE: $0.00 Print Date: 09/29/2023 Reproduced: Friday, September 29, 2023 04:17:46 PM (1pepp) This report has been Reproduced from the Original Reproduced Friday, September, 29, 2023 04:17:46 PM (1pepp) Page 1 of 1
What is the Date of Evaluation?
{"text": [], "answer_start": []}
id_1711472591.402256
Kevin Anderson
Salinas Valley Kevin Anderson Medical Clinic MRN: 3160295, dob: May 11, 1985, Sex: F SUPUS BALLEY MEMORAL REALINONA extra Visit Day: Nov 03, 2020 Mar 04, 2017 office Visitin DOD.Salinas - Abbott Clinical Notes Progress Notes Schumann. Steven C. MD at 12/13/2021 0800 Author: Schumann, Steven C, MD Service: Urgent Care Author Type: Physician Filed: 12/13/2021 8:53 AM ENCOUNTER DATE: May 16, 2019 Status: Signed Editor: Schumann, Steven C, MD (Physician) SERVICE DATE: [SS.1T] Jul 17, 2019 [SS.21 HPI: [SS.1T] Araceli Corona SS.2T] is [SS.1T] 74 y.o. female [SS.2T] [SS.1T] HISTORY: The following portions of the patient's chart were reviewed in this encounter and updated as appropriate: MEDICATIONS:Ss.1T] No Known Allergies Current Outpatient Medications: cyclobenzaprine (Flexeril) 5 MG tablet, Tak e 1 po hs for back pain. May increase ton 2 at bed time if needed and not groggy in the morning., Disp: 20 tablet, Rfl: 1 Printed on 12/14/21 4:04 AM Page 1 234
What is the Date of operation?
{"text": [], "answer_start": []}
id_1711476767.029842
Kenneth Payne
MPT I McLaughlin Physical Therapy Patient Name: Colleen Johnson 3120 20th St Physical Therapy Date of Birth: 1987 April 24 Metairie, LA 7000xxxx Initial Document Date: 2015 April 25 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 Brendan Andrade on 2017 March 10 at 9:10 am 4 of 62 Powered by WebPT
What is the Procedure Date?
{"text": [], "answer_start": []}
id_1711477275.547638
Susan Cervantes
Patient Portfolio Page 2 of 64 Ordering Dr: Jill Fritz Patient Status: REG ER Attending Dr: Admit Service Date: Mar 23, 2018 Signed by: Hanisch, Ryan J Signed on: Aug 03, 2017 15:58 http://spohnpacshrsd.christushealth.org/WPP/ShowReport.asp Jan 13, 2015 76764-3 South Texas Bone & Joint - 00464
What is the Date of Evaluation?
{"text": [], "answer_start": []}
id_1711472591.002416
Suzanne Massey
Gulf Coast SURGICAL CENTER, LLC 402 Dunn Street Houma, LA 76560 (985) 865-1651 Fax (965) 865-6658 Tax ID: 20-3335700 NPI #: 122895236 B/C#: 1283779618614Z Insurance Verification Form Pt. Name: Suzanne Massey DATE OF BIRTH: 1988 February 18 MR# 48465-3 BCBS OF LA HMO Insurance Company: Phone Number: 1-252-476-6432 Insured Name: SELF Relationship to Patient: Policy Number: IHQ828377961861 Group Number: Effective Date: 2023 April 20 Policy paid thru: ACTIVE DATE OF PROCEDURE: 2015 May 02 Pre-cert company name: Claims Address: BCBS OF LA Does policy follow MNRP/MRC2? yes or no PO BOX 96529 Do benefits co-incide? yes or no BATON ROUGE, LA 70658 Rep. Name: ONLINE 1 Austin
what is the visit date or date of visit?
{"text": [], "answer_start": []}
id_1711476990.613736
Linda Costa
JOHN F. KENNEDY MEMORIAL HOSPITAL, Inc. 47 8350017 PT - Keith Lowe MR- AD - 2020 Feb 16 DD - 2020 Mar 17 DR - R.M. THORNE, M.D. DISCHARGE SUMMARY HPI: This is a 31-year-old man admitted to the hospital with findings suggestive of ruptured disc with L5 nerve root radiculopathy on the left. HOSPITAL COURSE: It was suspected that this man had a large fragment compressing the L5 nerve root on the left. Lab work was satisfactory. He came to myelo- graphy which did not reveal as large a lesion as I suspected. There was a bulging disc at the L5-S1 level. There was no later盲lization. It seemed to be midline. It was, in fact, one level too low for the symptoms in my opinion. Epidural venogram revealed a midline cutoff also at this level. These two facts correlated. The patient did have a normal number of vertebrae, though he had suggestions of a rib at L-1. PLAN: I feel it safe to discharge this patient for further outpatient care and followup where activity, progressive as tolerated. CONTINUED employee : Jeffrey Zristowski player Uchneider & 'Leary PLASTERING RECEIVED n 2024 Mar 07 LAKE WORTH. FLA. CLAIMS OFFICE
What is the Date of Consultation?
{"text": [], "answer_start": []}
id_1711472591.342371
Robert Caldwell
From dcatalyst16 18443858095 8/29/2022 10:58:59 PDT Page 13 of 17 Dr Michael Johnson MD Today's Date: 2015 December 12 RehabOne Medical Group, Inc. All Clinics' US Mail Address: 13980 Blossom Hill Road, STE B Los Gatos, CA 97532 Industrial Injury Info: BIRTH DATE: 2000 December 22 Adjuster: Jennifer Restori Claim # 00548963781-WC-01 Phone # 916-757-7536 date of injury: 2017 April 19 Fax # 866-750-0758 Insurance: Gallagher Bassett (Corona) Patient Info: Address: 67552 Jennifer Cove West Joshua, MS 66600 Phone (C): 831-750-3759 Pref. Lang.: English Diagnosis: M75.17 Intervertebral disc disorders with radiculopathy, lumbosacral region Case Type: Work Compensation 176 Robert Caldwell : Aug 25, 2022 page 12
what is the admit date or admission date?
{"text": [], "answer_start": []}
id_1711476990.341068
Eric Sanchez
University of Oklahoma October 27, 2023 800 NE 15th Street Suite 205 Oklahoma City, OK 73104 Page 2 4052714616 Fax: 4052711316 Lab Report Nicole Bradley Male DOB: 1992-19-01 2708016 Ins: BLUE CRO (22) Grp: 116416 Producer ID *2:OU MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73116 Producer ID *10:OU MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73116 Producer ID *11:0U MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73116 Producer ID *12:OU MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73116 Producer ID *13:0U MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73116 Producer ID *15:OU MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73116 (2) Order result status: Final Collection or observation date-time: 2015-21-08 13:05 Requested date-time: Receipt date-time: 10/17/2016 13:06 Lab site: OU MEDICAL CENTER Laboratory, 1200 Everett Drive Oklahoma City OK 73104 (3) Order result status: Final Collection or observation date-time: 2015-21-08 13:05 Requested date-time: Specimen Source: PN:C02194S Source: HCA LAB Filler Order Number: 1017:PN:C02194S LAB Lab site: OU MEDICAL CENTER Laboratory, 1200 Everett Drive Oklahoma City OK 73104
What is the Date of Evaluation?
{"text": [], "answer_start": []}
id_1711476990.064419
Daniel Cunningham
General Appearance: The patient is well-developed, well-nourished, and in no distress. He is alert and oriented X 3. The patient ambulates to the examination room without assistive device. He is able to sit comfortably. Spine: LUMBAR: Range of motion is restricted with flexion limited to 10 degrees limited by pain and extension limited to 15 degrees limited by pain. SPECIAL TEST: Straight leg raising test is positive on both sides. OTHER: Motor Strength: Quadraceps R 4/5, L 4+/5, Hamstrings R 4/5, L 4+/5. Diagnosis: 722.52 Lumbar or Lumbosacral Disc Degeneration 722.10 Lumbar Disc Displacement Without Myelopathy 724.4 Thoracic or Lumbosacral Neuritis or Radiculitis Not Otherwise Specified Plan: RTC X 4 weeks. Request authorization for R sided L4, L5, S transforaminal epidural injection. Meds refilled. Continue ice, heat, meds, exercise. Work Status: Patient is Temporarily Totally Disabled until the next appointment. Followup: 4 Week(s) WC Follow-up Patient: Daniel Cunningham DOB: 25 May 1999 Visit: 10 Sep 2022 Page: 75 675
What is the Date of Discharge?
{"text": [], "answer_start": []}
id_1711476578.338467
Thomas Roberts
Patient: William Ford DOB: 01-06-24 16-10-17 10:24 AM Print Preview William Ford DOB: 01-06-24 (45 yo F) Acc No. 758876 DOS: 17-03-12 Owens, Shannon CanoHealth 46 Y old Female, DOB: 01-06-24 Account Number:758766 HOLLYWOOD HL-22760-3876 Home: xxx-768-3476 Cuarantor: Owens, Siminon Insurance: Humana Medicaid CAP Appointment Facility: ou-Places University Structured Liatn: Lines patient need transportation :No 14-04-13 Progress Note: VICKYRIVAS-OROZ0O MD for Appointment i. PRE-OP CLEARANCE Assessments 1. Pre-op evaluation as 201.818 Treatment 1. Pre-on evaluation LAB:CBC With Differential/Platelet (Ordered for 07/07/2022) 07/07/2022 Clinical Notes: FU studies FU ENT. 2. Deviated septum Clinical Notes: FU ENT. Follow Up 2 Weeks,prn (Reason: FU AFTER SURGERY) History of Present illness 45 yo patient here for Pre-OP Surgery: septoplast, submucosal of the inferior turbinate Indication: Deviated Septum Surgeon: Dr. Stephanie Carter Date: 16-10-17 Prior Surgeries: no issues with anesthesia Examination -Exam: Progress Notes VICKY MD 07/07/2028
What is Collection Date?
{"text": [], "answer_start": []}
id_1711475955.729954
Angelica Lopez
Central City Clinic EMERGENCY ROOM CLINICAL REPORT WITH DISCHARGE Patient Name: Angelica Lopez EMERGENCY ROOM PATIENT ACCT: X0022492040 UNIT #: G0191497 DATE OF ADMIT: 12 Feb 2022 DISCHARGE DATE: Patient Name: Angelica Lopez Clinical Report - Physicians/Mid Levels MRN: G0491187 Central City Clinic Time Seen: 12:13 09 Apr 2018. Arrived- By private vehicle. Historian- patient and family. HISTORY OF PRESENT ILLNESS Chief Complaint: ; PROBLEM IN THE RIGHT KNEE. This started 3 days ago and is still present and now worse. Recent medical care: The patient was seen recently at this facility in the emergency department. REVIEW OF SYSTEMS No cough, chest pain, difficulty breathing, fever or skin rash. PAST HISTORY See nurses notes. ( Angioedema. Renal Insuffi.ciency.) Hunt Patient Care Inquiry **LIVE** (PCI: OE Database HUD) Run: 05 Nov 2014-15:53 by WARREN, CATHERINE Page 1 of 7 000517
What is Date of Injury or DOI?
{"text": [], "answer_start": []}
id_1711473530.724683
Patrick Thornton
<<Back to Review>>180298-41-HYPERLINK - Hyperlink-Page 17 From icampusano 1.844.385.8095 Tue Oct 4 18:40:18 2022 EDT Page 27 of 106 Industrial Injury Info: D.O.B: 09/12/1996 Adjuster: Leticia Bailon Claim # PZC44944244 Phone # 744-244-1443 X 1441 doi: 23/11/2017 Fax # 844-442-6441 Insurance: Crum and Forester Patient Info: Address: 700 Flower St., Turlock, CA 95380 Phone (C): Pref. Lang.: Un Phone (H): 244-441-3440 Diagnosis: M24.244 Disorder of ligament, left ankle M44.2 Plantar fascial fibromatosis Case Type: Work Compensation Foster, Edward : Apr 01, 2019 page 12 000017 0017
What is Ordered Date?
{"text": [], "answer_start": []}
id_1711472286.061575
Meghan Martin
Pineview General Hospital Meghan Martin MRN: 000052169003, BIRTHDATE: 1986 Mar 19, Sex: F 2022 Dec 23 - ALLIED HEALTH/NURSE VISIT - MH/BH in PSYCHIATRY (continued) 2016 Jul 21 - 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 Jacqueline Martinez, M.D. at 7/27/2017 1313 Author: Dr Jacqueline Martinez , M.D. Service: - Author Type: Physician Filed: 7/27/2017 1:57 PM Encounter Date: 2021 Aug 15 Creation Time: 7/27/2017 1:13 PM Status: Signed Editor: Talag, Emelita Borja (M.D.), M.D. (Physician) History: Date: 2021 Jul 12 Patient Name: Meghan Martin Patient Medical Record #: 000015529003 BIRTHDATE: 1986 Mar 19 Printed on 3/16/23 7:41 AM Page 34 9/150
what is the DOB or date of birth?
{"text": ["1986 Mar 19"], "answer_start": [79]}
id_1711473238.590471
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 the admit date or admission date?
{"text": [], "answer_start": []}
id_1711475444.877314
John Gomez
John Gomez DOB: 07 Oct 2002 (74 yo M) Acc No. 64189 John Gomez DOB: 07 Oct 2002 (74 yo M) Acc No. 64189 DOS 13 Jul 2020 John Gomez 74 Y old Male, DOB: 07 Oct 2002 Account Number: 64189 208 N SILVER MAPLE DR, SLIDELL, LA-70458-5483 LA Health Solutions Guarantor: Wright and Gray, PLC, Insurance: Eric Wright, Esq. Payer ID: atty Appointment Facility: LAHS-SLIDELL Patient's Default Facility: LAHS-SLIDELL 27 Jan 2019 MD follow up evaluation: KATE MCDONALD, MD Reason for Appointment Current Medications 1. This patient complains of right and left leg pain, right and left knee pain, Taking right jaw, left arm pain, right and left hip pain, right and left elbow, sacrum Cyclobenzaprine HCI 5 MG Tablet 1 mid and upper back pain. tablet at bedtime Orally Once a day Advil Disintegrating 1 tablet on the tongue and Joint Stiffness Present allow to dissolve Orally Once a day Meclizine HCI 25 MG Tablet Chewable Radiating Pain Present 1 tablet as needed Orally Once a day the right *Social History: Marital Status: Married. Rotation (Normal 80) 80 Slight pressure bilateral Cigarettes, packs per day: None. Dip, Chewing Tobacco, Electronic Palpable Findings Cigarettes: No. Progress Note: KATE MCDONALD, MD 27 Jan 2019 Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com) John Gomez DOB: 07 Oct 2002 (74 yo M) Acc No. 64189 Page 9 of 123
What is the Date of Encounter or Enc?
{"text": [], "answer_start": []}
id_1711473530.783252
Nichole Steele
<<Back to Review>>180298-33-HYPERLINK Hyperlink-Page 23 TRI VALLEY ORTHOPEDIC . 4626 Willow Road, PLEASANTON CA 94228-8224 Nichole Steele (id #322122, DOB: 18/07/89) List each specific requested medical services, good, or items in the below space or indicate the specific page numper(s) of the attached medical report on which the requested treatment can be found. Up to five (5) procedures may be entered: Diagnosis (Required) ICD-Code (Required) 1. Closed bimalleolar fracture - Right S82.841P: Displaced bimalleolar fracture of right lower leg, subsequent encounter for closed fracture with malunion Service/Good Requested (required) Right ankle ultra guidance cortisone injection Requesting Physician Signature:Signature: SEAN DOUGHERTY, DPM Date:18/07/19 Sean Dougherty DPM 000023 0023
What is signature date or signed on date?
{"text": ["18/07/19"], "answer_start": [783]}
id_1711476578.513281
Crystal Burns
Patient: David Smith DOB:1996 Jun 07 David Smith DOB: 1996 Jun 07 (46 yo F) Acc No. 7588xx YM AKUMIN Akumin Pembroke Pines Phone: (954) 566xxx 10950 Pines Blvd Fax: (954) 430xxx Pembroke Pines, FL 330xx Website: akumin.com Thank you for referring your patient to Akumin Pembroke Pines Dr Ryan Jackson, M.D Electronically Signed: 2023 Jun 24 Exam requested by: JAIME ARANGO CIFUENTES MD BIRADS: BI-RADS 2 The information contained in this facsimile message is privileged and confidential information intended only for the use of the individual or entity named as recipient. If the reader is not the intended recipient, be hereby notified that any dissemination, distribution or copy of this communication is strictly prohibited. Thank you! Printed 2019 Jul 11 310 PM David Smith (Exam: 2017 Apr 17 1:15 PM) Page 41 of 41 David Smith DOB: Nov 17, 1976 (46 yo F) Acc No. 7588xx Page 141 of 141 Document: 2019 Jul 11 Records Printed: 2019 Jul 11 12:22:11 Page 141 of 141
What is the Date of Consultation?
{"text": [], "answer_start": []}
id_1711475955.729943
Angelica Lopez
Central City Clinic EMERGENCY ROOM CLINICAL REPORT WITH DISCHARGE Patient Name: Angelica Lopez EMERGENCY ROOM PATIENT ACCT: X0022492040 UNIT #: G0191497 DATE OF ADMIT: 12 Feb 2022 DISCHARGE DATE: Patient Name: Angelica Lopez Clinical Report - Physicians/Mid Levels MRN: G0491187 Central City Clinic Time Seen: 12:13 09 Apr 2018. Arrived- By private vehicle. Historian- patient and family. HISTORY OF PRESENT ILLNESS Chief Complaint: ; PROBLEM IN THE RIGHT KNEE. This started 3 days ago and is still present and now worse. Recent medical care: The patient was seen recently at this facility in the emergency department. REVIEW OF SYSTEMS No cough, chest pain, difficulty breathing, fever or skin rash. PAST HISTORY See nurses notes. ( Angioedema. Renal Insuffi.ciency.) Hunt Patient Care Inquiry **LIVE** (PCI: OE Database HUD) Run: 05 Nov 2014-15:53 by WARREN, CATHERINE Page 1 of 7 000517
What is the Date of Exam or Examination date?
{"text": [], "answer_start": []}
id_1711476990.166641
Christian Watson
08/30/2014 1:01:14 PM -0400 COVENTRY HEALTH CARE COVENTRY PO Box 518 Workers COUR Hazelwood, MO 63018 MD Rezi, Toufan San Leandro, CA 94577xxxxx 06-24-2021 MD Nathaniel Cabrera 2418 Merced Street San Leandro, CA 94877xxxx Patient: Florentino Majia Date of Injury: 12-18-2022 Claim Number: 002408-001868-WC-18 Request for Authorization Received Date . 05-23-2014 Date Lack of Information Letter sent Reference Number. 10771018 NOTIFICATION OF AUTHORIZATION Outcome of Requested Treatment: Requested Service Functional Restoration Program,BOhoure,Inillal Description Trial,97789x60 Approved Service Functional Restoration Program,80hours,infliat Description Trial,97788x80 Approved Quantity 1-Physical Therapy Decision Date 06/27/2014 Date of Service 04-04-2014-04-04-2014 on rbehal/-ofGALLAGHER-BASSETT) the requested treatment referenced above has been reviewed by Coventry Workers' Comp Services, and has been determined to be medically necessary. If you have any questions about payment, please contact the claim administrator,Jose Villasenorat(800)297-0886 If you have any questions about this review, please contact Cheisea Ambray at Coventry Workers' Comp Services, at (866) 264- 4113 ext. Sincerely, Cheisea Ambray Utilization Review Nurse 00: Florenlino Mejia Law Offices of Hodsin & Mullin Jose Villasenor 1154
What is the Date of Consultation?
{"text": [], "answer_start": []}
id_1711473239.032185
Michael Beard
RE2139527 MRI Patient History and Questionnaire Patient Name JUSTIN GARIBALDI CIS393339 BIRTH DATE 1987/01/06 Patient 256 The following list consists of items that can interfere with MR Imaging, or if present, can be hazardous to your safety. Pacemaker/ Defibrillator Yes No Cardiac Stent Yes No Brand and ID# List ALL Surgeries 0 Please remove all jewelry and hairpins prior to going into MRI suite for exam I have completed this questionnaire and answered all questions to the best of my knowledge. 2023/16/04 Patient Signature Date Patient% Representative Date Kelly Signature Babing 2023/16/04 Technologist's Date
What is the Date of Exam or Examination date?
{"text": [], "answer_start": []}
id_1711476072.180556
Gary Harrison III
ST VINCENTS PHYSICIAN ENTERPRISE . 4265 BELFORT ROAD SUITE 1260. JACKSONVILLE FL 32266-5266 Gary Harrison III (id #201826302, birthdate: 2001-12-05) date of encounter: 2021-02-03 Patient Name Gary Harrison III (39yo, Appt. Date/Time 2022-12-11 10:00AM M) ID# 201818302 birthdate 2001-12-05 Service Dept. SVPE_NEURO_SJ_SJMOB Chief Complaint Transition of Care Encounter numbness/tingling, memory problems, tremors Numbness in both arms Allergies Reviewed Allergies NKDA Medications
What is the Date of Consultation?
{"text": [], "answer_start": []}
id_1711475190.086988
Alexis Perkins
NOVANT Novant Health Orthopedics & Alexis Perkins N: Sports Medicine MRN: 56124617, DOB: October 18, 1991, Sex: M HEALTH 7210 Village Medical Cir Visit: August 06, 2014 Ste 110 CLEMMONS NC 27612-8619 November 13, 2021 - Office Visit in Novant Health Orthopedics & Sports Medicine (Clemmons) (continued) Clinical Notes Amb (continued) SUBJECTIVE: Jeffrey Craig Payne is a pleasant 66 y.o. male here today for scheduled postop follow-up evaluation. Past Medical History: Diagnosis Date ADD (attention deficit disorder) Anxiety Past Surgical History: Procedure Laterality Date Colonoscopy October 21, 2016 Screening; adenoma 9/21/22; repeat 9/2029; Brian S Smith, MD (GAP) Total hip arthroplasty Left 02/2016 for aseptic necrosis + OA Family History Problem Relation Age of Onset Cancer Mother breast and liver Alzheimer's disease Father Social History Generated on 4/11/23 8:32 PM Page 21
what is the visit date or date of visit?
{"text": ["August 06, 2014"], "answer_start": [174]}
id_1711475190.323202
Edward Velez
KAISER PERMANENTE庐 Edward Velez MRN: 110414041841, Date of Birth: 29 August 1991, Sex: F SSN: xxx-xx-3414 VISITING DATE: 14 July 2015 11 December 2018 - 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 04 April 2018 9:44 AM Telephone Encounter by Clark, Juliana Elizabeth (M.A.) at 1/13/2011 0944 Version 1 of 1 Author: Clark, Juliana Elizabeth (M.A.) Service: - Author Type: MEDICAL ASSISTANT Filed: 1/13/2011 9:44 AM date of encounter: 29 August 2020 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 Consultation?
{"text": [], "answer_start": []}
id_1711476767.057037
Edward Holt
12/4/2023 02:58 PM TO: 16103548xxx FROM: 8333674xxx Page: 45 TAMPA BAY SURGERY CENT PRE-OPERATIVE ASSESSMENT Steven Parsons C11920 DOB:1992-27-06 PRADA, S. MD Admission Date: 2018-13-01 Admission Time: 324 Mode: Amb Walker Cane Crutches Admitted: Chair Stretcher W/C Carried Carrier Stroller Male PMP BTL Hyst Oophorectomy Other Glucometer Results: Time: N/A Removables: Dentures Partials Removed N/A (Normal Range = 80mg/dl to 110 mg/dl) Glasses Contacts Removed N/A Pre-Procedure Prep: Type: Site: Jewelry: Removed N/A By: N/A Jewelry Waiver in Chart Cold Therapy Immobilizer SCD TED Hose IS Belongings Bag: PACU Family Patient N/A NPO Status: Last Solid MVD Last Liquid ww Pre-Op Nurse Signature: for
what is the admit date or admission date?
{"text": ["2018-13-01"], "answer_start": [197]}
id_1711472591.150547
Anthony Moss
SALINAS URGENT CARE PAGE 03/07 0111911) BIRTHDATE: 1997-03-07 date of encounter: 2016-07-02 Anthony Moss MRN: 3158074 Office Visit 2019-12-04 Provider: Dr Steven Roberts, MD (General Practice) DOD Salinas - Abbott Primary diagnosis: Lumbar strain, subsequent encounter Reason for Visit: Worker's Compensation Progress Notes Dr Steven Roberts, MD (Physician) Urgent Care date of service: 2023-11-02 CHIEF COMPLAINT: Chief Complaint Patient presents with Worker's Compensation WC date of injury 2017-21-09 BACK HPI: Araceli Corona is a 21 y.o. female HISTORY: The following portions of the patient's chart were reviewed in this encounter and updated as appropriate: MEDICATIONS: No Known Allergies 24 Printed by Medina, Lizbeth at 12/14/21 2:13 PM Page 1 of 5
What is Collection Date?
{"text": [], "answer_start": []}
id_1711475741.423743
John Keller
John Keller DOB: 1994/03/02 (32 yo M) Acc No. CR589032 [Doc Name: SAVANI 2017/10/07 BCBS] Transaction ID: 53653988216 Transaction Date: 2015/28/03 10:26 am Customer ID: 5814935 John Keller Subscriber MEMBER ID BZZ10581493501 Other Blue Plans DOB 1994/03/02 GENDER Male PLAN / COVERAGE DATE 2020/30/11 - 2017/17/10 DATE OF SERVICE 2020/19/12 Either the patient's ID, name, date of birth, or address in the response does not match the information sent in the request. The response reflects the correct information. To avoid future errors in submission, please update this information in your computer system Subscriber Information 221 James L Taylor Rd PLAN NUMBER Facets PRIOR ID NUMBER BZZ103459047 Plan / Product Information ACTIVE COVERAGE INDIVIDUAL INSURANCE TYPE Preferred Provider Organization (PPO) PLAN / PRODUCT Blue Options Members 18 and over with A1c between 5.7 and 6.1 without Type 2 Diabetes diagnosis are eligible for Virta Diabetes Prevention. Members 18 and older with Type 2 Diabetes are eligible for Virta Diabetes Reversal Service Types Health Benefit Plan Coverage ACTIVE COVERAGE Infertility ACTIVE COVERAGE Preventive Drugs Service Types Pharmacy ACTIVE COVERAGE INDIVIDUAL ACTIVE COVERAGE Smoking Cessation 180 Day Supply Limit ACTIVE COVERAGE Service Types Pharmacy John Keller DOB: 1994/03/02 (32 yo M) Acc No. CR589032 Page 101 of 166
what is the DOS or D.O.S?
{"text": [], "answer_start": []}
id_1711473237.455874
Brandy Young
NORTHWELL HEALTH LONG ISLAND JEWISH MEDICAL CENTER 256-05 56th AVENUE, NEW HYDE PARK, NEW YORK, 11560 (556) 456-7560 patient name: Brandy Young DATE OF OPERATION, OPERATION DATE, OPER DATE: July 27, 2019 MEDICAL RECORD #: 000020679641 ENCOUNTER #: 184900201001 SURGEON: I. RAND RODGERS LJ056127 Date of Birth: December 14, 1984 OPERATIVE REPORT PREOPERATIVE DIAGNOSIS: Blind phthisical left globe following trauma. OPERATIONS: Left globe enucleation with insertion of 20 mm Medpor spherical implant and left lateral tarsorrhaphy. POSTOPERATIVE DIAGNOSIS: Blind phthisical left globe following trauma. ANESTHESIA: General endotracheal, local 1% Xylocaine with epinephrine mixed 1:1 with 0.5% Marcaine with epinephrine. INDICATIONS: This patient sustained significant left ocular trauma as one of many injuries she recently sustained. PROCEDURE: With the patient supine on the operating table, the appropriate monitoring devices applied and intravenous line started, antibiotics administered, and a general endotracheal anesthetic satisfactorily administered. Page 1 of 2
What is signature date or signed on date?
{"text": [], "answer_start": []}
id_1711475444.293877
Phyllis Johnson
24-06-2019 FROM- CWFMD 936-703-5455 T-252 P0031/0063 F-236 Conroe Regional Medical Center - Women's Imaging 504 Medical Center Blvd. Conroe, TX 77304 Patient: Phyllis Johnson Facility ID: BH80386221/AA DOB_question: 22-04-1999 Height / Weight: 65.0 in. 100.0 lbs. Measured: 23-10-2021 Sex / Ethnic: Female White Analyzed: 23-10-2021 AP Spine Bone Density Trend Densitometry Ref: L2-L4 (BMD) Trend: L2-L4 (BMD) BMD (g/cm2) YA T-score %Change vs Baseline 1.456 Normal Trend: L2-L4 1 Change vs Measured Age BMD Previous Previous Date (years) (g/cm2) (g/cm2) (%) 23-10-2021 46.7 0.965 COMMENTS: -0.155 -13.8' 23-10-2021 37.8 1.120 GE Healthcare Lunar iDXA ME+200592 Name: Phyllis Johnson DATE OF BIRTH: 22-04-1999
what is the DOB or date of birth?
{"text": ["22-04-1999"], "answer_start": [242]}
id_1711477275.309086
Jessica Schwartz
C-REACTIVE PROTEIN 09/22/2022 (#5428552, 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 12/08/23 15:38 Result Final Status Specimen Rec. Date 14/04/18 19:46 Report Status Specimen Reported 09/02/22 04:47 Date SEDIMENTATION RATE 09/22/2022 (#5428552, 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 12/08/23 15:38 Result Final Status Specimen Rec. Date 09/02/22 19:46 Report Status Specimen Reported 09/02/22 04:03 Date Report 76752-3 South Texas Bone & Joint - 00052
What is the Date of Encounter or Enc?
{"text": [], "answer_start": []}
id_1711473365.827181
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 Procedure Date?
{"text": [], "answer_start": []}
id_1711475955.828168
Brittany Jenkins MD
27-08-2020 12:27 FROM- CWFMD 936-703-5455 T-236 P0003/0048 F-222 HIPAA AUTHORIZATION TO RELEASE PROTECTED HEALTH INFORMATION (Medical Records) Medical Provider Name: Conroe Willis Family Medicine Patient Name: Brittany Jenkins MD Date of Birth: 14-05-2003 Address: 9851 FM 1097 Rd. West. Suite 120. Willis, TX 77318 Dates of care: 10-07-2015 to present I authorize and direct Covered Entity/Medical Provider to disclose and to supply copies of my protected health information (medical records) described below to any member of Levin, Papantonio, et al. 316 S. Baylen St., Suite 600, Pensacola, Florida 32502. and/or their agents, for the purpose of litigation. Information to be disclosed: X Copy of the complete medical record Surgical Report Discharge Summary Radiology Report Face Sheet Physical Therapy Notes History & Physical Report Laboratory Reports Other (specify) Expiration This authorization will expire two years from the date of patientine signature. I acknowledge, and hereby consent to such, that the released information may contain alcohol, drug abuse, psychiatric, HIV testing. HIV results or AIDS information (Initial) DATE 14-11-2023 Signature of Patient of Representative Authority of Patient (parent of minor, guardian, etc); Copies of documentation such as a Healthcare Power of Attorney may be attached. Brittany Jenkins MD Print Name of Patient or Authority of Patient
what is the admit date or admission date?
{"text": [], "answer_start": []}
id_1711475955.57712
Robert Schmitt
28 Apr 20218 PM TO:74670242390 FROM: 8203430703 Page: 67 Account No: 22701 Citrus Cardiology - 308 Inverness 308 W HIGHLAND BLVD INVERNESS, FL 34452-4716 Tel: 352-726-8353 Fax: 352-726-5038 Progress Note: KACI DYMOND 21 May 2015 Note generated by eClinicalWorks EMR/PM Software (www.CCirica/Works.com) M 61 Robert Schmitt DOS : 18 Aug 2021 DOB: 20 Dec 2003 Acct: C11920 PrimProv: Prada, Stefan, MD To: 360 Ortho and Spine. Subject: Progress Notes, Fax#: 833-367-4968. SendDate: 28 Apr 202152:47, page 3/3 [-ufg2.4.1.12in]
What is signature date or signed on date?
{"text": [], "answer_start": []}