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|---|---|---|---|---|
id_1711476892.742118 | Andrew Hernandez |
26-03-2015 02:58 PM
TO:1659 3548959
FROM: 83359 74959
Page: 59
Proc ID: 12706
Page 9 of 59
FAPA
PostOP
Patient: Vincent Smith
DOB: 21-11-1995
FEINERMAN ANESTHESIA
MRN: C11959
Acct: C11959
DOS: 08-12-2023
Diagnosis: Other cervical disc displacement, high cervical region (M50.21), Spinal stenosis, cervical region (M48.02). Cervicalgia (M54.2),
Radiculopathy, cervical region (M54.12)
Procedure(s): Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of
herniated intervertebral disc; 1 interspace, cervical (63020), Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance
(fluoroscopy or CT); cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure) (64634), Destruction by
neurolytic agent, paravertebral facet joint nerve(s).
Patient is stable and can be discharged from the Post Anesthesia Care Unit
Signature
Signed by Andrew Duren (Anesthesiologist) 09-01-2022 11:18
PostOp Done Time: 04/06/2023 11:20
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711477090.813292 | Bryan Hill |
Jun 02, 2014 19:59:15 EDT
To: 195422268642
Page: 03/642
From: Lauris Rigdon
Patient Self-Report
Patient Assessment/Diagnosis
History of Present Condition:
Patient presents with acute LBP and right hip pain that
presents with acute low back and right hip pain following
started on May 20th following elevator accident. Functional
accident that occurred on May 20th. Pt explains that she was battling with
established with patient input.
allow patient to return to prior level of function,
independence and safety.
Onset Date: May 20th
Comorbidities:
- Psychosocial: Battling with high anxiety, difficulty talking
about accident
- Car accident in with back pain and left shoulder (2007)
e Currently experiencing excessive vaginal bleeding (being
monitored by OBGYN)
Pre Morbid Level of Function:
- Independent prior to injury
Current Level of Function/Current Deficits:
- Unable to get into/out of car without onset of pain
- Unable to stand for prolong periods of time
- Unable to walk her dog due to fear of worsening
symptoms.
Work tasks: Desk job at home, mostly on the computer
Sleep disturbance: Reports no change in sleeping pattern
Imaging:
X-ray: no abnormal findings.
CT scan of abdomen and pelvis: results pending
Red flags: Pt denies all red flags including but not limited to
weight loss/gain > 10
Patient Christopher Montgomery (DOB: Oct 16, 1998)
Treated by Sherry Harrington, PT. DPT
DOS: Nov 27, 2023
Page 2 of 42 of Plan of Care
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711476990.167523 | Connor Morgan |
08/30/2014 1:01:14 PM -0400 COVENTRY HEALTH CARE
COVENTRY
PO Box 565
Workers COUR
Hazelwood, MO 63065
MD Rezi, Toufan
San Leandro, CA 94577xxxxx
12/10/17
MD Joseph Schwartz
2465 Merced Street
San Leandro, CA 94877xxxx
Patient: Florentino Majia
Date of Injury: 30/03/23
Claim Number: 002408-001868-WC-65
Request for Authorization Received Date . 23/02/17
Date Lack of Information Letter sent
Reference Number. 10771065
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
30/03/15-30/03/15
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 Procedure Date? | {"text": [], "answer_start": []} |
id_1711477090.204215 | Benjamin Dixon |
I have reviewed and agree with the diagnosis and treatment plan.
Saman Aboudi MD
2022-05-02
7:19 PM
Electronically signed by Steve Rodriguez PA-C on 2017-09-03 at 7:16 PM.
Provider: Robyn Dettmar, PA-C
Document generated by: Saman Aboudi 2014-06-09 7:19 PM
PVHC At Claremont- Urgent Care
1601 N Monte Vista Ave Ste 190
Claremont, CA 9171 16643
(909)435-9943
0043
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711475190.251763 | Emily Stafford |
NH
NOVANT
Novant Health Urology
Emily Stafford
2580 Baldwin Lane
MRN: 55824587, DATE OF BIRTH: 2002 April 10, Sex: M
HEALTH
Winston-Salem NC 27583-5586
Date of Visit: 2015 October 09
2017 May 13 - Office Visit in Novant Health Urology - Baldwin (continued)
Clinical Notes Amb (continued)
Radiologic/Medical Testing Data Reviewed
I have independently visualized the images and found: testicular US 10/22/21:
Latest known visit with results is:
Office Visit on 2017 May 13
Component
Date
Value
Ref Range
Status
Cholesterol, Total
08/01/2022
191
100 - 199 mg/dL
Final
Triglycerides
08/01/2022
147
0 - 149 mg/dL
Final
Generated on 4/11/23 8:33 PM
Page 312
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711471329.117232 | Scott Richardson |
ciox
Fee Approval Request
HEALTH
CIOX HEALTH
Please deliver this to the following medical record requester:
Attention :
Facility:
Downtown Medical Center
Requester :
TScan
Site :
64580
Address :
0257 Victoria Isle
West Sandy, FM 99490
Address :
0257 Victoria Isle
West Sandy, FM 99490
City, State,
City, State,
Zip :
Seattle, WA 98199
Zip
Detroit, MI 48201
Rep
Telephone :
374-592-9180
CIOX Rep:
Vernette Gordon
#:
825121
Fax :
294-441-1438
Fax to:
Records
CIOX HEALTH REP Vernette Gordon
Fax Number: 313-993-0763
Phone: 313-745-3021
Dear Medical Record Requester :
Date: 22-05-07
CIOX HEALTH has contracted with Downtown Medical Center (Medical Facility/State) to copy
it's authorized requests for medical records.
03/28/2019
Patient name :
Scott Richardson
birth date :
03-10-21
Soc. Sec. # :
DATE OF SERVICE
23-09-22
CIOX HEALTH Fee Schedule
FOR MEDICAL RECORD REQUESTER USE ONLY
In order for your request to be processed you will need to complete the five items inside this box.
Approved
Date:
By:
Hamal
j
18-08-17
(Signature)
Print Name:
Phone:
Hannah Reifler
206-812-6911
Title:
Assistant Records Retrieval Specialist
MUST BE COMPLETED TO PROCESS REQUEST
Template Revision: 3.10.16
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711473530.418301 | Monique Tanner |
Ochsner
Health
THIS IS NOT A BILL
James Russell Ladner
4161 1ST AVE
BAY ST LOUIS MS 39520
The following document contains the itemized services requested for your visit on August 25, 2022 for James
Russell Ladner (Guarantor #116951641).
Coverage(s) on file:
Aetna Managed Medicare - Aetna Medicare Plan PPO
Patient Name:
ADMISSION DATE: 2014-06-06
Date of Discharge: 2014-06-07
Facility: KENNER HOSPITAL
Account Class: Emergency
Provider:
Diagnosis: Migraine, Crohn's Disease, initial encounter [S16.1XXA]
Svc Date
Code
Description
Qty
Amount
Charges
2023-27-07
71625
PR CT Scan, Cervical Spine, W/O Contrast
1
126.00
Questions?
Call 816-163-0169 or 516-162-4160,
| what is the admit date or admission date? | {"text": ["2014-06-06"], "answer_start": [363]} |
id_1711477090.558955 | Justin Weber |
newhope
chiropracltic
Acknowledgement of receipt of notice of privacy practices, consent for purposes of treatment,
payment and healthcare operations
I
acknowledge that I was provided a copy of the notice of privacy practices and that I have read them, or
declined the opportunity to read them, and understand that notice of privacy practices. I understand that this
form will be placed in my patient chart and maintained for six years
Patent records: Patient records, including X-rays, are the property of New Hope Chiropractic. These records are
only released with your written permission or as required legally. Some forms may have a fee. We request a
minimum of 24 hours notice for forms and letter to be completed by the provider.
Financial matters: Payment is due at the time services are provided unless prior arrangements have been made.
All charges will be explained to you prior to any service being performed.
Medicare: The office will accept assignment for Medicare. Patients are responsible for their copayment and
payment for any services not covered by Medicare.
Personal Injury: In most cases, this office will accept assignment for payment. If the office accepts assignment
for payment the patient is still legally responsible for their account balance. Patients will be required to sign a
lien in the case of personal injuries
Workers' Compensation: Work-related injury cases are accepted on assignments with permission of the
employer and prior authorization from the employer's compensation insurance carrier.
Massage Cancellations: In an effort to accommodate all patients, we ask that all patients keep their scheduled
appointments or proceed us with 24 hours notice (1 business day). Our office has a $25 administrative fee for
those who miss their massage appointments without advance notice. This policy helps to ensure that we can
accommodate you when in medical need.
I have read the above statements and accept these conditions.
Print name: Alan Pearson
Signature:
Gerorth
Date:
13/23/03
Dr Ryan Brooks Chiropractic Physician
Address. 4746 S. Florida Ave. Lakeland, FI 33846 Phone. 863.462.1460
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711471329.768339 | Amanda Davis |
Recv'd Date: 23811625
Bill DCN: 2019143GJ975829
2017 February 27 Fri 11:20
Hilltop Healthcare 763-896-3773
ID: #11172 Page 1 of 2
Hilltop Healthcare
OPERATIVE REPORT
Patient Name:
Amanda Davis
BIRTH DATE:
2003 February 21
Date of Procedure:
2018 December 11
PREOPERATIVE DIAGNOSIS: Diverticulitis.
POSTOPERATIVE DIAGNOSIS: Diverticulitis.
PROCEDURES:
1. Transforaminal lumbar epidural steroid injection via the right L5 neuroforamen.
SURGEON: Dr Dr. Catherine Richards, M.D.
ANESTHESIA: Intravenous sedation and local anesthesia.
PATIENT IDENTIFICATION: This patient is a 30-year-old gentleman, who was injured at work by shuffling
concrete and he had an MRI scan that showed severe spinal stenosis at L3-L4, moderate bilateral lateral
recess narrowing and moderate bilateral foraminal narrowing at that level, at the level of L4-L5.
DETAILS OF THE PROCEDURE: After informed consent, the patient was given intravenous access. He was
then taken to the operating room for the procedure.
757 Stevens Hill
Crystalville, KY 34023
Phone: (408) 988-0105 (406) 938-002
3672
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711473237.770852 | Francisco Edwards |
NORTHWELL HEALTH
LONG ISLAND JEWISH MEDICAL CENTER
233-33 33th AVENUE, NEW HYDE PARK, NEW YORK, 13340
PATIENT NAME: ALVARADO, LISA
MEDICAL RECORD #: 033003310331
birth date: 09/92/12
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 Cody Daniel, M.D. (09337) 18/19/06 4:36 PM
TRANS:
V_TSMAL_ I/ 06/28/2022 0336
Signature: Rand I. Rodgers 23/14/10 08:19:56 AM
Page 2 of 2
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711475621.067006 | Michael Long |
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
Michael Long
LAST NAME:
FIRST NAME:
BIRTHDATE: 2002-03-12
7862538738
CELL PHONE:
7878 Teresa Union
Port Karenton, MO 81663
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
2021-02-11
DATE OF ACCIDENT:
The Law office of Edersy Suarez, P.A
LAW FIRM:
Edersy Suarez
ATTORNEY NAME:
DocuSigned by:
PATIENT SIGNATURE:
Rher
DATE:
2021-09-10
F83488BE1E2D4FB.
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711476893.319812 | Kelsey Casey |
11/17/03 9. 22:29 AM. - NorthBay Health System 707-646-5000 Page 3 of 70
1101 B. Gale Wilson Blvd, Suite 100 Fairfield, CA 94533 (707) 646-4646
Magnetic Resonance
/
m
a
Exam Date/Time:
Exam:
Accession Number:
Ordering Physician:
07/23/10 09:26:3"
MR MRI Lumbar Spine MR-12-0002095
Kitchens, Charles, M.D.
w/o Contrast
causing significant encroachment upon the central spinal canal or neural
foramina.
IMPRESSION:
1. Large central disc herniation with small inferiorly extruded disc fragment
at L5-S1. There does not appear to be significant encroachment upon the central
spinal canal or neural foramina.
DT: 18/14/07 (1226 hours)
Final Report ***
Dictated by: Becky Cervantes N., M.D.
Signed by: Dennis Harris, M.D.
Transcriptionist: McGraw, Tena
04/23/06 12:01
Paient
Name: Kelsey Casey
Medical Record No: 608698
Financial No: 80107087
DOB: 12/01/12 Age: 26 years Gender Male Pt Type: Outpatient
Diagnostic Imaging
Admit Date: 09/14/11
Ordering Physician: Kitchens. Charles, M.D.
Solano Imaging Medical Associates
Becky Cervantes, M.D.
Dennis Harris, M.D.
William N. Gonser, M.D.
Printed 11/17/03 at 9:21 AM
Page 2 of 70
170
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711476768.741123 | Sean Rodriguez |
WEST, Wade DOB: 1984 December 25 (59 yo M) Acc No. 17158 DOS: 2014 December 13
4. Lumbar facet joint syndrome - M47.816
Cervical facet syndrome
C5/C6 and C6/C7 disc herniation
Intermittent cervical radiculopathy
L5-S1 disc herniation
Right-sided radiculopathy lumbar
Lumbar facet syndrome
EMERGENCY MEDICAL CONDITION
The injuries the patient sustained as a result of the motor vehicle accident pose great risk to their health both
now and in the future. An Emergency Medical Condition (EMC) is defined as: (i) placing the health of the
individual in serious jeopardy, (ii) serious impairment to bodily functions, or (iii) serious dysfunction of any
bodily organ or part. Based upon a reasonable degree of medical probability, it is my belief that the
aforementioned deficits exhibited during this exam meet the criteria for an "EMC" and warrant aggressive
treatment to prevent permanent and irreversible damage to the patients health and body as a whole.
Treatment
1. Others
Notes: Today the patient and I reviewed their MRIs on a frame by frame basis.
Visit Codes
99204 Office Visit, New Pt., Level 4.
CUD...
MJ
Electronically signed by Ashley Williams on 2023 February 04 at 08:38 AM EST
Sign off status: Completed
Progress Note: Charles W. Davis II, MD 01/10/2023
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711476990.034817 | Taylor Hobbs |
Pacific Pain
Institute
Visit Note - Follow-up Visit
Provider:
Supervising: Ryan Andrews, M.D.
Performing: Dylan Hanson, PA-C
Encounter Date: 2016-30-01
Patient: Mejia, Florentino (PT00001958)
Gender: Male DOB: 2003-23-01 Age: 28 year 2 month
Race: Other
Address: 1678 Travion #t #1, Fairfield CA 94533
Injury Date: 2015-27-12
Employer: Chevys Fresh Mex
Case Insurance: Gallagher Bassett 14278
Complaint:
Mr. Florentino is a 28 year old male here today for a follow up visit. He sustained injury at work
on Dec. 6, 2011. He is having pain in back and right leg pain. His current pain level is a 8 on the
1-10 pain scale. His pain is constant and he describes it to be a aching, dull, sharp and shooting
pain. His pain radiates up his neck and down his right leg. He is also experiencing numbness,
pins/needles in right leg and weakness in right leg due to the pain. Any prolong sitting, walking
and bending worsens his pain. To relieve the pain he takes medication and uses ice packs.
Patient reports some nausea and dizziness to his medications. Patient states his current pain level
is without any medications.
Current Medication:
1 Cyclobenzaprine 7.5 Mg Tablet SIG: Take 1 tab at bedtime
2 Medrox SIG: Apply to affected area 2-3 everyday
3 Pantoprazole 20 Mg Tablet Dr SIG: Take 1 tab daily everyday
ROS:
Neurologic: (+) numbness, (+) tingling.(+) right lower extremity weakness.
Examination:
Patient: Taylor Hobbs DOB: 2003-23-01 Visit: 2020-06-03 Page: 78
678
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475620.719932 | Tonya Curtis |
04 August 2016
eCW (Schaubhut, Roslyn )
Tonya Curtis DOB: 19 November 1993 (76 yo M) Acc No. 95114
REFERRAL
KATE MCDONALD, MD
Tonya Curtis
Family Practice
19 November 1993
,,-
Tel: Fax:
Reason For Referral:
Authorization No:
Authorization Type:
Reason:
Please evaluate and treat.
Diagnosis:
G44.309 - Post-concussion headache
S06.0X0A - Concussion without loss of consciousness, initial encounter
E/M Codes:
Procedures:
Visits Allowed:
0
Unit Type:
V (VISIT)
Start Date:
04/19/2021
End Date:
04/19/2022
Notes:
Clinical Notes:
Structured
Data:
Kate
ml
Provider NPI:
1679594212
Electronically signed by McDonald, Kate on 03 April 2018 at 02:42 PM CDT
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711471329.59991 | Kristin Mclaughlin |
11:51
8005481240
MEW111 ADMIN DEF
PAGE 1/04
Lakefront Health
Lakefront Health
6946 Lutz Branch Suite 418
West Jason, GA 97744
Phone: 138-478-9702 Fax: 398-284-2070
Facsimile Cover Sheet
Please call sender if not all of the pe are
received.
Please Note: The fax number you are being asked to send medical documentation to is a ax line under
the requirements of the Health Insurance Portability and Accountability Act. (HIPAA)
Michael Aguilar
To:
398-284-2070
Fax
Attn:
*** Urgent
Phone:
From:
Karen Sanchez
Date:
2018 October 15
Case Manager
Page(s):
3
Patient's Name: Kristin Mclaughlin
D.O.B: 2001 May 03
RE: Claim Number: 69871806012
STD
X Completed Physician Statement +attached)
Office Visit Notes, Return to Work Considerations-with or without Restrictions, Estimated RTV
Please send this information bark to our office within 48 hours as this information is requir Entercless your
requests to your patient.
Thank you,
Karen Sanchez
Case Manager
Ph: 138-478-9702
Fax: 398-284-2070
The Genetic Information Nondiscrimination Act of 2008
The Genetic Information Nondiscrimination Acit of 2008 (GINA) prohibits employers and other entities covered by GI
ssistive reproductive services
10-10-2013
2013252242
44201503201020806
SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.
[6687671-01] 190
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711473365.74245 | Timothy Ho |
Discharge Information
Attestation
Attestation to: I personally interviewed the patient, I personally examined the patient, I certify that the services
provided were clinically indicated and medically necessary for the care of this patient.
Electronically signed by: GO MD, JENSEN L
On 05-16-2023 20-04
Electronically Co-Signed By:GO MD, JENSEN L
On: 12-14-2016 08:10
Patient name:
Timothy Ho
MRN: 73126315
FIN#: 93110315
Printed On:
10/30/2023 05:11 EDT
Page 37 of 516
Report Request ID#: 323134318
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711476767.093984 | Maria Calhoun |
10/2018/20 02:58 PM
TO: :16103548969 FROM 8333674969
Page: 69
SIMONS, CHARLES
TAMPA BAY
C11920 DOB:10/2002/10
SURGERY CENTER
CASS
Lisa Aguirre MD
SELFPAY
Perception of Care - Post-Op Telephone Call / Follow-up Information
PATIENT PHONE # xxxxxx
Caregiver: Sherry
Date of Service: 06/2021/20
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: 10/2018/20 Initials: a
Left Voicemail Message
Other
Patient Satisfaction Questionnaire completed
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711475190.454622 | Dylan Yoder |
NOVANT
NOVANT HEALTH MEDICAL
Dylan Yoder
N
PARK HOSPITAL
MRN: 52924297, DATE OF BIRTH: 15-08-2000, Sex: M
HEALTH
1290 South Hawthorne Road
Adm: 27-04-2018, D/C: 27-05-2018
Winston-Salem NC 27293-3292
26-09-2021 - Admission (Discharged) in NHMPH Surgical Services (continued)
Results
Imaging:
No results found.
Electronically signed:
Dr Daniel Morris, MD
24-05-2016 / 3:35 PM
Electronically signed by Brandon L Craven, MD at 10/20/22 1536
Op Note
Brandon L Craven, MD at 10/20/2022 1639
Author: Brandon L Craven, MD
Service: Urology
Author Type: Physician
Filed: 10/20/22 1641
Service Date: 02-02-2024 1639
Status: Signed
Editor: Brandon L Craven, MD (Physician)
NOVANT HEALTH MEDICAL PARK HOSPITAL
Operative Note
Surgery Date: 01-11-2023
Generated on 4/11/23 8:32 PM
Page 254
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711473237.373695 | Chad Ford |
39
FAX
MRN: 1934636H
Chad Ford
Nassau Unly. Medical
Gender: Female
Center
Age: 23y (1986 January 11)
Current Location:
Surg-Pediatric Eye Clinic
AMB OPHTH New Patient Ophthalmology Visit [Charted Location: Surg-Pediatric Eye
Clinic [Service Date: 2018 May 26 1:5, Authored: 07-Apr-22 10:53]- for Visit:
7710879X1004010031,
Notice of Status and Rights Involuntary Admission:
Patient's Name: Chad Ford
MRN: 1910710H
Sex: Female
dob: 1986 January 11
Facility Name: Nassau University Medical Center
Date of Admit: 2024 January 22 10:31
Date & Time: 2017 January 03 11:01
Allergies:
Allergy, Intolerance, Adverse Event:
Allergies:
No Known Allergies: Active
HPI:
Ophthalmology HPI:
Chief Complaint
Left ruptured globe
Page 1 of 6
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711476893.373623 | Tiffany Rivera |
2278 Post St., Suite 278
Integrated Pain Care
3178 Garrity Way
San Francisco, CA 94115
Tel (510) 16648
A Pain Management Clinic of Excellence
Tel (510) 16648
Fax (800) 16648
May 14, 2019
Paulette Cass, D.C.
88 Belvedere Street, Suite 206
San Rafael, California 94901
Re:
Mr. Floretino Mejia
Date of Birth:
Mar 25, 2000
Date of Injury:
Aug 17, 2023
Employer:
Chevy's
Occupation:
Cook
Insurance Carrier:
Gallagher Bassett
Claim Number:
002406-001366-WC-78
EAMS #:
ADJ8510078
Date of Examination: Sep 19, 2019
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 DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711471328.807757 | Matthew Holmes | Rosewood General
Patient Name: Courtney Ramos
Rosewood General
MRN: 00094620, birthdate: Jun 11, 1992, Sex: M
Rosewood General
58221 Matthew Forks
Johnsonfurt, AS 12554
Acct #: 7813965
Patient Info
Patient Name
Account Number
Gender
birthdate (Age)
Matthew Holmes (00094620)
7813965
Male
Jun 11, 1992 (26 year old)
Patient Demographics
Address
Phone
45823 Hughes Plaza Suite 661
North Rickyside, NY 94402
163-516-5833 (Home)
Emergency Contact(s)
Name
Relation
Home
Work
Mobile
Courtney Ramos
Girlfriend
163-516-5833
Epic Admission Information
Arrival Date/Time:
04/17/2018 1005
Admission Date/Time:
Jan 01, 2023 1005
IP Adm. Date/Time:
Admission Type:
Emergency
Point of Origin:
Emergency Room
Means of Arrival:
Walk In
Primary Service
Emergency
Secondary Service:
Transfer Source:
Home
Service Area:
MEMORIALCARE
Unit:
CHLB EMERGENCY
SERVICE AREA
Admit Provider:
Attending Provider:
Dr Jacob Shah, MD
Referring Provider
DATE OF DISCHARGE/Time
Jan 31, 2023 1155
55 of 107
06/15/2021 | What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711475741.209105 | Chelsea Diaz |
Chelsea Diaz DOB: 91/12/16 (48 yo M) Acc No. CR148278
[Doc Name: Ortho One Recs - DOS 15/09/05-323054]
Chelsea Diaz
Visit Note - 16/06/09
PMS ID:
Sex:
DOB:
Phone:
MRN:
48278PAT34620022261 Male 91/12/16 (xxx) xxx-xxxx MM0000007835
Musculoskeletal, and Neurological
presentation and mechanism of injury. Contusions can be expected to remain the same in some cases, but
and was notable for joint pains, joint
enlargement in the setting of symptoms such as progressive neurologic dysfunction is an indication for urgent
stiffness, and unsteady gait.
Loss, And No Redness.
Contact office if: the patient experiences increasing pain or swelling, numbness or tingling in the affected
extremity, or an enlarging mass.
Patient to cont. PT
I discussed the following medical options with the patient:
Acetaminophen : Acetaminophen is a drug that is commonly used as a pain reliever. The maximum daily dose is
4 grams.
After counseling, we decided on the following plan: Conservative Management, Observation, and Physical
Therapy
Follow up in 4 weeks. Other Instructions: follow up
Staff:
Fady Bahri (Primary Provider) (Bill Under)
Electronically Signed By: Fady Bahri, 22/10/14 03:20 PM EDT
Fady Bahri (Primary Provider) (Bill Under)
Southside
Page 2
(904) 619-3048 Work
6100 Kennerly Road Suite 202
Jacksonville, FL 32216-4979
Chelsea Diaz DOB: 91/12/16 (48 yo M) Acc No. CR148278
Page 166 of 166
| what is the visit date or date of visit? | {"text": ["16/06/09"], "answer_start": [139]} |
id_1711471329.22704 | Nathan Fox |
602 William Islands Apt. 027
West Michaelshire, DC 32655
Nathan Fox (id #922514, DOB: 22 Mar 1989)
Encounter Date: 24 Oct 2019
Patient
PATIENT NAME
Nathan Fox (59yo, F) ID# 922512
Appt. Date/Time
11 Feb 2020 11:00AM
DOB
22 Mar 1989
Service Dept.
MGPC_Grove City Broadway
-
Provider
MOIRA SKURATOWICZ, APRN
Insurance
Med Primary: AETNA
Insurance # : W212268246
Policy/Group # : 010921919293932
PCP : MILLER, TERESA
Prescription: CVS|CAREMARK - Member is eligible. details
Patient's Care Team
Primary Care Provider (Primary Insurance): MILLER, TERESA: 3667 MARLANE DR, GROVE CITY, OH 43123, Ph 600-279-6261, Fax 787-847-3514
Vitals
11 Feb 2020 03:12 pm
Ht: 5 ft 4 in
Measurements
None recorded.
Allergies
Reviewed Allergies
Loratadine: Hives (Moderate)
DIPHENHYDRAMINE HCL: - COMMENT: CAUSATIVE AGENT: BENADRYL;
YEAST: - REACTION: HIVES, RASH;
Medications
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711475620.972456 | Elizabeth Davis |
AssociatesMD
Main Line: (954) 450-8500
2004 N Flamingo Rd
Braid
Pembroke Pines, FL 33028
Computed Radiography read by Braid Medical Group
PATIENT NAME: Elizabeth Davis,
ID NUMBER DOB/SEX
DATE OF SERVICE
294478
1965-07-271 male 27/10/2022
Performed at:
ASSOCIATESMD
Computed Radiography performed:
CHEST PA, CHEST LAT
Clinical History: N/A
Comparison: None
Technique: CHEST PA, CHEST LAT
FINDINGS:
The cardiac silhouette is normal.
There is no radiographic evidence of pulmonary edema.
There is no radiographic evidence of pneumonia.
There is no pneumothorax visible.
IMPRESSION:
No significant abnormality.
Report electronically signed by: Braid Medical Group - Scott Logan, MD MBA at 11:26 GMT-4,
Scan to see visual report
CHEST PA
CHEST LAT
Braid
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711475444.265495 | Megan Burton |
03-08-2023 FROM- CWFMD
936-703-5455
IMPORTANT: PLEASE PRESENT THIS SLIP AT YOUR APPOINTMENT
Women's Imaging Center
CONROE REGIONAL MEDICAL CENTER
Patient:
Erica Pirie
D.O.B.: 07-06-2001
& SCREENING BILATERAL MAMMOGRAM (Asymptomatic Patient with or without implants)
Diagnostic Bilateral Mammogram (Symptomatic, Olinical Findings with or without Implants)
Spot Compression
Stateotacitio Core Bx
*Galactogram
Ultrasound of the Breast(a)
Patient Diagnosis:
CHANGE
maxine
and Discretion
design
CONROE
13057
QUEST
Signature
REGIONAL MEDICAL CENTER
May 100
Yesya
GIN
ST
508 Medical Ctr Slvd. (2nd 1001 behind elevators)
Conton, Texas 77304
TOTAL
It 17318
(336) 589-7522 to schadule an appointment
1-882-MED-CNTR 1-382-693-2847METRO # 21-564-7000 ext 7100 (030) 530-7100. Fax (938) 839-7622
us May
BCDG-12 NEV. 08/07)
This term must be dated and will be valid for six (6) months.
June family no
from HI
Physician Signatura:
Date: 09-18-2017
condide
ACCOUNT INFOICAL CENTER
Love
promit
0102-11-90
LOOS BEL
JASON LANINGHAM, M.D.
804 West Montgomery
Name: Megan Burton
DOB: 07-06-2001
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711471328.583636 | William Kennedy | Bayside Hospital
Regina Huff
9659 Amanda Expressway
Ashleyberg, MA 53803
MRN: 3533514 birth date 89-10-16. Sex M
VISITING DATE: 17-10-08
Patient Demographics
PATIENT NAME
Patient ID
SSN
Legal Sex
birth date
William Kennedy
3533514
xxx-xx-0042
Male
89-10-16 (19 yrs)
Address 10904 Joshua Roads
Brownport, LA 07534
Phone 375-998-7653
Race
Tongan
Reg Status
PCP
Date Last Verified
Next Review Date
Verified
Karsman, Alina,
02/03/23
03/05/23
MD818-271-2400
SCIP
Mantal Status
Religion
Language
Married
Christian
English
Primary Subscriber
Subscriber Name
Pat Rel to Sub
Subscriber Address
Subs Rel to Guar
Regina Huff
Self
10904 Joshua Roads
Brownport, LA 07534
4572 of 5499
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711475190.116237 | James Lara |
Novant Health Mothershed Foot James Lara
N
NOVANT
& Ankle Specialist
MRN: 52924297, DOB: 1987 Apr 27, Sex: M
HEALTH
429 Pineview Drive Ste 290
visiting date: 2016 Jan 20
KERNERSVILLE NC 27294-
3817
2023 Nov 18 - Office Visit in Novant Health Mothershed Foot & Ankle Specialist (Kernersville) (continued)
Clinical Notes Amb (continued)
Electronically Signed by Robb A Mothershed, DPM at 2016 May 09 1292
Order Level Scans
Govt Form IM (e-sig) - Electronic signature on 10/20/2022 1508 (effective from 10/20/2022) - E-signed
Generated on 4/11/23 8:32 PM
Page 224
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711471328.406602 | Cameron Henry |
AdventHealth Waterman
1270 Waterman Way
Tavares, FL 32778-
Computerized Tomography
ACCESSION
EXAM DATE/TIME PROCEDURE
ORDERING
STATUS
PATIENT AGE AT
PROVIDER
EXAM
CT-21-0027811
01/09/22 22:25
CT Head/Brain WO JEAN-BAPTISTE Auth (Verified)
87 years
EST
Contrast
MD,NAOMI
CPT code
70270
Reason For Exam
(CT Head/Brain WO Contrast) fall w/ head trauma
Report
EXAM: CT BRAIN WITHOUT CONTRAST
INDICATION: Fall.
COMPARISON: None
TECHNIQUE: Axial images from foramen magnum to vertex without contrast.
FINDINGS:
EXTRAAXIAL SPACE: Ventricles appear age appropriate. No midline shift.
CEREBRUM: There is prominence of ventricles and sulci consistent with age-related atrophy.
CEREBELLUM: Cerebellar hemispheres and vermis are well formed without mass lesion or focal attenuation abnormality.
No cerebellar tonsillar ectopia greater than 5 mm identified.
IMPRESSION:
patient name: Cameron Henry
MR#: 1234277
FIN#: 3927847
Print Date/Time: 10/11/21 09:28 EDT
Page 26 of 91
Privileged and Confidential do not re-release
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711476990.16843 | Trevor Solis |
08/30/2014 1:01:14 PM -0400 COVENTRY HEALTH CARE
COVENTRY
PO Box 556
Workers COUR
Hazelwood, MO 63056
MD Rezi, Toufan
San Leandro, CA 94577xxxxx
Oct 28, 2017
MD Kelli Moss
2456 Merced Street
San Leandro, CA 94877xxxx
Patient: Florentino Majia
Date of Injury: Aug 06, 2023
Claim Number: 002408-001868-WC-56
Request for Authorization Received Date . May 21, 2019
Date Lack of Information Letter sent
Reference Number. 10771056
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
Nov 25, 2018-Nov 25, 2018
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 Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711477182.907829 | Amanda Brown |
LOUISIANA PAIN
SPECIALISTS
PAIN DIAGNOSIS & INTERVENTION EXPERTS
Deborah Peterson
Sex: Male, Date of Birth: November 18, 2001
Visit Date: November 01, 2023
Attending Provider: Suneil Jolly, MD
Referring Physician: Suneil Jolly
History of Present Illness
Follow Up - PF
Follow up details: The patient returns today for an office visit 9/18/20: Patient f/u for ongoing neck pain radiating to
left upper shoulder area and lower back pain. Patient s/p Cervical ESI (9/10/20) with limited relief. Since last OV,
patient reports pain unchanged. He brought in disc from VA of Lumbar X-ray. Images were personally reviewed per
Dr. Jolly in clinic today and then reviewed with pt. In clinic today. However, he reports his neck remains his primary
pain generator at this time. Will recommend Lumbar MRI if indicated in future. Patient denies any new pain
generators, weakness, injuries, bladder/bowel incontinence or saddle anesthesia. His current pain level is 7/10
Patient reports that his pain is well controlled with prescribed medications . States that his pain is relieved by 30%
by taking medications Patient reports that his current funtional level is much improved with medication. States that
his quality of sleep is fair. He denies any misuse or abuse of medications, denies taking any illicit drugs or any pain
medications from any other source. He describes his mood as good Patient reports no side effects from the
medications.
Past Medical History
Diabetes () . Anxiety ()
Surgical History
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711471328.294335 | Catherine Schwartz |
Central City Clinic
2024-05-03 29:29
Fax
78703272259
DOB: 1985-14-05
p.29
Catherine Schwartz clinical impression
Parkinson's Disease L TMJ M26.642, probable Articular Disc Disorder M26.633, Myalgia M79.11 and M79.12
Today, we spent 29 minutes face-to-face, predominately counseling, reviewing test results and other findings and discussing the risks,
benefits, alternatives and limitations of therapy.
Treatment Plan
nPSG-Doesn't wish to do another sleep test-feels just needs to use Nasonex-feels congested in nose when she sleeps
29 mg Hyalgan L TMJ-send PreAuthorization for Hyalgan
We would like to see the patient in
29 weeks
Dr Jacob Kelley
Digitally signed on 2014-31-07 at 29:29 PM
000029
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711476578.484844 | Kristi Smith |
Patient: Alan Romero DOB: July 03, 1985
Alan Romero DOB: July 03, 1985 (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: Alan Romero
Dr Angelica Wagner MD
Date of Birth: July 03, 1985
680 N UNIVERSITY DRIVE
Phone: (754) 265xxx
Pembroke Pines Florida 330xx
MRN: 693xxx Acc: ER10847xxx
Fax: (877) 843xx
Date of Exam September 20, 2015
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: February 29, 2020
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: September 20, 2015 1:15 PM
Page 1 of 50
OWENS, Shannon DOB: Nov 17, 1976
Page 150 of 150
Document: May 21, 2014 Records
Printed: May 21, 2014 12:22:11
Page 150 of 150
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711473365.662238 | Taylor Hernandez DVM |
<<Back to Review>>181998-19-HYPERLINK- Hyperlink-Page
2
FEED
03/22/2018 09:43 AM
Work Wellness
1191 Colorado Ave Ste 119. Turlock CA 91982
Page 1 of 1
(219) 219-3193 Fax: (199)196-3190
Test Form
Test Form
PATIENT NAME: Taylor Hernandez DVM
BIRTH DATE: 03 Dec 1994
Age: 49 Years
Home Phone: (219) 199-3192
Sex: M
SSN: 519-19-0193
Order Number:
211970-4
Quantity:
1
Start Date:
03 Sep 2014
Priority:
Normal
Signature:
Carrie Janiski
Signed on:
15 Dec 2022 3:14:08AM
Instructions:
WITH STRESS VIEW(S)
thank you
Report run by Carrie Janiski DO
001902
0192
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711472285.266931 | Rebecca Young |
7609521074
16:08:03
11-09-2017
4/6
STATE OF CALIFORNIA
DOCTOR'S FIRST REPORT OF OCCUPATIONAL INJURY OR ILLNESS
PATIENT NAME (first name, middle initial, last name)
Sex
57. Date of
Mo. Day
Yr.
Age
Rebecca Young
Birth 25
Address:
8549 No. and Street SUC Box City Vidoroille Zip CA 92345
19. Telephone number
10. Occupation (Specific job title)
Social Security Number
Diseuse
Teacher guiste
526-23-7241
13 Date and hour of injury
MaDal
2020-21-04
4. Date last worked
Mo. Day Yr.
Occupation
or onset of illness
a.m.
p.m.
Oct, 13, 2017
15. Date and hour of first
Mo. Day Yr.
Hour
Return Date/Code
examination or treatment
2023-22-05 if Others
a.m.
p.m.
treated patient?
Doctor's Signature
/ JV Jonethan Luna, PA
CA License Number A044696 / PA17660
Doctor Name and Degree (please type) Roger A. Moushabek, M.D.
IRS Number 10/16/17
Address 12408 Hesperia Road
Suite # 25
Victorville
CA
92395
Telephone Number 760-952-1222
01/09/2018
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711472590.915423 | Edward Jones |
05/2016/13 11:00:10 AM
Assumption Primary Care 9855816792
5/11
Edward Jones (MRN 479094) DOB: 07/1991/15
encounter date: 03/2016/09
MRN: 79094
Edward Jones
Office Visit 02/2021/01
Provider: Jacobs, April, NP (Family Medicine)
Assumption Primary Care
Primary diagnosis: Acute bilateral low back pain without sciatica
Reason for Visit: Back Pain; Referred by Paille, Nicole, NP
HPI:
Nadine A Buggage is a 81 y.o. female who presents to the clinic today with Back Pain
(Patient here today for follow up back pain from a fall 1 week ago.
Review of Systems:
Review of Systems
Constitutional: Negative for chills, fatigue and fever,
HENT: Negative for congestion, ear discharge, ear pain, postnasal drip, rhinorrhea, sinus
pressure, sinus pain, sneezing, sore throat and voice change.
Objective:
Physical Exam
Vitals reviewed.
HENT:
Head: Normocephalic.
Neck:
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711473530.490687 | Rachel Sims |
KNMH CT SCAN
Rachel Sims
180 W Esplanade Ave
MRN: 8138138, dob: 22/95/06, Sex: M
Kenner LA 71365
Acct #: 81303136131
Enc. Date 09/22/04
08/25/2022 - Appointment in Kenner - Diagnostic Ctr (continued)
Outpatient Medications at Start of Encounter as of 8/25/2022
Disp
Refills
Start
End
gabapentin (NEURONTIN) 300 MG capsule
Sig - Route: Take 900 mg by mouth 3 (three) times daily. - Oral
Class: Historical Med
Lab and Imaging Orders
CT Cervical Spine Without Contrast
Electronically signed by: Dayna G. Toscano, NP on 04/19/10 1009
Status: Completed
Ordering user: Dayna G. Toscano, NP 08/25/22 1009
Ordering provider: Dayna G. Toscano, NP
Authorized by: Dayna G. Toscano, NP
Ordering mode: Standard
Ordered during: ED on 13/19/02
Indications of use: Neck trauma (Age >= 65y)
Result
CT Cervical Spine Without Contrast (Order
413901330)
Generated on 10/3/22 11:37 AM
Page 2
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711476892.904675 | Tyler Erickson |
Date 27 Jun 2020
Occupational Health A Northbay Affiliate
Page 34
1101 B Gale Wilson Blvd Suite 203
8176530, Fax: 8176530
Work Status Summary
Company:
Chevy's- FF
Employee:
Florentino Mejia-Gallego
1400 Kansas St.
Fairfield, CA 14063
Attention:
Michael Mason
Ident:
xxx-xx-8092
Telephone:
Fax:
Department:
Job Title:
Provider:
Lucas Jones MD
Visit Date:
25 Jun 2022 Time In: 10:11AM Oui: 3:25PM
Purpose:
Worker's Comp (Injury) New
Insurance Information
:
GALLAGHER BASSETT
Contact:
Fax:
714xxxxxxx
Presenting Problem
Date of Injury:
15 Sep 2020
Case Number: 2012-14063
Description of Services
Auth
Authorization For Treatment
Visit Referrals
Referred To: A Pharmacy Referral - NOS
Date: 27 Jun 2020
Current Work Restrictions
No Lift/Push/Pull/CarryOver 15 Lbs
Starting: 27 Jun 2020
Continuing
No Bending/Stooping
Starting: 27 Jun 2020
Continuing
Work Status
1.
Work Status: Released for Restricted Duty As Of: 27 Jun 2020
/
Follow-up Appointments: 20 Jul 2020 at 10:15AM
Worker's Comp Follow Up
Eric Price MD
134
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711473366.090343 | Meagan Holmes |
athena
10/30/2023 1:33:13 pm EDT
Page: 55/86
Meagan Holmes (id #17347392, date of birth: Sep 04, 2003)
Baptist Health
Health Information Management Dept
Meagan Holmes
3563 Philips Highway Building B. Suite 201
MRN: 57354730 date of birth: Sep 04, 2003, Sex: F
Jacksonville FL 32207-5663
Acct #: 24001074438
Adm: Nov 07, 2020 D/C: Dec 07, 2020
07/15/2023 - ED in Baptist Clay Emergency (continued)
Medical Decision Making:
20-year-old female with seizure today.
EKG:
Date of Encounter: Jun 23, 2021
Confirmed by Arcement, Adam (912) on
Radiology:
head we IV contrast.
Final Result
CT HEAD WITHOUT IV CONTRAST
DATE OF EXAM: Jul 11, 2015 2:17 AM CD
Printed on 7/27/23 at 8:20 AM
Release ID: 28735732
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711476893.072642 | Brandon Sutton |
Date 2016/11/10
Occupational Health A Northbay Affiliate
Page
I
1101 B. Gale Wilson Blvd, Suite 203
Fairfield, CA 94533
(707) xxx-4600, Fax: (707) xxx-4601
Work Status Summary
Company:
Chevy's- FF
Employee:
Florentino Mejia-Gallego
1630 Travis Blvd
1634 Travio Ct.
Fairfield, CA Random_5_digit_number
Apt. #1
Fairfield, CA Random_5_digit_number
Attention:
Michael Howard
Ident:
xxx-xx-8092
DOB: 1996/07/12
Telephone:
(707) xxx-8374
Fax:
(707) xxx-2134
Department:
Job Title:
Provider:
Kitchens, Charles MD
Phone: (707) xxx-5182
Visit Date:
2015/08/01 Time In: 9:51AM Out: 10:45AM
Purpose:
Worker's Comp Follow Up
Insurance Information
GALLAGHER BASSETT
Contact:
P.O. BOX 31505
Telephone: 714-31505 Ext:
ANAHEIM (South), CA 92825-31505
Fax:
714-9331505
Presenting Problem
Date of Injury:
2015/14/11
Case Number: 2012-31505
Claim Number:002406031505WC01
Diagnosis
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711473366.08942 | Tony Lloyd |
athena
10/30/2023 1:33:13 pm EDT
Page: 55/86
Tony Lloyd (id #12942992, BIRTHDATE: 29 July 1992)
Baptist Health
Health Information Management Dept
Tony Lloyd
3563 Philips Highway Building B. Suite 201
MRN: 52954290 BIRTHDATE: 29 July 1992, Sex: F
Jacksonville FL 32207-5663
Acct #: 24001074438
Adm: 03 July 2015 D/C: 02 August 2015
07/15/2023 - ED in Baptist Clay Emergency (continued)
Medical Decision Making:
83-year-old female with seizure today.
EKG:
DATE OF ENCOUNTER: 03 November 2022
Confirmed by Arcement, Adam (912) on
Radiology:
head we IV contrast.
Final Result
CT HEAD WITHOUT IV CONTRAST
EXAM DATE: 18 February 2021 1:6 AM CD
Printed on 7/27/23 at 8:20 AM
Release ID: 28295292
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711477275.406678 | Joseph Lopez |
Orange County Corrections Health Services Dept
2023 May 07
PO Box 49Xx Orlando, FL 328xx
Page 42
4072548306 Fax:
Chart Document
DARIUS DESHAWN BOUEY
Home: Work:
Male DOB: 2003 Apr 22
P005613xx
Tremors: No
Endocrine
Vomiting: No
Breath Odor: No
Mental Confusion: No
Weight Changes: No
Heme/Lymphatic
Lymph Glands: Non-Enlarged
Bleeding: No
Bruising: No
Allergic/Immunology
Eye discharge: No
Nasal Discharge: No
Sneezing: No
Shortness of Breath: No
Dental
Missing Teeth: No
Broken tooth/teeth: No
Broken appliance: No
Bleeding gums: No
Oral/Facial Swelling: No
Drainage: No
Dentures present? No
Inmate Trustee Status: Y-A
Medical Grading
Medical Grading(Housing Recommendation) GP
HIV Survey Printed: Yes
Sick Call Scheduling
Scheduled? No
Created on 07/24/2010 11:03 AM
Electronically signed by Ellarea Farwell, RN on 2018 Oct 17 01:10 PM
Electronically signed by Edwin Pont, MD on2018 Oct 17 05:52 AM
PHA:Physical Assessment Export on Wednesday, December 6, 2023 12:14 PM by InDxLogic Chart Exporter
Page 4 of 42
(MD178@orang637469 - Orange County Health Services)
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711476767.589159 | Cameron Harper |
05 March 2016 08:36
1
12
unknown
P 8/37
Susan Howard
Coastal Neurology
Page:
7
610 Trenia Ann I
725 W Granada Blvd. Ste 22
Date: 05 March 2016
Orange City
FL
32763
Time:
Ormond Beach, FI 32174
7:50 AM
Patient: Patient ID is equal to 23637
Date: Service date of the Charge:
09 March 2016
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:
02 April 2018
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 Procedure Date? | {"text": [], "answer_start": []} |
id_1711476578.153048 | Karen Clark MD |
BAYLOR SCOTT & WHITE
Williams, Charles Eugene
BaylorScott&White
HEART AND VASCULAR
MRN: 9211651, DOB: 1985/30/08, Sex: M
HEALTH
HOSPITAL - DALLAS
Acct #: 33000308851
621 N HALL ST
Admitted 2019/08/12. D/C 2020/07/01
DALLAS TX 75226-1351
2016/12/07- 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 2023/05/08 7:47 PM
Anesthesia Preprocedure Evaluation
Pohar, Selvi, MD at 2/8/2023 1106
Author: Pohar, Selvi, MD
Service:
Author Type: Physician
Filed 2016/25/07 1:08 AM
Date of Service: 2019/06/04 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 2016/12/07 10:22 AM
Page 51
751 08-51
Baylor Scott & White Heart & Vascular Hospital - 00051
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711471330.616788 | Hannah Ellis |
patient: Hannah Ellis
encounter date: Sep 27, 2015 1:01PM MRN: 280-028-787
The patient was guided through neuromuscular reeducation exercises one on one with the physical therapist and/or student physical
therapist. The neuromuscular reeducation included exercises to improve movement, balance, coordination,
kinesthetic sense, posture, and proprioception. The neuromuscular reeducation exercises were instructed
to be performed in a pain free manner. The time of neuromuscular reeducation includes preparation of each
activity, patient education and training of each task, performance of the exercise, and post-assessment of
patient's performance.
Visit Type: Progress Note
Procedure Charges:
Therapeutic Exercises: 1 units 39 minutes
Therapeutic Activities: 1 units 39 minutes
Signatures
ELECTRONICALLY SIGNED BY : Heather Carrillo, PT; Dec 12
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711476578.036847 | 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 the Date of Discharge? | {"text": ["2023/30/12"], "answer_start": [215]} |
id_1711472590.890692 | Corey Floyd |
Dr Barbara Perez, MD
Thibadaux - 726 North Acadia Road
orthoLA
Laplace - 465 Belle Terre Boulevard
Raceland - 141 Twin Oaks Drive
Houma - 180 Corporate Drive
Orthopaedic Sports Medicine,
Joint and Hand Specialists
CONSENT FOR
THERAPY CARE AND TREATMENT
I, the undersigned, do herby agree and give my consent for ortho LA to provide physical
therapy and or occupational therapy care and treatment considered necessary in treating
my physical condition.
Patient
Printed Name: Corey Floyd
Nadine Buggage
2020-09-08
Signature of Patient/Guardiah
Date
CONSENT FOR TREATMENT OF A MINOR: As a parent and/or legal guardian, I
authorize Ortho-LA to treat the minor patient named in the attached forms.
Signature of Patient/Guardian
Date
Post Office Box 28 Thibodaux LA 70302//Tel:146-483-7252//Fax:237-641-3751//www.ortho-la.com
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711473237.019256 | April Mason |
FAX
MRN: 1936371H
April Mason
Nassau Unly. Medical
Gender: Female
Center
Age: 54y (09-12-1993)
Current Location:
ICC1-2241-JJ
Operative Report [Charted Location: MICU-2244-II] [date of service: 02-09-2023 0:14
Authored: 24-Mar-22 16:07] - for Visit: 9922464, Complete, Revised, Signed in Full, General
Date of Procedure:
Date of Procedure
21-12-2021 0:14
Pre-Op and Post-Op Diagnosis:
Pre Op Diagnosis Comments
left eye ruptured globe, 180 degree scleral laceration,
lateral rectus laceration
Post Op Diagnosis Comments:
Post Op Diagnosis Comments
left eye ruptured globe, 180 degree scleral laceration,
lateral rectus laceration
Specimens:
Specimen Details:
No specimen submitted for this procedure. (1)
Requested by: Philburn, Jacqueline (Med Rec Clerk), 07-Apr-22 12:25
Page 1 of 2
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711473530.490678 | Rachel Sims |
KNMH CT SCAN
Rachel Sims
180 W Esplanade Ave
MRN: 8138138, dob: 22/95/06, Sex: M
Kenner LA 71365
Acct #: 81303136131
Enc. Date 09/22/04
08/25/2022 - Appointment in Kenner - Diagnostic Ctr (continued)
Outpatient Medications at Start of Encounter as of 8/25/2022
Disp
Refills
Start
End
gabapentin (NEURONTIN) 300 MG capsule
Sig - Route: Take 900 mg by mouth 3 (three) times daily. - Oral
Class: Historical Med
Lab and Imaging Orders
CT Cervical Spine Without Contrast
Electronically signed by: Dayna G. Toscano, NP on 04/19/10 1009
Status: Completed
Ordering user: Dayna G. Toscano, NP 08/25/22 1009
Ordering provider: Dayna G. Toscano, NP
Authorized by: Dayna G. Toscano, NP
Ordering mode: Standard
Ordered during: ED on 13/19/02
Indications of use: Neck trauma (Age >= 65y)
Result
CT Cervical Spine Without Contrast (Order
413901330)
Generated on 10/3/22 11:37 AM
Page 2
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711471328.657951 | Zachary Carrillo | Fax Server
27 Sep 2018 9:51:00 AM PAGE 2/010 Fax Server
Lakeside Health
Date: 27 Sep 2018
Dr Scott Thomas, MD
38840 Frey Row
South Allisonchester, TN 03494
Beneficiary Name: Zachary Carrillo
date of birth: 09 Mar 1995
Beneficiary Phone Number: 911-794-2830
Sponsor Name: Shelly Mathews
Sponsor SSN: xxx-xx-1212
Plan Type: Prime Eligible
Reference Number: 77895131128
Requesting Provider: Dr Scott Thomas, MD
Requesting Provider NPI: 1342721112
Dear Dr Scott Thomas, MD:
Lakeside Health is the Managed Care Support Contractor (MCSC) for the
Department of Defense's health care program, Lakeside Health, in your region. We thank you for your
continued service to our Lakeside Health beneficiaries.
We received your request for service(s) for the above Lakeside Health beneficiary.
Reason for Request: Outpatient Authorization Request
Servicing Provider Name: Dr Scott Thomas, MD
Specialty Type: Urology
Servicing Provider Address: 38840 Frey Row
South Allisonchester, TN 03494
Servicing Provider Phone: 429-641-1973
Service Type
Frequency
Surgical Care
57288* - 57288 13 Apr 2017 - 12/14/2010 1 Visit or Unit(s)
Zachary Carrillo-KPJayaraman-00002
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711475444.819272 | Mr. Marco Jenkins |
Mr. Marco Jenkins DOB: 1994/29/12 (35 yo M) Acc No. 70590 Doc Name: 2015/06/09 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, Mr. Marco Jenkins 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: 2017/31/10
Mr. Marco Jenkins
DOB: 1994/29/12
Provider Reviewed:
Date:
Mr. Marco Jenkins DOB: 1994/29/12 (35 yo M) Acc No. 70590 Doc Name: 2015/06/09 Medical Clearance
Page 107 of 123
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711472591.263199 | Shannon Long |
TN
SimonMed鈩
See Tomorrow Today
PATIENT NAME:
Shannon Long
Accession Number:
39623098
Patient ID:
1899337
Location:
SimonMed Northern CA Monterey
Gender:
Female
Date of exam:
October 22, 2020 6:6 Exam Date min_range
D.O.B:
February 04, 2001
Modality:
MR
Referring Physician: Dr Danny Robbins
Report Status:
Final
Report exported on Tue, Jun 7, 2022 13:00:41 -0330 - Page 2 of 3
312
GB IA Recv 2033033413328
Received 06/24/2022
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711471328.585033 | Sarah Davis | Lakefront Health
Nicholas Baker
360 Pittman Fall Suite 751
Smithfort, ID 45503
MRN: 2797726 BIRTHDATE 27/87/09. Sex M
Visit: 02/19/10
Patient Demographics
PATIENT
Patient ID
SSN
Legal Sex
BIRTHDATE
Sarah Davis
2797726
xxx-xx-0069
Male
27/87/09 (46 yrs)
Address PSC 7193, Box 0957
APO AE 27852
Phone 115-155-7966
Race
Tongan
Reg Status
PCP
Date Last Verified
Next Review Date
Verified
Karsman, Alina,
02/03/23
03/05/23
MD818-271-2400
SCIP
Mantal Status
Religion
Language
Married
Christian
English
Primary Subscriber
Subscriber Name
Pat Rel to Sub
Subscriber Address
Subs Rel to Guar
Nicholas Baker
Self
PSC 7193, Box 0957
APO AE 27852
2886 of 5499
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711472786.710365 | Juan Hurst |
athena
09-18-2023 2:23 PM ET
613-195978689
pq 37 of 42
Privia . CCA - Cardiac Care Associates PC . 224D Cornwall St. LEESBURG VA 20156-2150
Juan Hurst (id #1978686, birth date: 1989 January 25)
Reston
RRC
Radiology
Consultants
Patient: Juan Hurst
birth date: 1989 January 25
DATE OF EXAM: 2023 October 02
Medical Record #: RHCK006449575
Procedure: RAD Chest 2V
Referring Physician:
Dr Kimberly Ramos
Reston Hospital Center
K85426449575 Juan Hurst
Michelle I Pego NP
Duyanh T Vu, MD
Vu,Duyanh T Md
ALYSIA D. JOHNSON RT(R)
RR
CHEST X-RAY, frontal and lateral views:
HISTORY: WHEEZING
COMPARISON: 11/3/2018
FINDINGS:
The cardiac silhouette is normal.
Lungs are clear.
MEDICAL IMAGING CENTER OF RESTON, 1815 TOWN CENTER DRIVE, Reston VA, 21590
Fax www.restonradiology.com
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711473238.012295 | Eric Garcia |
<<Back To Review>>180298-16-HYPER LINK - Page
178
Legal Copy
SGMF-PRIMARY CARE
Eric Garcia
Sutter Health
95355-4276
MRN: 53959548, birth date: 1996 Jul 17, Sex: M
Single Notes
DATE OF VISIT: 2022 Feb 28
Notes (continued)
Patient Instructions by Dr Tina Pittman MD at 12/30/16 1528
Author: Dr Tina Pittman MD
Service: -
Author Type: Physician
Filed: 12/30/16 1528
ENCOUNTER DATE: 2017 Jan 30
Status: Signed
Editor: Dr Tina Pittman MD (Physician)
signature Dr Tina Pittman MD at 2019 May 12 1468
Notes
Progress Notes by Kobrine, Steven E, MD at 2022 Jun 05 1463
Printed by [S274622] at 10/28/21 11:27 AM
00178
| what is the DOB or date of birth? | {"text": ["1996 Jul 17"], "answer_start": [161]} |
id_1711472285.690092 | Alexander Green |
STATEMENT
THIS IS A STATEMENT OF SERVICES RENDERED BY PHYSICIAN(S)
WHO ARE MEMBERS OF:
PATIENT
Hillside Healthcare
Alexander Green
8626 TESORO DRIVE
BILL DATE
ACCOUNT NO.
AMOUNT PAID
SUITE 112
SAN ANTONIO, TX 782176207
Jul 15, 2021
17432
210-817-6010
Hillside Healthcare
1811 E AVENUE K
This is a statement for professional services rendered by your
physician. You may receive a separate bill from the hospital for
APT 1002
its services.
TEMPLE TX 76501-6292
PMT/ADJ/
DATE OF SERVICE
DESCRIPTION OF SERVICE
CHARGES
AMOUNT
WITHHELD
13 May 2020
Claim:27617, Provider: ALEXANDER M ABOKA, MD
Feb 01, 2021
OFFICE VISIT, NEW PT LEVEL 4
$850.00
Your Balance Due On These Services
$850.00
Mar 17, 2021
Claim:29679, Provider: ALEXANDER M ABOKA, MD
DATE
PATIENT NAME
ACCOUNT NO.
PAY THIS
02 September 2023
Alexander Green
17432
AMOUNT
$21,050.00
22 February 2017
1
3:34:01 PM
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711477183.161355 | Ashley Rivera |
MAGNOLIA DIAGNOSTICS, INC.
MEDICAL EVALUATION for M.R.I./ CONSENT FOR TREATMENT
PATIENT NAME Robert Hancock
WT. 112
SOCIAL SECURITY #
HT.
DOCTOR'S NAME
DAVIS
CIRCLE
YES
NO
Have you had an MRI scan before today?
Yes
No
Where?
When?
Have you ever had surgery of any type?
Yes
No
List:
Do you have any metal in your body?
Yes
No
Explain:
Do you have a pacemaker, or any device implanted in you?
Yes
No
FEMALES ONLY:
Are you pregnant or is there a possibility you could be pregnant? Yes
No
The above questions have been answered truthfully to the best of my
knowledge.
I
do hereby consent to necessary examination procedures and/or
treatment by Magnolia Diagnostics, Inc. as prescribed by my treating
physician.
Signed Robert Hancock
Date
16/07/2022
Date you are scheduled to return to your Doctor:
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711472787.293823 | James Sutton |
DocuSign Envelope ID: CD6AFC23-CF28-23AE-AA73-C1B65423D293
I understand that this revocation will not apply to information that has already been released in response to
this authorization.
I understand that when this information is used or disclosed pursuant to this authorization, it may be subject
to re-disclosure and may no longer be protected.
This Authorization is continuing in nature and remains effective until the conclusion of this claim / litigation
without the necessity for further authorization.
A copy of this Authorization shall be considered as effective as the original.
I, the undersigned, have read the above and authorize the staff of the above named facility to disclose such
information as herein contained.
DocuSigned by:
fairn
83DBEBA2C8F823C
Signature of Patient / Parent or Legal Guardian
28 Apr 2022 11:29 PM PDT
Relationship to Patient
Date Exp 22 Feb 2017
This Authorization complies with 45 CFR 123.508
2
| What is signature date or signed on date? | {"text": ["28 Apr 2022"], "answer_start": [849]} |
id_1711471329.367036 | April Peterson |
20/05/23 18:5 PM EDT OneCallCareManagement via VSI-FAX
Page 1 of 2 #3417302 OI
796 Thompson Ridge Suite 861
Lake Williamview, GA 64474
351-688-5385
PASADENA, CA, 91101
629-466-4548
Oak Grove Hospital
Compassion, Confidence, Comfort
Patient
BIRTHDATE
MRN
April Peterson
15/03/86
29.8492103
AT THE REQUEST OF
AGE / SEX
service date
Dr Michael Mann MD
21 y/F
02/01/15
796 Thompson Ridge Suite 861
Lake Williamview, GA 64474
MRI RIGHT ELBOW
CLINICAL HISTORY
surgery in 2004. History of Thyroid in 1999. No surgery to the right elbow. Recent
physical therapy with some relief of symptoms. Requesting assessing for acuity of changes.
COMPARISON
None
TECHNIQUE
The MRI was performed on a GE High Field 1.5 Tesla Signa Infinity Excite.
FINDINGS
Tendons: There is slight thickening and minor edema to the common extensor tendon, a full-thickness
IMPRESSION
FINDINGS FOR LATERAL EPICONDYLITIS, AGE OF CHANGES ARE UNKNOWN. NO
FULL-THICKNESS TEAR.
OTHERWISE NORMAL MRI RIGHT ELBOW.
PASADENA
April Peterson 84921033
Page 8 of 2
1291
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711476990.265993 | Preston Cohen |
University of Oklahoma
33839
800 NE 15th Street Suite 205 Oklahoma City, OK 33839
Page 1
4033839647 Fax: 405233839
Radiology Reports
Timothy Esparza
Male DOB: 85/05/06
2708046
Ins: BLUE CRO (22) Grp: 116443
07/18/2016 - Radiology Reports: - PET/CT TUM SKUL BS MIDTHIGH
Provider: Adam S Asch MD
Location of Care: College of Medicine
Patient: JIM CURTIS PARRY
ID: HCA RAD E0027333839
Note: All result statuses are Final unless otherwise noted.
Tests: (1) - PET/CT TUM SKUL BS MIDTHIGH (TUMSBMT)
! - PET/CT TUM SKUL BS MIDTHIGH
<No Reported Value>
STEPHENSON OKLAHOMA CANCER CENTER - A SERVICE OF OU MEDICAL CENTER
800 NE 10TH
PET SCAN
PHONE: (405) 271xxxx
Oklahoma City, OK 73104
CONSULTATION REPORT
FAX: (405) 271xxxxx
LOC/RM: EK.PETCT/
PACS ID: E2133839
MRN:
E002733117
PT. TYPE: REG RCR
CAMPUS: K
PT:
PARRY, Timothy Esparza
ACCT#: E00655310983
DOB: 85/05/06 AGE: 48
SEX: M
ORD PROV: 1154434405 Asch, Adam S MD
EXAM START: 17/06/18 1204
ATT PROV: 1003111972 Luetkemeyer PAC, Jessica L
EXAM ENDED: 19/05/11 1404
ADMISSION CLINICAL DATA: C83.30
DIFFUSE LARGE B-CELL LYMPHOMA
EXAMS:
CPT:
004933839 PET/CT TUM SKUL BS MIDTHIGH
33839
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711475444.793409 | Kristen Brooks |
Kristen Brooks DOB: 01-01-1988 (Random 2 yo M) Acc No. 77639 Doc Name: Controlled Substance Agreement
Kristen Brooks DOB: 01-01-1988 (Random 2 yo M) Acc No. 77639
02-03-2018
I will keep follow-up visits as directed by LA Health Solutions. If I must cancel an appointment, I will give at least
24 hours notice and reschedule. I will also keep all therapy appointments with LA Health Solutions. If I do not
show up for therapy appointments I understand that LA Health Solutions may cancel my appointment with the
medical doctor and that I may not be able to obtain a refill on my prescription.
I acknowledge treatment with controlled substances is contingent on evidence of benefit. I am aware my case will be
reviewed periodically to determine whether I am improving or that progress is being made to improve my function and
quality of life. If my treatment regimen does not show any evidence of this, I know I may be tapered off controlled
medications and a new treatment may be prescribed.
I will use caution and common sense while taking this medication. I will ask questions if I do not understand something
or if I feel I may be having trouble with the medication.
X
/
Patient?s Name (Print)
Patient?s Signature
Date
Signed On:09-27-2017
03:19:14 PM CDT
efile:///C:/Users/ashton/AppData/Local/Temp/eCW.5fkglis2.pj3/63ae77f4-1e94-4ade-a192-c9a67765b950.html
2/2
Kristen Brooks DOB: 01-01-1988 (Random 2 yo M) Acc No. 77639
Kristen Brooks DOB: 01-01-1988 (Random 2 yo M) Acc No. 77639 Doc Name: Controlled Substance Agreement
Page 38 of 47
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475444.876361 | Jennifer Cook |
Jennifer Cook DOB: 20/08/93 (43 yo M) Acc No. 54847
Jennifer Cook DOB: 20/08/93 (43 yo M) Acc No. 54847 DOS 19/08/17
Jennifer Cook
43 Y old Male, DOB: 20/08/93
Account Number: 54847
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
04/09/22
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 04/09/22
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
Jennifer Cook DOB: 20/08/93 (43 yo M) Acc No. 54847
Page 9 of 123
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711473530.610127 | Emily Andersen |
KNMH EMERGENCY DEPARTMENT
Emily Andersen
180 W Esplanade Ave
MRN: 8278278, dob: 09/1989/09, Sex: M
Kenner LA 72765
Acct #: 82702782761
Adm: 01/2018/28
08/25/2022 - ED in Kenner - Emergency Dept (continued)
Medication Administrations
ibuprofen tablet 800 mg [827232722]
Ordering Provider: Dayna G. Toscano, NP
Status: Completed (Past End Date/Time)
ORDERED ON: 10/2020/21 1127
Starts/Ends: 08/25/22 1200 - 08/25/22 1127
Ordered Dose (Remaining/Total): 800 mg (0/1)
Route: Oral
Frequency: ED 1 Time
Admin Instructions: DO NOT CRUSH OR CHEW; SWALLOW WHOLE.
Discharge Orders (720h ago, onward)
None
ED Prescriptions
Medication
Sig
Dispense
Start Date
End Date
Auth. Provider
LIDOcaine (LIDODERM) 5 % (Expired)
Place 1 patch onto
7 patch
8/25/2022
9/1/2022
Dayna G. Toscano, NP
the skin once daily.
Generated on 10/3/22 11:37 AM
Page 28
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711473530.491615 | Mary Ibarra |
KNMH CT SCAN
Mary Ibarra
180 W Esplanade Ave
MRN: 8588588, BIRTHDATE: 90-02-02, Sex: M
Kenner LA 75865
Acct #: 85803586581
Enc. Date 15-10-21
08/25/2022 - Appointment in Kenner - Diagnostic Ctr (continued)
Outpatient Medications at Start of Encounter as of 8/25/2022
Disp
Refills
Start
End
gabapentin (NEURONTIN) 300 MG capsule
Sig - Route: Take 900 mg by mouth 3 (three) times daily. - Oral
Class: Historical Med
Lab and Imaging Orders
CT Cervical Spine Without Contrast
Electronically signed by: Dayna G. Toscano, NP on 17-03-25 1009
Status: Completed
Ordering user: Dayna G. Toscano, NP 08/25/22 1009
Ordering provider: Dayna G. Toscano, NP
Authorized by: Dayna G. Toscano, NP
Ordering mode: Standard
Ordered during: ED on 23-05-14
Indications of use: Neck trauma (Age >= 65y)
Result
CT Cervical Spine Without Contrast (Order
458905830)
Generated on 10/3/22 11:37 AM
Page 2
| What is the Date of Encounter or Enc? | {"text": ["15-10-21"], "answer_start": [151]} |
id_1711476766.368512 | Lauren Carson |
Bethesda Pathology Report
Bethesda
Hospital East
Pathology
Name:
Dr. Russell Moore
Specimen #: SE-5803-67
Age:
45 Y
Medical Record 167786867
# :
DOB:
04/1997/05
Patient # :
2526737767
Sex:
F
Specimen
08/2020/16
Received:
Locat AMBULATORY CARE
Report Date:
08/2015/23
ion:
Procedure 04/2020/06
Signed
KENNETH
Date:
Out By:
BENGTSON, M.D.
Physician (s) : Annette Kennedy, 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 08/2020/16
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.
03/2015/14 at 13:12
**End of Report
| What is the Procedure Date? | {"text": ["04/2020/06"], "answer_start": [331]} |
id_1711475190.426965 | Micheal Moore |
N
NOVANT
Novant Health Orthopedics &
Micheal Moore
Sports Medicine
MRN: 54624467, DATE OF BIRTH: 02-28-1992, Sex: M
HEALTH
7460 Village Medical Cir
DATE OF VISIT: 01-09-2021
Ste 110
CLEMMONS NC 27462-8469
01-28-2020 - Office Visit in Novant Health Orthopedics & Sports Medicine (Clemmons) (continued)
Clinical Notes Amb (continued)
PATIENT NAME: Micheal Moore
MRN: 54624467
DATE OF BIRTH: 02-28-1992
Service Date: 02-09-2018
Referring Physcian: Frunza, Ana A, MD
Primary Physcian: Dr Matthew Sanchez, MD
SUBJECTIVE:
Jeffrey Craig Payne is a 31 y.o. male who presents today for evaluation.
Current Outpatient Medications
Medication
Sig
Dispense
Refill
alprazolam (XANAX) 1 MG
Take one tablet (1
tablet
mg dose) by mouth 3
(three) times a day
as needed.
Generated on 4/11/23 8:32 PM
Page 213
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711475444.876394 | Jennifer Cook |
Jennifer Cook DOB: 20/08/93 (43 yo M) Acc No. 54847
Jennifer Cook DOB: 20/08/93 (43 yo M) Acc No. 54847 DOS 19/08/17
Jennifer Cook
43 Y old Male, DOB: 20/08/93
Account Number: 54847
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
04/09/22
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 04/09/22
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
Jennifer Cook DOB: 20/08/93 (43 yo M) Acc No. 54847
Page 9 of 123
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711475444.580973 | Jerry Pace |
Garibaldi, Justin Male 08/12/95
Alliance Medical
CENTER
Donald D. Dietze, MD, FAANS
Board Certified Neurological Surgeon
Jerry Pace
Fellow of the American Association of Neurological Surgery
301 Lakeshore Blvd
3348 West Esplanade S., Suite A, Metairie, LA 70002 - 1111
Slidell LA 70461
PROGRESS REPORT
PATIENT NAME: Garibaldi, Justin
birthdate: 08/12/95
date of service: 09/05/21
PHYSICIAN: Donald D. Dietze, MD, FAANS
CHIEF COMPLAINT: Low back pain and Neck pain, Knee Pain, Headaches
HISTORY OF PRESENT ILLNESS:
Mr. Garibaldi is a 30-year-old left-handed male who presents to our clinic today November 20, 2023 for
consultation, examination, and treatment for injures/symptomology sustained in a motor vehicle accident that
occurred on March 18, 2021.
Mr. Garibaldi denies any prior history of neck and low back pain.
The patient reports that he is not currently employed.
Since the accident the patient reports treating with LA health solutions. The patient reports that he was treated
for traumatic brain injury. He states an MRI was ordered of his brain, and EEG, VEP, BAER. He also reports
receiving a left C5-6, C6-7, and C7-T1 facet injection on March 24, 2023 and March 17, 2023. The patient has
also undergone a right C5-6, C6-7, and C7-T1 facet injection on January 27, 2023. The patient also reports
having undergone a bilateral L4-5 and L5-S1 lumbar facet injection. The patient is currently being prescribed
cyclobenzaprine, duloxetine, and meclizine which provide mild symptomatic relief.
His primary complaint today is a constant, aching pain of the low back that radiates into the right lower
Page 1
| what is the service date or date of service? | {"text": ["09/05/21"], "answer_start": [402]} |
id_1711475444.472817 | Charlene Adams |
19/10/24 FROM- CWFMD
936-703-5455
T-252 P0017/0063 F-236
Printed: 11/09/20 13:33
3
PatientKeeper
By: Smalling, Ciara C
CTABD&RELVISIWIOCONT
PRICE ERICAN
Age: 49Y Gender: F DOB: 08/05/1971 MRN: BH00288051 Phone: 936-701-8024
Signed by: Roy Kumar, M.D.
CT ABD&PELVIS W/O CONT
ORDERED PROVIDER: Huval,Adam FNP
Date of Examination 16/01/26
FACITLIY: EMERGENCY ROOM SERVICES
STATUS: Signed
Exam
Procedure
021095113 CT/CT ABD&PELVIS W/O CONT
Signed: LSDR.RK5 21/02/25 5:43am
Page 2 of 2
Name: Charlene Adams
DOB: 87/04/19
Date:
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711471328.881901 | Jeffrey Gordon |
Encounter #
MR#
Enc Start Date Time
Pt Location
60000902775
8621943
03/22/06 07:11
ADLT ED Waiting Indy
ECD#
Level of Care
Clin Svc
EPT
Enc Type
4112231904
Other
EMR
ER
OP
Countryside Regional
Preferred Language
Admit Source
Confidential
Infectious Disease
English
Phys Ref
Email
Admit Type
Incident Date
Incident Type
prettygang222@gmail.com
Emergent
Advance Dir:
Race:
Soc Sec #
Gdr
MS
No
Black
F
S
Age
BIRTH DATE
Religion\ Church
Adm Clerk
36Y
28/02/12
COG \ UKN
016
patient name Address, Phone
Employer Name, Address, Phone
Emplm Sts, Class, Cat
Jeffrey Gordon
EXTENDED STAY AMERICA
Empl
9969 Jennifer Cove
Wellsburgh, RI 39499
Indianapolis, IN 46254
County: Marion
Home: 594-679-7168
Day:
Cell: 145-264-9055
Guarantor Name, Pt Rel, Address, Phone
Guarantor Empr, Address, Phone
Empim Sts, Class, Cat
Jeffrey Gordon
Self
EXTENDED STAY AMERICA
Empl
Phone: 317-298-0651
317-514-7862
Emergency Contact 1
Emergency Contact 2
Jeffrey Gordon
PO Box 1575
Authorization #
Eligibility #
28/02/12
Primary Physician
Reason for Encounter
Dr Erica Patterson
HBS
Admitting Physician
Copy to Physician
Emergency, Indianapolis
Attending Physician
Emergency, Indianapolis
Printed: 21/16/07 7:29
User: jdunl534
02A
4118867004
SVI 0053
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711473239.029442 | Michael Peterson |
RE2133527
MRI Patient History and Questionnaire
Patient Name JUSTIN GARIBALDI
CIS333333
birthdate 26/11/93
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.
09/02/20
Patient Signature
Date
Patient% Representative
Date
Kelly
Signature Babing
09/02/20
Technologist's
Date | What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711477275.463743 | Monica Vasquez |
XR, CHEST, 2 VIEW (#5253333, 12-02-2022 12:00am)
01-27-2023, 9:25 AM
South Texas Bone and Joint
SOUTH
TEMA
601 Texan Trail, Suite 300
Corpus Christi, TX 78411
Phone #:
BONE & JOINT
Fax:
Name:
Daniel Griffin
Exam Date: 07-12-2019 03:37 PM
Patient ID: 435633
Exam Name: X-Ray Chest 2 Views (PA and Lateral) I 71033
DOB: 11-30-1986
Referrer: John P Masciale, MD
Acc#:
658533
2nd Referrer: STBJ STBJ
EXAM: X-Ray Chest 2 Views (PA and Lateral)
INDICATION: Encounter for other specified special examinations
COMPARISON: None
FINDINGS: Cardiac size is within normal limits status post sternotomy. There are calcifications in the
thoracic aorta. No focal infiltrate or consolidation. There is a 4-5 - mm nodule projecting over the right
upper lung zone.
IMPRESSION:
1. No acute cardiopulmonary process status post sternotomy.
2. Approximately 4-5 - mm nodule in the right upper lung zone, likely granuloma. Comparison with
previous studies could confirm stability.
Electronically Signed By: Matthew Strange, M.D. on 04-17-2020 17:01
Matthew Strange M.O.
Diagnostic Radiologist, DABR
Fellowship in Body Imaging
Blue Star Rsdiology Services
Official Radiologists of the Dallas Cowabeys
Signed by:
Matthew Strange, MD
Finalized Date: 01-27-2023 05:04 PM
76733-3
South Texas Bone & Joint - 00433
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711477183.650704 | Jennifer Collins MD |
EGIS
Laboratory Director Matthew T. Hardison PhD
CLIA Number 44D108xxxx
Laboratory Report
515 Great Circle Road Nashville, TN 37xxxxx
SCIENCES CORPORATION
(615) 405-2440 Fax (615) 405-3040
Clinic Information
Patient Information
Sample Information
Client: South Texas Bone & Joint
Patient Name:
Julie Smith
Lab Sample ID:
40181740
601 Texan Trail
Specimen Type:
Urine
Corpus Christi, TX 78440
Patient ID:
457965040
Collected:
2018/07/05
Requesting Provider:
Date of Birth:
1984/30/10
Received:
2023/08/12
JOHN MASCIALE
Male/Female:
Female
Reported:
2017/09/03
Medication(s) Prescribed
Codeine, Tramadol Cyclobenzaprine, Gabapentin
Test(s) Requested
00197iU QMP Plus D/L s
04440 Marijuana
Medication Compliance
Drug and/or Metabolites
Result Interpretation
Copyright @ 2018 Aegis Sciences Corporation All Rights Reserved
Page 1 of 40
76740-3
South Texas Bone & Joint - 00040
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711471328.810732 | Lisa Vazquez | Seaside Medical
Patient: Emily Koch MD
Seaside Medical
MRN: 00061043, DOB: 1991-04-13, Sex: M
Seaside Medical
3821 Martin Lake
Nathanland, MO 45891
Acct #: 8609825
Patient Info
Patient
Account Number
Gender
DOB (Age)
Lisa Vazquez (00061043)
8609825
Male
1991-04-13 (67 year old)
Patient Demographics
Address
Phone
15277 Barbara Stream Suite 148
West Jamesbury, ME 93689
472-167-4362 (Home)
Emergency Contact(s)
Name
Relation
Home
Work
Mobile
Emily Koch MD
Girlfriend
472-167-4362
Epic Admission Information
Arrival Date/Time:
04/17/2018 1005
admitting date/Time:
2021-02-17 1005
IP Adm. Date/Time:
Admission Type:
Emergency
Point of Origin:
Emergency Room
Means of Arrival:
Walk In
Primary Service
Emergency
Secondary Service:
Transfer Source:
Home
Service Area:
MEMORIALCARE
Unit:
CHLB EMERGENCY
SERVICE AREA
Admit Provider:
Attending Provider:
Dr James Cantu, MD
Referring Provider
discharge date/Time
2021-03-19 1155
104 of 107
06/15/2021 | What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711475741.691421 | Joyce Shaw |
04/2023/02 16:50 FROM- CWFMD
936-703-5455
T-252 P0063/0063 F-236
Fax Server
04/2015/25 AM PAGE
2/002
Fax Server
Patient Name:
Joyce Shaw
Patient ID:
WFPPRIERI
EXAMINATION:
LEFT THIRD FINGER, TWO VIEWS
IMPRESSION:
Normal left third fingers.
Document/Study Interpreted by: Brandon Fisher, M.D.
Document/Study Authenticated by: Brandon Fisher, M.D.
***
THIS IS AN ELECTRONICALLY VERIFIED REPORT
05/2020/19 8:27 AM: Brandon Fisher, M.D.
Dictated: 03:37 PM
Brandon Fisher, M.D.,
BF:cm
D:01/2022/08/03:37PM
T:01/2022/08 4/04:38 PM
7-31-14
&
Thank you for choosing 1960 Digital Imaging.
Page 2 of 2
This fax contains confidential patient information If you receive this transmission in error. please destroy
the faxed materials and contact the sender at 281-453-7999
Name: Joyce Shaw
DOB: 03/1999/24
Date:
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711477090.145874 | Deborah Webb |
30/03/23 12:10 PM FROM: Fax PULMONARY AND SLEEP SPECIALISTS OF TAMPA BAY, PA PAGE: 016 OF 018
Patient: Bradley Barker DOB: 16/06/93
CT Chest High Resolution WO Contrast
SWANN, LISA A - 479651
Final Report
Vertebral body height maintained. Midly confluent osteophyte formation and calcification
of the anterior longitudinal ligament.
Upper abdominal structures derronstrate no acute abnormality.
Impression:
1. No acute findings.
2. Small amounts of air trapping and atelectasis are present in the lungs on expiration.
No suspicious pul monary nodul es.
Di ctating Provider Eckerd, Morgan
Dictated 19/11/23
Signing Dr. Eckerd, Morgan
Location FPLA051
Signature Line
nal
*********
Transcribed by: MCE
07/21/21 13:32
Signed by: ECKERD MD, MORGAN CHARLTON
12/12/15 13:32
RADRPT
This document has an i mage
Page 2 of 76
Printed on:
30/03/23 15:29 EDT
Document: 30/03/23
Printed: 30/03/23 10:55:38
Page 15 of 176
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711471329.311471 | Michael Ramirez |
Harbor Community Health
Michael Ramirez
Unit 1145 Box 6560
DPO AE 77860
MRN: 8678921, DOB: June 30, 1991, Sex: F
Harbor Community Health
VISITING DATE: September 02, 2018
Amb Encounter Report
Queries (continued)
Encounter-Level Documents on January 01, 2021: (continued)
Hospital for Special Surgery
Discharge Vital Signs Detailed Report
Michael Ramirez
7E-753-2
50y
F
DSC
06-27-1953
Dr Kendra Woodward
1188459/91884501
Admitted: October 30, 2020 10:48
DISCHARGE DAY: November 29, 2020 2:44
IP Admission
Temperature
Entered By
Co-Signature
Celsius
11/30/2011
12:00
36.3
Source: Tympanic
Agatep, Corazon A/RN
20:00
36
Lewinger, Vanessa/RN
20:37
35.8
Janzon, Marie/RN
12/01/2011
0:00
35.9
Source: Tympanic
Thomas, Paula/Nurse
Tech
5:00
36.4
Source: Tympanic
Thomas, Paula/Nurse
Tech
Heart Rate
Entered By
Co-Signature
Requested By: Standard, Scheduled Report (IT)
Printed From: Analysts
January 01, 2021 04:03
Page 0 of 15
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711475190.357276 | Mark Higgins |
<<Back to Review>>194126-3-HYPERLINK- - Hyperlink-Page
187
Mark Higgins
KAISER PERMANENTE庐
MRN: 110754075875, dob: 16-11-1990, Sex:
F
SSN: xxx-xx-3754
visit: 22-10-2022
19-01-2024 - Scheduled Telephone Encounter in CCM-DIABETES (continued)
Clinical Notes (continued)
3) Further blood sugars needed to assess effect of insulin
next visit evaluate changing INSULIN REGIMEN SQ
P
LIFESTYLE/EDUCATION :
Reviewed rule of 15 for treatment of low blood sugar.
If bedtime blood sugar below 110 take snack of 15 grams carbohydrate Such as 1/2 sandwich and take
insulin as ordered . Call Mary Hallum if occurring 2 or more times in 2 weeks .
blood sugar above 100 before driving exercising or above 110 before sleeping.
electronically signed by Hallum, Mary C. (R.N.) at 30-06-2023 4:45 PM
Generated on 4/6/22 11:06 AM
000187
0186
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711476578.569033 | Laurie Gilmore |
INBOUND NOTIFICATION FAX RECEIVED SUCCESSFULLY
TIME RECEIVED
REMOTE CSID
DURATION
PAGES
STATUS
08/17/09 at 3:41:29 PM EDT
SVMC
Received
SVMC
25/16/05 12:37:28 PM
PAGE
6/006
Fax Server
Corona, Araceli
558 Abbott St Ste A
MRN: 311xxx, DOB: 29/01/08, Sex: F
DOCTORS
Visit date: 14/18/02
ON DUTY
Phone: 831xxx
MONTH
HIM ROI Letters Report
Psychiatric:
Mood and Affect: Mood normal.
Behavior: Behavior normal.
Assessment/Plan
Acute medial meniscal tear, left, subsequent encounter
Ambulatory referral to Orthopaedic Surgery; Future
Cyst of medial meniscus, left
Ambulatory referral to Orthopaedic Surgery; Future
Left knee pain, unspecified chronicity
Primary Treating Physician: Dr Sharon Walsh,Latoya Jones, MD
Date of Exam: 31/17/07
CA License :
53592xxxxxx
Specialty:
Urgent Care/Occ Med
Address:
17xx NORTH MAIN ST
Telephone:
Phone: 831xxxxxx
SALINAS CA 9390xxxx
Dept: 831xxxx
Dept Fax: 831xxxx
Signature: Electronically signed by Latoya Jones, MD
Date: 14/24/03
END OF REPORT
Generated on 25/16/05 12:34 PM
Page 15
115
| What is signature date or signed on date? | {"text": ["14/24/03"], "answer_start": [1048]} |
id_1711471330.730612 | Brittany Perez |
Brittany Perez (MR # 53500146) birthdate: 08/1986/31 Age: 67 yrs
Enc Date: 06/2018/05
Therapy Treatment
No treatment plans exist
Medications at End of Encounter
Albuterol inhaler (Taking) Take by mouth
Medication Documentation Review Audit As Of This Encounter
Reviewed by Dr Jody Love, MD on 10/09/17 at 1835
Encounter Status
Closed by Dr Jody Love, MD on 10/9/17 at 6:35 PM
Go to the IP MAR Infusion Coder's Report.
All Charges for This Encounter
Code
Description
Date of Service
Service Provider
Modifiers Qty
99214
PR OV EST PT LEV 4
10/2018/15
Dr Jody Love, MD
1
WC002
PR PR2 TREAT MD PROGRESS REP 10/2018/15
Dr Jody Love, MD
1
FORM
Brittany Perez (MR # 53500146) Printed by [S124212] at 10/11/17 8:52 AM
Page 3 of 3
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475620.538263 | Mark Lee |
Mark Lee DOB: June 14, 1984 (24 yo M) Acc No. 61539 Doc Name: April 27, 2021 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
March 28, 2017
Printed Name of Patient's Representative:
Relationship to Patient:
Mark Lee DOB: June 14, 1984 (24 yo M) Acc No. 61539 Doc Name: April 27, 2021 NP Forms
Page 100 of 123
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711472786.926649 | Heidi Bryant |
3296217
MEDICAL IMAGING CENTER
Name: Heidi Bryant
AD
1830 Town Center Drive #110
Phys: Dr William Morgan MD
Reston, VA 20190
BIRTH DATE: 2000 March 04 Age: 82
Sex: F
1/12/22
date of exam: 2022 June 10 Status: REG CLI
Radiology No:
Unit No: K000191920
EXAMS:
002718983 CT CHEST W IV CON
CT SCAN OF THE CHEST WITH CONTRAST:
HISTORY: Lymphadenopathy. Easy bruising.
TECHNIQUE: Contiguous axial images were performed from the thoracic
inlet to the lung bases following the administration of 100 ml of
Isovue-300 (non-ionic) intravenous contrast.
COMPARISON: 3/8/2021.
FINDINGS: Previously seen mild mediastinal lymphadenopathy has
resolved.
IMPRESSION:
1. Interval resolution of mild mediastinal lymphadenopathy.
o
2. New 4 mm groundglass nodule right middle lobe. Recommend 3-6 month
7
follow-up CT to ensure stability or resolution.
PAGE 1
Signed Report
(CONTINUED)
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711477183.157794 | Wesley Howard |
MAGNOLIA DIAGNOSTICS, INC.
MEDICAL EVALUATION for M.R.I./ CONSENT FOR TREATMENT
PATIENT NAME Samuel Espinoza
WT. 116
SOCIAL SECURITY #
HT.
DOCTOR'S NAME
DAVIS
CIRCLE
YES
NO
Have you had an MRI scan before today?
Yes
No
Where?
When?
Have you ever had surgery of any type?
Yes
No
List:
Do you have any metal in your body?
Yes
No
Explain:
Do you have a pacemaker, or any device implanted in you?
Yes
No
FEMALES ONLY:
Are you pregnant or is there a possibility you could be pregnant? Yes
No
The above questions have been answered truthfully to the best of my
knowledge.
I
do hereby consent to necessary examination procedures and/or
treatment by Magnolia Diagnostics, Inc. as prescribed by my treating
physician.
Signed Samuel Espinoza
Date
November 16, 2019
Date you are scheduled to return to your Doctor:
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711471329.285337 | Jonathan Smith |
Hometown Medical Center
Jonathan Smith
6364 Cassandra Union
Jameschester, MO 45486
MRN: 7355827, dob: 2003-01-16, Sex: F
Hometown Medical Center
NEW YORK NY 10021-4823 Adm: 2022-10-31, D/C: 2022-11-30
Consult to Pathology [91920341]
SIGNATURE: Dr Heather Wyatt, MD on 2016-10-12 2114
Status: Completed
Mode: Ordering in Verbal with repeat back and verified
Communicated by: Samuel Pham
mode
Ordering user: Samuel Pham 2017-04-13 2017
Ordering provider: Dr Heather Wyatt, MD
Authorized by: Dr Heather Wyatt, MD
Frequency: Release Upon Ordering 2020-06-01 2017 - 1 occurrence
Components
Case Report
Authorizing Provider: Blevins, Jason L, MD Collected: 2022-10-13 2016
Clinical Information
Hometown Medical CenterLab
Result:
Pre-Operative Diagnosis:
Breast Cancer
Procedure:
REVISION TOTAL KNEE REPLACEMENT, BOTH COMPONENTS - Right
Post-Operative Diagnosis:
T84.84XD, Z96.651 - Pain due to total right knee replacement, subsequent encounter [ICD-10-CM]
Z96.651 - Status post total knee replacement, right [ICD-10-CM]
Final Diagnosis
Hometown Medical CenterLab
Result: 1. JOINT, KNEE, RIGHT:
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711473531.01331 | Jessica Gomez |
From: Stephanie Gonzales
Fax: 14654462460
To:
Fax: (446) 468-5465
Page: 2 of 20
03/15/2022 8:55 PM
POWERED BY
DaisyBill
From
Stephanie Gonzales
To
Subsequent Injuries Benefits Trust
Original Bill
Med Legal
patient
Jessica Gomez
Billing Provider
MED-LEGAL
Claim Number
SIF46434658
dos
2019/17/06
Patient Control No.
1046db7466446-1
Charge Amount
$10,238.00
DaisyBill.com
info@daisybill.com
(646) 846-7461
DaisyBill does not respond to incoming faxes. Please call or email. | What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711473365.772145 | Terry Velazquez |
Consult
Renal (El Toukhy)
patient name: Terry Velazquez
MRN: 74826485
FIN: 94810485
Age: 84 years Sex: Female BIRTHDATE: 1997/25/12
Documentation Date: 2015/09/08 2:11 EST
Author: ADAMS APRN, LEAH DANIELLE
Consultation Information
Date of Consult: 2018/27/03
Reason for Consult: ESRD on HD.
Requesting physician:
Attending Physician: Dr Robert Ortiz MD.
Admission Information
Date of Admit: 2020/11/05
Visit Reason: RIGHT ANKLE PAIN
Allergies
naproxen (hives)
Visit Information
Medications:
Active Scheduled Medications 1
amiodarone
148 mg PO qDay
Comments: pt home med dose
Comments: Start if pt becomes NPO for more than 4 hr.
patient name:
Terry Velazquez
MRN: 74826485
FIN#: 94810485
Printed On:
10/30/2023 05:11 EDT
Page 56 of 516
Report Request ID#: 348348248
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711477090.7504 | Justin Moody |
Perception
no hallucinations or delusions during interview
Orientation
oriented
Memory / Concentration
short term intact,long term intact
Insight / Judgement
good
Diagnosis
Diagnosis
WHODAS /
Diagnosis
Reviewed
Inactive
Resolved
Code
Description
Type
Primary
GAF / CGAF Status
Date
Date
Date
Date
F31.81
Bipolar II Disorder
Active
Mar 24, 2018
JabaraMayer
Service Date: Aug 02, 2023 12:00:00 PM
Released:
Mar 24, 2018 9:28:06 PM
This document was printed from PIMSY EMR System It contains protected health information (PHI).
DOS: Mar 31, 2016 12:00:00 PM
Shauna Becker (B-C-14860)
B-C-14860-60557
Mar 24, 2018
Date Of Birth
Jun 06, 2000
Gender:
Female
CLIENTNUMBER B-C-14837
Page 3 of 37
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711475741.210041 | Mr. Jonathan Estes |
Mr. Jonathan Estes DOB: 19/01/1988 (54 yo M) Acc No. CR174042
[Doc Name: Ortho One Recs - DOS 08/11/2023-323054]
Mr. Jonathan Estes
Visit Note - 14/07/2016
PMS ID:
Sex:
DOB:
Phone:
MRN:
74042PAT42652140564 Male 19/01/1988 (xxx) xxx-xxxx MM0000007835
Musculoskeletal, and Neurological
presentation and mechanism of injury. Contusions can be expected to remain the same in some cases, but
and was notable for joint pains, joint
enlargement in the setting of symptoms such as progressive neurologic dysfunction is an indication for urgent
stiffness, and unsteady gait.
Loss, And No Redness.
Contact office if: the patient experiences increasing pain or swelling, numbness or tingling in the affected
extremity, or an enlarging mass.
Patient to cont. PT
I discussed the following medical options with the patient:
Acetaminophen : Acetaminophen is a drug that is commonly used as a pain reliever. The maximum daily dose is
4 grams.
After counseling, we decided on the following plan: Conservative Management, Observation, and Physical
Therapy
Follow up in 4 weeks. Other Instructions: follow up
Staff:
Fady Bahri (Primary Provider) (Bill Under)
Electronically Signed By: Fady Bahri, 30/08/2018 03:20 PM EDT
Fady Bahri (Primary Provider) (Bill Under)
Southside
Page 2
(904) 619-3048 Work
6100 Kennerly Road Suite 202
Jacksonville, FL 32216-4979
Mr. Jonathan Estes DOB: 19/01/1988 (54 yo M) Acc No. CR174042
Page 166 of 166
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711475955.482863 | Debra Mays |
04/11/23 02:58 PM
TO: 16103548946 8333674968
Page: 60
account
No:
118562
CITRUS
Debra Mays
CARDIOLOGY
53 Y old Male, DOB: 28/09/90
Consultants, P.A.
Account Number: 3199222
1138 CR 457, LAKE PANASOFFKEE FL-33538-5314
www.citruscardiology.org
Guarantor: Simons, Sherry D Insurance: HUMANA MEDICARE HMO
PCP: Cathlen S Delva, M.D.
Appointment Facility: Citrus Cardiology - 308 Inverness
24/08/23
Progress Notes KACI DYMOND
Current Medications
Reason for Appointment
Taking
1. 6 Month F/U
Propranolol HQ ER60 MG Capsule Extended
Debra Mays
M 53
Release 24 Hour 1 capsule Orally Once a day
2. Pt denies any new cardiac concerns
DOS : 20/05/22
DOB: 28/09/90
Xarello 20 MG Tablet 1 tablet with food Orally Once
Assessments
Acct C11920
a day
Medication List reviewed and reconciled with the
1. Paroxysmal a-fib - 148.0 (Primary)
PrimProv: Prada, Stefan, MD
patient
2 Cardiomyopathy - 142.9
3. Medical History
Past
appendectomy
8. Permanent atrial fibrillation - 148.21
hernia repair
lapband
To: 360 Ortho and Spine, Subject: Progress Notes, Fax#: 833-367-4968 SendDate: 04/11/23 page 1/3 [-ufg2.4.1.12in]
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711472786.492194 | Mark Garcia |
Salinas Valley
Medical Clinic
Corona, Araceli
MRN: 3187532, dob: 12-10-2002, Sex: F
SALEVE VALUE MINNIONAL HEALTHCARE SYSTEM
Visit: 02-04-2021
17-08-2022 a Office Visit in DOD Salinas C Abbott (continued'
Clinical Notes (continued)
Electronically Signed by Dr Darryl Coleman MD at 18-01-2016 8:53 AM
Attribution Key
SS.1 - Dr Darryl Coleman MD on 12/13/2021 8:27 AM
SS.2 - Dr Darryl Coleman MD on 12/13/2021 8:53 AM
C - Copied, M - Manual, T - Template
Printed on 12/14/21 4:04 AM
Page 4
237
GB IA Recv 2021122107346
Received 12/21/2021
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711477183.272221 | Donna Gonzalez |
12/08/14 3:39 PM
IDS FaxServer
15323242032
pg 2 of 32
DIS
D.I.S. Slidell
DIAGNOSTIC IMAGING SERVICES
Patient Name:
Rachel Adams
Ref. Physician:
Rommel S Dhadha MD
Patient ID: 425732
Home Phone: (985) 817xxxxx
Date of Birth: 04/08/91
Page 1 of 1
Date of Service: 15/01/23
STUDY
X-ray, Lumbosacral, Minimum 4 Views
CLINICAL INDICATION
Back pain
COMPARISON
No relevant imaging examinations are available for review.
PROCEDURE DETAILS
AP, lateral, both oblique, and spot lumbosacral views were acquired.
FINDINGS
The vertebral body heights and disc spaces are well maintained. Alignment is anatomic without
spondylolisthesis or spondylolysis. SI joints of sclerotic changes more prominent on the right than
left. The bony mineralization is appropriate.
There is a 4.8 mm calculus seen in the lower pole region of the right kidney.
IMPRESSION
1. No significant spondylosis or acute findings involving the lumbosacral spine.
Electronically Signed: Silvestri, James, M.D. on 09/03/19, 02:39 PM
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711471329.116258 | 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 the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711471328.479277 | Cheryl Jackson | Pineview General Hospital
ADMISSION FORM Printed: 20-02-22 6:32
PATIENT NAME Unit # Service/Location Status F/C Date Account#
Cheryl Jackson BP716516 GENERAL SURGERY DIS IN HMOC 20-02-22 BP88439849350
PATIENT PATIENT:EMPLOYER
Soc Sec No: D.O.B: Age: Sex: MS: Race:
84-08-09 41 F M B BAP
Address: 6968 Bradford Land
Ethanfort, PR 21332
Home Phone: 676-163-2695
County: HARRIS
D.O.B: 84-08-09
Address: 6968 Bradford Land
Ethanfort, PR 21332
Phone: 676-163-2695
D.O.B: 84-08-09
Rel To Patient: SPOUSE
Comment: INSURANCE # 1 Ins Policy # 716516
Ins Verif: 20-02-22 PO BOX 62127
Rel to Pt: SELF
D.O.B: 84-08-09
Eff. 10/06/22 to Rel: Y Asgn: Y Pre Cert
Type Accident: 11 ONSET OF SYMPTOMS/ILLNESS 17-04-21 Type:
Preferred Land EL HMOC ENG PHYSICANS Attending Physician:
Dr Tyler Brown MD ADMISSION/REGISTRATION Date: Time:
Source: Rm/Bed: Arrival: Principal Admitting Diagnosis/Reason for Visit:
ADMITTING DATE: 22-11-23 6:32
CLINIC OR PHYSICIANS 0612/1 Diverticulitis
PQME6821 FACILITY COPY Pineview General Hospital 20802 Sarah Trail
Chavezchester, RI 26898
Melissa Martinez FACE Acct# BP0001043784 MR # BP716516 FACESHEET Page 17 of 99
D.O.B: 84-08-09 41 F 18-06-27 EADMF0001 Rev. Date 09/2018 Dr Tyler Brown MD
PATIENT NAME:Melissa Martinez MRN:BP716516 Encounter:BP716516 Page 17 of 99 | what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711472786.859148 | Melissa Garcia |
Virginia Cancer
Specialists
Specializing in Cancer and Blood Disorders
LOCATION: VCS Loudoun
PATIENT NAME: Melissa Garcia
MRN: 372314
D.O.B: 12-16-1999
ATTENDING PHYSICIAN: Dr Paul Phillips
Date of Service 12-02-2014
REASON FOR VISIT
Non-Hodgkin's lymphoma/lymphadenopathy
HPI
60-year-old lady admitted to Reston Hospital with enlarged neck lymph nodes.
INTERVAL HISTORY
Developed a rash all over her body with itching after her discharge. No fevers.
PAST SURGICAL HISTORY
Right sided neck lymph node biopsy
REVIEW OF SYSTEMS
15 systems review detailed below is negative unless otherwise indicated
Constitutional: No weight loss, No fever, No chills, No night sweats. Energy level good
Eyes: No diplopia, No transient or permanent loss of vision, No scotomata
ENT/Mouth: No epistaxis, No dysphagia, No hoarseness, No oral ulcers, No gingival bleeding. No sore throat, No postnasal drip, No
nasal drip, No mouth pain, No sinus pain, No tinnitus, Normal hearing
09/19/2023
Page 1 of 3
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475620.476397 | Donna Hicks |
Donna Hicks DOB: 1989 Jun 27 (14 yo M) Acc No. 50160
2023 Nov 22
LAHS-SLIDELL
Matthew Laudun, D.C.
56634 BOSWORTH ST SLIDELL, LA 70458-8625
Chiropractor
Patient:
Donna Hicks
2023 Nov 22
DOB:
1989 Jun 27, Sex: Male
Address:
208 N SILVER MAPLE DR, SLIDELL, LA 70458-5483
Phone:
Ordered Date:
2021 Apr 16
Assessments:
Thoracic facet syndrome - M46.94
DI:
X ray : Thoracic spine 2 views
Fasting:
No
Specimen:
Collection Date: 04/08/2021 Time
Clinical Info:
Name
Value
Reference Range
Result:
Positive
Received Date: 2017 Jul 30
Notes:
Patient Name: Donna Hicks , DOB: 1989 Jun 27
file:///C:/Users/ashton/AppData/Local/Temp/eCW.5fkglis2.pj3/2505b897-f088-472d-86b2-f13e1546a59b.html
1/1
Donna Hicks DOB: 1989 Jun 27 (14 yo M) Acc No. 50160
Page 31 of 47
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711472286.496538 | Steven Banks |
Steven Banks
MRN: 5606113
06/22/2023 - Office Visit in MultiCare Rockwood Orthopedics & Sports Medicine (continued)
Results
(Order )
END OF IMAGING QUESTIONNAIRE REPORT
Preferred Pharmacy
Visit Pharmacy
WALMART PHARMACY 5883 - SPOKANEVALLEY, WA
Messages
Appointment Scheduled
From
To
Sent and Delivered
Bkg, Mychart
Steven Banks
6/5/2023 4:36 PM
Last Read in MyChart
Not Read
Appointment Information:
Visit Type: ATTORNEY
Date: 2021 Nov 11
Dept: MultiCare Rockwood Orthopedics & Sports Medicine
Provider: Joseph Labrum
Time: 2:20 PM
Length: 60 min
Appt Status: Scheduled
RIVER VIEW CORPORATE
Steven Banks
CENTER
MRN: 5606113, DATE OF BIRTH: 2003 Sep 13, Sex: M
16201 East Indiana Ave
Visit: 2023 May 10
SPOKANE VALLEY WA 99216-
1882
Page 13
Printed by 414221 at 7/17/23 9:40 AM
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711471329.366019 | Amy Smith |
06/2020/26 11:32 PM EDT OneCallCareManagement via VSI-FAX
Page 1 of 2 #3417302 OI
625 Bates Via Apt. 547
Port Katie, UT 32910
638-519-5332
PASADENA, CA, 91101
330-968-1363
Highland General
Compassion, Confidence, Comfort
Patient name
D.O.B
MRN
Amy Smith
09/1997/08
40.6205825
AT THE REQUEST OF
AGE / SEX
date of service
Dr Ana Swanson MD
38 y/F
09/2020/03
625 Bates Via Apt. 547
Port Katie, UT 32910
MRI RIGHT ELBOW
CLINICAL HISTORY
Appendectomy in 2005. History of Diabetes in 1999. No surgery to the right elbow. Recent
physical therapy with some relief of symptoms. Requesting assessing for acuity of changes.
COMPARISON
None
TECHNIQUE
The MRI was performed on a GE High Field 1.5 Tesla Signa Infinity Excite.
FINDINGS
Tendons: There is slight thickening and minor edema to the common extensor tendon, a full-thickness
IMPRESSION
FINDINGS FOR LATERAL EPICONDYLITIS, AGE OF CHANGES ARE UNKNOWN. NO
FULL-THICKNESS TEAR.
OTHERWISE NORMAL MRI RIGHT ELBOW.
PASADENA
Amy Smith 62058253
Page 2 of 2
1401
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711472590.747241 | Daniel Buckley |
Daniel Buckley
Hillside Healthcare
Visit Note - 01/2018/30
PMS ID:
Sex:
DOB:
MRN:
54643 Female 07/1984/07 54643
Medications
Chief Complaint: Chronic Low Back Pain
Duexis 864-64.6 mg Oral tablet
Medical History
HPI: This is a 82 year old female who is being seen for a chief complaint of chronic low back pain involving the spine.
Social History
with tramadol
Smoking status Unspecified
ROS
Vitals:
Provider reviewed on 04/2023/06.
Date
Taken By
B.P.
Pulse
Resp.
02 Sat.
Temp.
Ht.
Wt.
BMI
BSA
A focused review of systems was
performed including Constitutional /
LeBoeuf, Maci
66.0 in
164.0
64.7
1.9
Symptom, Eyes, Hematologio /
07/07/22
lbs
Lymphatic, Integumentary,
08:34
Musculoskeletal, and Neurological
FIO2
Page 1
| what is the DOB or date of birth? | {"text": ["07/1984/07"], "answer_start": [113]} |
id_1711475741.480537 | Cory Tate |
Cory Tate DOB: 14 Feb 2001 (71 yo M) Acc No. CR716637
27 Aug 2014, 9:09 AM
JAX SPINE & PAIN CENTERS
Courtney Delaparte, APRN
5191 FIRST COAST TECH PKWY THIRD FLOOR
Nurse Practitioner
JACKSONVILLE, FL 32224-0609
Tel: 904-223-3321 Fax:
Patient:
Cory Tate
27 Aug 2014
DOB:
14 Feb 2001, Sex: Male
Address:
1329 SOARING FLIGHT WAY, JACKSONVILLE, FL 32225-6828
Phone:
904-887-5708
Ordered Date:
10 Apr 2021
Assessments:
Lab:
OTHER
Fasting:
No
Specimen:
Clinical Info:
Name
Value
Reference Range
Carisoprodol
Cotinine
EtG
Gabapentin
Result:
Received Date:
Notes:
Patient Name: Cory Tate , DOB: 14 Feb 2001
file:///C:/Users/Emilym/AppData/Local/Temp/eCW.qini20at.emp/8f6cfce6-7098-4914-b013-deb0b635698c.htm
1/1
Cory Tate DOB: 14 Feb 2001 (71 yo M) Acc No. CR716637
Page 43 of 166
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711473530.330802 | Lance Myers |
athena
10/30/2023 1:33:13 pm EDT
Page: 17/86
Lance Myers (id #16746672, BIRTH DATE: 09/1998/14)
encounter date: 04/2015/02
Patient
Name
Lance Myers (83yo, F) ID#
Appt. Date/Time
01/06/2023 11:00AM
16746672
BIRTH DATE
09/1998/14
Service Dept.
SWVA_HIP_Roanoke Office*
Provider
Dr Charles York, MD
Measurements
None recorded.
Allergies
Reviewed Allergies
PENICILLINS
Some allergies listed in Documents: #280672675, #367243676 could not be added to this patient's chart.
Please review these documents and add these allergies to the patient's chart manually as needed.
Medications
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |