am-infoweb/rap_phase2_26march_custom · Datasets at Hugging Face

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id_1711475190.51037	Jeffrey Mendez	<<Back to Review>>194126-2 HYPERLINK-Hyperlink-Page 188 KAISER PERMANENTE庐 Jeffrey Mendez MRN: 110284072888, Date of Birth: 07/01/1992, Sex: F SSN: xxx-xx-3284 Visit Day: 01/07/2014 06/10/2017 - Work Comp in OCC PHYSICAL THERAPY -STE 5038 All Charges for This Encounter Code Description Service Date Service Provider Modifiers Qty 97014 APPLICATION MODALITY TO 1 OR MORE 07/12/2016 Lattupally, Shirisha (P.T.) 1 AREAS; E-STIM Physical Medicine Notes THERAPIST, PHYSICAL Progress Notes by Lattupally, Shirisha (P.T.) at 9/25/2007 1010 Version 1 of 1 Author: Lattupally, Shirisha (P.T.) Service: - Author Type: THERAPIST, PHYSICAL Filed: 9/25/2007 10:10 AM ENCOUNTER DATE: 22/08/2018 Creation Time: 9/25/2007 10:10 AM doi: 24/08/2015 Generated on 4/12/22 10:33 AM 000188 0187	What is the Date of Consultation?	{"text": [], "answer_start": []}
id_1711472786.49035	Travis Dennis	Salinas Valley Medical Clinic Corona, Araceli MRN: 3121290, dob: 1993 December 26, Sex: F SALEVE VALUE MINNIONAL HEALTHCARE SYSTEM visiting date: 2015 May 02 2014 November 28 a Office Visit in DOD Salinas C Abbott (continued' Clinical Notes (continued) Electronically signed by Dr Dr. Sandra Estes MD at 2018 September 19 8:53 AM Attribution Key SS.1 - Dr Dr. Sandra Estes MD on 12/13/2021 8:27 AM SS.2 - Dr Dr. Sandra Estes 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 Collection Date?	{"text": [], "answer_start": []}
id_1711472786.856402	Brian Gordon	Virginia Cancer Specialists Specializing in Cancer and Blood Disorders LOCATION: VCS Loudoun patient name: Brian Gordon MRN: 389604 D.O.B: 87-07-23 ATTENDING PHYSICIAN: Dr Amber Foster SERVICE DATE 22-01-25 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 Encounter or Enc?	{"text": [], "answer_start": []}
id_1711477275.579164	James Reed	CT, LUMBAR SPINE, W/ CONTRAST (#54463xx, 11/15/04 12:00am) Patient Portfolio Page 1 of 2 MCKESSON Patient Name: Paige Jacobs DOB: 07/97/02 Empowering Healthcare ID: MV00480852 Study Date: 25-Sept-2022 14:50 Final Report CT SPINE LUMBAR W CONT CHRISTUS Health System SST - SPOHN HOSPITAL SOUTH 5950 Saratoga Blvd. Corpus Christi, Tx 78414 RADIOLOGY REPORT Signed Patient: Paige Jacobs DOB: 07/97/02 F 69 Account #: AV0001604xxx Med Rec #: MV00480xxx Patient Location: AV.ED/ Procedure: SPINE LUMBAR DE CONT CPT:721xx Requisition #: 22-0238552 REPORT #: 0925-0652 Date of Exam: 12/15/03 Time of Exam: 1353 HISTORY: post op wound to lumbar, pain, discharge COMPARISON None. TECHNIQUE: CT lumbar spine with intravenous contrast. A CT dosimetry report is saved to PACS. CT scanner utilized a dose reduction technique. FINDINGS: Electronically signed by: Ryan Hanisch MD 19/23/02 3:53 PM CDT Workstation: RPCCWRS130P6 Dictated By: HANISCH, RYAN J MD Date Dictated: 19/23/02 1553 Signed By: HANISCH, RYAN J MD Date Signed: 19/23/02 1542 CC: LILJEBI ; MARIA L AYARZAGOITIA, FNP Admitting MD: 76729-3 South Texas Bone & Joint - 00452	What is Ordered Date?	{"text": [], "answer_start": []}
id_1711475620.722579	Rebecca Flores	2015/06/05 eCW (Schaubhut, Roslyn ) Rebecca Flores DOB: 1987/01/05 (78 yo M) Acc No. 39486 REFERRAL KATE MCDONALD, MD Rebecca Flores Family Practice 1987/01/05 ,,- 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 2022/27/12 at 02:42 PM CDT	What is the Date of Encounter or Enc?	{"text": [], "answer_start": []}
id_1711475190.482283	Bethany Houston	N NOVANT NOVANT HEALTH Bethany Houston KERNERSVILLE OUTPATIENT MRN: 52324237, DATE OF BIRTH: 10/1996/04, Sex: M HEALTH SURGERY Adm: 05/2019/04, D/C: 06/2019/03 1230 Kernersville Medical Parkway, Suite 234 KERNERSVILLE NC 27234- 7198 03/2019/15 - Admission (Discharged) in Novant Health Kernersville Outpatient Surgery Center (continued) Clinical Notes Acute (continued) rosuvastatin calcium (CRESTOR) TAKE 1 TABLET(5 MG) BY MOUTH AT BEDTIME 5 mg tablet Improvement from treatments: 80% relief from last bilateral L4-5 TFESI Side effects from medicines: None Activity Level-_adequate Abberant Behavior- Procedures; 04/2020/07 - L4/5 TFESI Images: X-Ray Lumbar Spine (3/5/2021): TECHNIQUE: 2 views lumbar spine. Generated on 4/11/23 8:33 PM Page 325	what is the admit date or admission date?	{"text": ["05/2019/04"], "answer_start": [151]}
id_1711473530.749964	Charles Rogers	TOWER PHYSICAL THERAPY, INC. Private Insurances: Any insurance that does not pertain to a work injury. Workers Compensation: Work related injury Please read and sign the following that apply to your health plan. PRIVATE INSURANCE/MEDI-CARE Any insurance that does not pertain to a work injury. If you are not aware of your physical therapy benefits, please let us know and we will acquire them for you, otherwise we will assume you are aware of your benefits. Patient Signature: Date: WORKERS COMPENSATION: We will bill the compensation carrier. Patient Signature: Ed Foster Date: 17-01-2024 000083 0083	what is the DOS or D.O.S?	{"text": [], "answer_start": []}
id_1711476990.583088	Karen Little	4054426744 fax 01:10:44 p.m. 24/12/2021 27/28" (800) xxxxxxx R: Central Laboratory: 4144 South Mingo Road, Tulsa, 74146 Patient Name: Jennifer Gonzales Provider: M Monem Gillan MD MRN: 525170844 1014015 DOB/Age/Sex: 06/07/2000 54 years Male Consulting: Deliver to: GILLAN, M MONEM 1211 N SHARTELL STE 700- OKLAHOMA CITY, OK 73103- Hematology CBC Collected Date: 20/02/2015 12:13 Procedure Normal Abnormal Units Reference Range Received Verified Date/Time Date/Time WBC 6.0P1 10e9/L [4.0-11.0] 04/28/2022 21:02 04/28/2022 21:55 Chemistry General Chemistries Collected Date: 20/02/2015 12:13 Procedure Normal Abnormal Units Reference Range Received Verified Date/Time Date/Time Glucose 104 H P1 mg/dL [70-100] 04/28/2022 21:02 04/28/2022 21:53 Printed: 05/01/202004:45 186501203 Page 1 of 44	What is the Date of Encounter or Enc?	{"text": [], "answer_start": []}
id_1711473530.494446	Bryan Chen	KNMH CT SCAN Bryan Chen 180 W Esplanade Ave MRN: 8348348, birthdate: 11/1985/17, Sex: M Kenner LA 73465 Acct #: 83403346341 Enc. Date 01/2018/15 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 04/2018/25 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 02/2024/24 Indications of use: Neck trauma (Age >= 65y) Result CT Cervical Spine Without Contrast (Order 434903430) Generated on 10/3/22 11:37 AM Page 2	What is the Date of Consultation?	{"text": [], "answer_start": []}
id_1711471330.56622	Michael Mcdaniel	Doctors of Manteca patient name: Michael Mcdaniel Attending Provider: Dr Lisa Ramirez MRN #: 153795 Admission Date: 21/04/21 Account #: 23465013953 date of discharge: 21/05/21 D.O.B/Age/Sex: 14/11/88 / 61 years / Female Lab Medical Director(s): Dr Mark Vang, MD Discharge Documentation/Instructions Attachment(s): Most recent to oldest [Reference 1 2 Range]: 12.5 g/dL 12.6 g/dL Hgb [12.0-16.0 g/dL] (2/19/20 5:10 AM) (2/18/20 5:23 AM) 31.1 pg 31.4 pg MCH [27.0-31.0 pg] HI HI (2/19/20 5:10 AM) Report Request ID: 246234232 Page 1 of 334	what is the DOB or date of birth?	{"text": ["14/11/88"], "answer_start": [223]}
id_1711477090.145026	Richard Jones	15 August 2014 12:10 PM FROM: Fax PULMONARY AND SLEEP SPECIALISTS OF TAMPA BAY, PA PAGE: 016 OF 018 Patient: Matthew Graves DOB: 25 February 1989 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 06 May 2019 Signing Dr. Eckerd, Morgan Location FPLA051 Signature Line nal ********* Transcribed by: MCE 07/21/21 13:32 Signed by: ECKERD MD, MORGAN CHARLTON 21 June 2023 13:32 RADRPT This document has an i mage Page 2 of 75 Printed on: 15 August 2014 15:29 EDT Document: 15 August 2014 Printed: 15 August 2014 10:55:38 Page 15 of 175	What is the Date of Consultation?	{"text": [], "answer_start": []}
id_1711477090.81242	Brittany Mendoza	06-02-2022 19:59:15 EDT To: 195222268622 Page: 03/622 From: Lauris Rigdon Patient Self-Report Patient Assessment/Diagnosis History of Present Condition: Patient presents with acute LBP and right hip pain that presents with acute low back and right hip pain following started on May 20th following elevator accident. Functional accident that occurred on May 20th. Pt explains that she was battling with established with patient input. allow patient to return to prior level of function, independence and safety. Onset Date: May 20th Comorbidities: - Psychosocial: Battling with high anxiety, difficulty talking about accident - Car accident in with back pain and left shoulder (2007) e Currently experiencing excessive vaginal bleeding (being monitored by OBGYN) Pre Morbid Level of Function: - Independent prior to injury Current Level of Function/Current Deficits: - Unable to get into/out of car without onset of pain - Unable to stand for prolong periods of time - Unable to walk her dog due to fear of worsening symptoms. Work tasks: Desk job at home, mostly on the computer Sleep disturbance: Reports no change in sleeping pattern Imaging: X-ray: no abnormal findings. CT scan of abdomen and pelvis: results pending Red flags: Pt denies all red flags including but not limited to weight loss/gain > 10 Patient John Peters (DOB: 11-28-1985) Treated by Jennifer Flores, PT. DPT DOS: 08-23-2018 Page 2 of 22 of Plan of Care	What is the Date of Discharge?	{"text": [], "answer_start": []}
id_1711475620.322197	Lisa Collins	Lisa Collins DOB: 21/06/98 (67 yo M) Acc No. 63888 22/09/23 Lisa Collins DOB: 21/06/98 (67 yo M) Acc No. 63888 DOS: 05/08/20 97140 MANUAL THERAPY, Modifiers: 59 72040 X-RAY OF CERVICAL SPINE 3 view 72070 X-RAY OF THORACIC SPINE AP/LAT 72100 X-RAY OF LUMBAR SPINE 2 view Follow Up 2 - - 3 Days Electronically signed by Dr. Nicholas DiGerolamo Jr, DC on 30/08/17 at 01:40 PM CDT Sign off status: Completed Visit Status: CHK (Check Out) Provider: Matthew Laudun, D.C. Date: 06/04/19 Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com) Lisa Collins DOB: 21/06/98 (67 yo M) Acc No. 63888 Page 30 of 47	what is the admit date or admission date?	{"text": [], "answer_start": []}
id_1711477183.326242	Pamela Johnson	Jun 03, 2019 9 33 24 AM PST (GMT-8) FROM 9856749749-TO 15048424047 Page of 2 MRO Jun 03, 2019 Initials: DISCON LAW FIRM, L.L.C. 424 N. Causeway Blvd., Suite A Mandeville, LA 70455 Thomas M. Discon September 18, 2022 Via Facsimile: 504.842.4047 Ochsner Medical Center Ochsner Health Services Medical Records Department 1514 Jefferson Highway New Orleans, LA 70121 Re: Our Client: Wanda Cross DOB: Sep 18, 2003 DOI: Oct 22, 2017 Dear Sir or Madam: Our firm has been retained by Mr. James Ladner for injuries sustained in an accident on Oct 22, 2017. Enclosed please find a medical authorization executed by Mr. Ladner authorizing your office to release directly to our firm a certified copy of his entire medical file, including an itemized statement for services rendered, from January 1, 2022, to present. Further please consider this correspondence a reminder that your treatment of Mr. With kindest regards, I remain Very truly yours, s/Thomas M. Discon THOMAS M. DISCON TMD/djl Enclosure	What is Collection Date?	{"text": [], "answer_start": []}
id_1711473365.911448	Anne Marks	I have not violated Labor Code 139.3 and the contents of the report and bill are true and correct to the best of my knowledge. Signed this date, Solano County, California. DATE: 23-07-14 CURRENT MEDS: See med List (0935) No Level: 8/10 ALLERGIES/ADVERSE REACTIONS Patient Instruction: Pain: Yes MEDICATIONS: nKDA Acceptable pain level: Learner: Pain Is the primary reason for this visit LATEX: no Patient: Family: Rev IS train and MRI rese Teaching Method: Verbal Presentation: Cort pun W lower back unable Demonstration: Written Materials: to set & Stend A protest Medication: Medications dispensed: Description OCCUPATIONAL HEALTH Provider: SHEILA LEDERER, PA A NorthBay Affiliate Keeping Solano's Workforce Healthy Service Date: 22-07-16 Patient: MEJIA-GALLEGO, D.O.B: 97-11-06 FLORENTINO Follow Up Visit Employer : CHEVY'S-FF Injury Date : 20-12-06 OH-26 Rev. 03-12 230	What is Date of Injury or DOI?	{"text": ["20-12-06"], "answer_start": [922]}
id_1711471328.381658	Julia Bell	2018 November 25 13:47 Fax 18039734602 p.6 Tuesday, April 12, 2022 History and Exam Patient Name Julia Bell Female birthdate: 2000 September 14 Age: 64 years, 8 months date of visit: 2020 September 13 Referred By: History Chief Complaint: " I have a 24/7 guard a doctor made for me in new orlands and he told me to eat with-it and i tried but it doesn't work out" HPI: History of Migraine with ablation on multiple meds Started years ago SFH: Does not smoke ETOH use Rarely - Wine No Illicit Drug Hx Medications: Albuterol inhaler Allergies: None Health Alerts: High Blood Pressure, TMJ Disorder, Alcohol Use, Arthritis, Sinus Trouble Exam Date Recorded: 2018 November 25 Ht. 4'5" Wt. 57kg General: General: -No pre/post auricular surgical scar -No overlying erythema -CN VII is HB-I bilaterally Joint Examination (R/L): -Superficial pain: 0/0 000047	what is the admit date or admission date?	{"text": [], "answer_start": []}
id_1711475190.317913	Jordan Davis	KAISER PERMANENTE庐 Jordan Davis MRN: 110194019819, DATE OF BIRTH: 2002-11-30, Sex: F SSN: xxx-xx-3194 Visit: 2019-05-30 2020-06-20 - Telephone in ADULT AND FAMILY MEDICINE (continued) Clinical Notes (continued) Status: Signed Editor: Clark, Juliana Elizabeth (M.A.) (MEDICAL ASSISTANT) Signature Clark, Juliana Elizabeth (M.A.) at 2016-06-30 9:44 AM Telephone Encounter by Clark, Juliana Elizabeth (M.A.) at 1/13/2011 0944 Version 1 of 1 Author: Clark, Juliana Elizabeth (M.A.) Service: - Author Type: MEDICAL ASSISTANT Filed: 1/13/2011 9:44 AM Encounter Date: 2019-06-25 Creation Time: 1/13/2011 9:44 AM Status: Signed Editor: Clark, Juliana Elizabeth (M.A.) (MEDICAL ASSISTANT) Generated on 4/12/22 10:33 AM 000564 0563	what is the DOS or D.O.S?	{"text": [], "answer_start": []}
id_1711475190.547135	Regina Parker	Regina Parker MRN: 5672673 Preferred Pharmacy (continued) Referral (continued) Order MRI ARTH SHOULDER W/ CONTRAST RIGHT [676335615] signature: Dennis S Frerichs, PA-C on 24/23/03 0679 Status: Completed This order may be acted on in another encounter. Ordering user: Dennis S Frerichs, PA-C 02/22/23 0949 Authorized by: Dennis S Frerichs, PA-C Ordered during: Office Visit on 25/19/06 Screening Form General Information Patient Name: Regina Parker MRN: 5672673 birthdate: 12/90/12 Mobile: 567-967-4679 Sex Assigned at Birth: Male MC ROCKWOOD MAIN CLINIC Regina Parker - SPOKANE MRN: 5602313, birthdate: 12/90/12, Sex: M 400 East 5th Ave date of visit: 22/16/08 Spokane WA 99202-1334 Page 89 Printed by 414221 at 7/17/23 9:40 AM	what is the DOB or date of birth?	{"text": ["12/90/12"], "answer_start": [506]}
id_1711472285.690909	Matthew Chung	STATEMENT THIS IS A STATEMENT OF SERVICES RENDERED BY PHYSICIAN(S) WHO ARE MEMBERS OF: PATIENT NAME Seaside Medical Matthew Chung 8626 TESORO DRIVE BILL DATE ACCOUNT NO. AMOUNT PAID SUITE 112 SAN ANTONIO, TX 782176207 Jul 15, 2021 15032 210-817-6010 Seaside Medical 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 16 February 2023 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 19 May 2017 Matthew Chung 15032 AMOUNT $21,050.00 10 November 2023 1 3:34:01 PM	What is Date of Injury or DOI?	{"text": [], "answer_start": []}
id_1711475620.750908	Martha Curry	Martha Curry DOB: 28/11/93 (53 yo M) Acc No. 56005 Doc Name: 08/08/18 Financial Disclosure Disclosure of Financial Interest Form LA HEALTH SOLUTIONS, LLC and LYLE J. SCHWEEN, BS DC DISCLOSURE OF FINANCIAL INTEREST as required by R.S. 37:1744 and LAC 46:XXVII.911, et seq Date: 21/06/17 Patient Name: Martha Curry Louisiana law requires LA HEALTH SOLUTIONS, LLC and LYLE J. SCHWEEN, BS DC, and other health care providers to make certain disclosures to a patient when they refer a patient to another health care provider or facility in which the health care provider has a significant financial interest. One of the health care providers listed above may refer you, or the named patient for whom you are legal representative, to: PATIENT ACKNOWLEDGEMENT I, the above-named patient, or legal representative of such patient, hereby acknowledge receipt, on the date indicated and prior to the described referral, of a copy of the foregoing Disclosure of Financial Interest. (Signature of Patient or Patient's Representative) Print Name: Justin Ganloald Date: 30/03/19 Martha Curry DOB: 28/11/93 (53 yo M) Acc No. 56005 Doc Name: 08/08/18 Financial Disclosure Page 103 of 134	What is the Date of operation?	{"text": [], "answer_start": []}
id_1711475620.347787	Mr. Andrew Hayes DDS	Mr. Andrew Hayes DDS DOB: 89-04-26 (24 yo M) Acc No. 92572 15-10-19 Mr. Andrew Hayes DDS DOB: 89-04-26 (24 yo M) Acc No. 92572 DOS: 18-11-06 10. Sprain of sacroiliac region, initial encounter - S33.6XXA 11. Sprain of right rotator cuff capsule, initial encounter - S43.421A 12. Cervical muscle pain - M54.2 Treatment Manual Therapy: Massage Region: Left cervical, Right cervical, Left trapezius, Right trapezius Duration 8 minutes Electrical Stimulation: Spinal E-Stim Region: Left cervical, Right cervical, Left trapezius, Right trapezius, Left quadratus lumborum, Right quadratus lumborum, Left sacroiliac, Right sacroiliac Duration: 10 minutes Cold Therapy: Spinal Cold Therapy Region Left cervical, Right cervical, Left trapezius, Right trapezius, Left quadratus lumborum, Right quadratus lumborum, Left Sacroiliac, Right Sacroiliac Duration 10 minutes Procedure Codes 97140 MANUAL THERAPY, Modifiers: 59 97014 ELECTRIC STIMULATION THERAPY Follow Up 2 - 3 Days Electronically signed by MATTHEW LAUDUN , D.C. on 21-05-02 at 01:05 PM CDT Sign off status: Completed Visit Status: CHK (Check Out) Mr. Andrew Hayes DDS DOB: 89-04-26 (24 yo M) Acc No. 92572 Page 23 of 47	what is the DOS or D.O.S?	{"text": ["18-11-06"], "answer_start": [142]}
id_1711472591.029533	Christopher Mcmahon	Gulf Coast Surgical Center LLC Christopher Mcmahon D.O.S: 27 January 2020 2:30:00 PM ID / Visit: 48590 / 1 PATIENT INFO: SEX: F DATE OF BIRTH: 21 January 2003 AGE: 50 MAIN PHONE: 566-379-7497 ADDRESS: 034 Jimenez Valleys Apt. 894 Carolynmouth, ME 02615 RESPONSIBLE PARTY: BUGGAGE, NADINE A 034 Jimenez Valleys Apt. 894 Carolynmouth, ME 02615 RSP SSN: RSP OCC: TRMC RSP PH: 623-567-5262 I UNDERSTAND AND AGREE THAT, AT THE TIME THE PATIENT HAS MET GULF COAST SURGICAL CENTER LLC's MEDICAL CRITERIA TO LEAVE THE FACILITY, I WILL HAVE A RESPONSIBLE ADULT PRESENT TO TAKE ME/PATIENT HOME. I RELEASE GULF COAST SURGICAL CENTER LLC FROM ANY RESPONSIBILITY FOR EVENTS IN VIOLATION OF THIS AGREEMENT. Nadine Buggage Miniton 20 January 2017 1593 Witness Date Time Signed	what is the service date or date of service?	{"text": [], "answer_start": []}
id_1711471329.003598	Paul Moore	Downtown Medical Center 44151 Nash Park Port Lindamouth, AS 18299 Paul Moore M MRN: 8655141, D.O.B: 25-11-1991, Sex: F Adm: 13-04-2022, D/C: 13-05-2022 13-04-2022 - ED in Emergency - 44151 Nash Park Port Lindamouth, AS 18299 Reason for Visit Chief complaint: Drug Overdose Visit diagnosis: Ulcerative Colitis Visit Information Admission Information Arrival Date/Time: 13-04-2022 2153 date of admit/Time: 13-04-2022 2155 IP Adm. Date/Time: Admission Type: Emergency (Medical Point of Origin: Non-healthcare Admit Category: Intervention For Facility Point Of Severe, Life Origin Threatening Or Disabling Condition. Means of Arrival: Ambulance, Guilford Primary Service: Emergency Medicine Secondary Service: N/A Transfer Source: Service Area: WAKE FOREST Unit: Emergency - High BAPTIST MEDICAL Point, Main Hospital CENTER Admit Provider: Attending Provider: Dr Joseph Hanna, Referring Provider: A Referral Self MD Discharge Information Date/Time: 13-05-2022 0102 Disposition: Home Or Self Care Destination: - Provider: - Unit: 44151 Nash Park Port Lindamouth, AS 18299 Follow-up Information Follow up With Specialties Details Why Contact Info Dr Steven Simmons, MD Obstetrics and Schedule an appointment Recheck today 405 LINDSAY STREET Gynecology as soon as possible for a symptoms High Point NC 27262 visit in 2 days 378-740-3347 Events ED Arrival at 07-04-2018 2153 Unit: Emergency - Downtown Medical Center User: Logan Nichols Printed on 6/24/23 12:23 PM Page 1	What is Ordered Date?	{"text": [], "answer_start": []}
id_1711471328.294313	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 the Date of Evaluation?	{"text": [], "answer_start": []}
id_1711475620.478225	Cindy Taylor	Cindy Taylor DOB: 1985/27/04 (66 yo M) Acc No. 52602 2021/28/07 LAHS-SLIDELL Matthew Laudun, D.C. 56634 BOSWORTH ST SLIDELL, LA 70458-8625 Chiropractor Patient: Cindy Taylor 2021/28/07 DOB: 1985/27/04, Sex: Male Address: 208 N SILVER MAPLE DR, SLIDELL, LA 70458-5483 Phone: Ordered Date: 2020/09/02 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: 2016/22/07 Notes: Patient Name: Cindy Taylor , DOB: 1985/27/04 file:///C:/Users/ashton/AppData/Local/Temp/eCW.5fkglis2.pj3/2505b897-f088-472d-86b2-f13e1546a59b.html 1/1 Cindy Taylor DOB: 1985/27/04 (66 yo M) Acc No. 52602 Page 31 of 47	What is the Date of Evaluation?	{"text": [], "answer_start": []}
id_1711476893.293612	Ian Sutton	11 Sep 2019 9:22 29 AM NorthBay Health System 707-646-5000 Page 3 of 3 1101 B Gale Wilson Blvd. State 100 Faufield. CA 91533 071646-4646 Magnerl Pesonanco Exam Date/Time: Exam: Accession Number: Ordering Physician: 16 Dec 2018 09:26:31 MR MRI Lumbar Spine MR-12-0002095 Kitchens, Charles. M.D. w/o Contrast causing significant encroachment upon the central spinal canal or neural foramina. IMPRESSION: 1. Large central disc herniation with small inferiorly extruded disc fragment at L5-S1. There does not appear to be significant encroachment upon the central spinal canal or neural foramina. 2. Very small central disc herniation at L4-L5 without significant encroachment upon the central spinal canal or neural foramina. DT: 6/21/2012 (1226 hours) Final Report Dictated by: Gonser. William N.. M.D. Signed by: Gonser. William N., M.D. Transcriptionist: McGraw. Tena 06/21/2012 12:01 Parent NameIan Sutton Medical Record No 6051651 Financial No 8010198 DOB 23 Apr 1984 Age 26 years Gender Male PI Diagnostic Imaging Type Outpatient Admit Date 12 May 2022 Ordering Physician Kitchens Charles MD Solano Imaging Medical Associates Evelyn Lopez. MD Cindy Ibarra. MD William N Gonser. MD Properto 25 2012 Page 2 of 51 251	What is the Date of Discharge?	{"text": [], "answer_start": []}
id_1711475955.518978	Catherine Vega	2020/03/01 02:58 PM TO:16103548946 FROM: 8333674968 Page: 59 CITRUS 2020/11/04 okpie CARDIOLOGY Consultants, P.A. CARDIAC: CLEARANCE DATE: 2022/12/12 OFFICE PHONE NUMBER: 352-726-8353 PATIENT: Catherine Vega ADDRESS: 1138 Cr 457 LAKE PANASOFFKEE FL 33538 ACCOUNT: 6669354 RE: Surgical Procedure endoscopic cervicas & Lumbar rugery To Whom It May Concern: THESE ARE SUGGESTED RECOMMENDATIONS This letter is to certify that the above-named patient has been under my care for AFIB, nonischemic cardiomyopany HTN Take usual cardiac medications the morning of the procedure. YES NO (Circle One) Additional Notes: BIRI Class I- 391.30.day risk for compensive cardiovascular conplication METSZ4.0 If you have any further questions, please do not hesitate to contact my office. Sincerely, K.Dynond, APRN Physician Signature Physician Name Nishant DONAND Nerella MD Catherine Vega M 24 DOS: 2021/18/09 DOB: 2003/12/08 Citrus Cardiology Consultants, P.A. Acct: C11920 PrimProv: Prada, Stefan, MD	What is the Date of Discharge?	{"text": [], "answer_start": []}
id_1711471328.339078	Andrew Daniel	Hometown Medical Center 260 East Washington Ave Jonesboro, AR 76001 870-960-4100 Patient: Andrew Daniel Room #: Age/Sex: 40 F Med Rec #: SM94454595947 BIRTH DATE: 18 February 2015 Account #: SV94454595947 Attending Doctor: Dr Brandon Morris MD Hospital Service: Ordering Doctor: Daniel Smith MD admission date: 06 December 2016 Primary Care Provider: Patient Status: REG CLI Primary Insurance: BLUE ADVANTAGE IMAGING SERVICES STATUS: Signed Report #: 0460-0181 6700459.001 ECG/Electrocardiogram exam date: 28 January 2017 Test Reason : Blood Pressure : / mmHG Vent. Rate : 60 BPM Atrial Rate : 60 BPM P-R Int : 160 ms QRS Dur : 60 ms QT Int : 606 ms P-R-T Axes : 42 60 15 degrees QTc Int : 460 ms Disease: Pneumonia Cannot rule out Anterior infarct , age undetermined Nonspecific T wave abnormality Abnormal ECG No previous ECGs available electronically signed by Amanda Smith (1032) on 05 February 20191:01:38 PM Referred By: Amanda Smith Confirmed By: Amanda Smith electronically signed by: Matthew Juarez, MD Carotid Ultrasound Page 1 of 60 PARHAM-0607 000060	What is Date of Injury or DOI?	{"text": [], "answer_start": []}
id_1711477275.792708	Tiffany Torres	Report #: 1008-0022 Signed CHRISTUS SPOHN HEALTH SYSTEM - CORPUS CHRISTI - SOUTH Operative Report PATIENT NAME: Russell Bradford DATE OF BIRTH: 12/84/05 MEDICAL RECORD NUMBER MV00422822 ACCOUNT NUMBER AV0022605022 LOCATION: AV.MS3A ADMIT DATE: 23/19/09 DISCHARGE DATE: 23/19/10 ATTENDING PHYSICIAN: ASMIK ASATRIAN MD PROCEDURE DATE: 21/16/02 PREOPERATIVE DIAGNOSES: Deep and superficial reactive seroma, status post incision and drainage of reactive seroma and application of wound VAC ANESTHESIA: General ESTIMATED BLOOD LOSS: 30 mL cc: Patient Status: DIS IN M.R.#: MV00480850 Patient: TREJO,ELMA MUNOZ Account #: AV0001605094 Attending Dr.: ASMIK ASATRIAN, MD Admit/Service date: 10/23/10 Discharge date: 23/19/10 DOB: 12/84/05 Loc/Room #: AV.MS3A/AV.302-1 Medical Records' copy Medical Records Primary Care Dr.: LILJEBI Page 1 of 22 76722-3 South Texas Bone & Joint - 00322	what is the visit date or date of visit?	{"text": [], "answer_start": []}
id_1711477183.558557	Jesse Welch	Amanda Fisher DOB: 1999 June 03 (62 yo M) Acc No. 19280 DOS: 2014 September 27 areas of pain in addition to treatment plan detailed below. All patient questions were invited and answered. DIAGNOSTICS AND RECORDS REVIEWED: Imaging/Testing: Available imaging and reports (documented above), were reviewed and discussed with patient. CHIRO/PT AND HOME EXERCISE COUNSELING: The importance of a doctor-directed pain management therapy program including education, manual therapies, passive modalities, activity modification, exercise, and home exercise plan (HEP) training was discussed with the patient. MEDICATION COUNSELING: Risks, benefits, and alternatives of medications were thoroughly discussed with patient. Follow Up 80 weeks after procedure for re-evaluation BOARD CERTIFIED ORTHOPEDIC SURGEON Electronically signed by ALEXANDER ABOKA on 2015 August 17 at 01:41 PM EDT Sign off status: Completed Provider: ALEXANDER M ABOKA, MD Date: 2014 August 04 Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)	What is the Date of Exam or Examination date?	{"text": [], "answer_start": []}
id_1711477275.607465	Wendy Schneider	CHRISTUS Spohn Hosp South 5950 Saratoga Blvd. Corpus Christi, TX 78414 ADMISSION/SERVICE DATE TIME DISCHARGE DATE TIME ACCOUNT NUMBER Jan 19, 2019 1514 AV0001606094 CHRISTUS Spohn Hosp South 5950 Saratoga Blvd. Corpus Christi, TX 78414 PATIENT NAMBAD DRESS UNIT NUMBER ROOMIESD & ADMIT COURCH LOCIGNO ACCOMMIDDATION STATUS TREJO, ELMA MUNOZ CONFIDENTIAL REG ER 1 NON HLTH F 601 HUGHES AVE MV00480850 AV.ED DOB: Nov 27, 1987 MARTLSTAT LANGUAGE ADMIT PRIORT CLASS ADMIT CLERK PALICE, TX 78332-6580 D AGE: 69 SPOKEN N M BNG ER MM Alternate Address? SEX: F RACE WH RELIGION: CA WRITTEN ENG SSN: Other Name: ETHN: HISPANIC OR LATINO ORIGIN Other Hisp,La PATIENT EMPLOYER NEXT OFKIN ADDRESS ERSON TO NOTIEY ADDRESS RETIRED TREJOJJACOB TREJO MICHAEL RELATIONSHIP: SON RELATIONSHIP: SON OCCUPATION: RE 76729-3 South Texas Bone & Joint - 00346	What is signature date or signed on date?	{"text": [], "answer_start": []}
id_1711473365.798756	Brittany Rice	Consult 573 mg with meals Epogen 10,730 units/mL injectable solution 10,730 units Subcutaneous Dialysis Histories Past Medical History: Past Medical History HTN Hypertension Atrial fibrillation Hemodialysis Past Surgical History: Procedure List: 2023 Nov 15 Ankle Open Reduction Internal Fixation Family History: No qualifying data available. , Family history review on 2019 Apr 17. History of Present Illness Patient is a 67 yo female, traveling to Orlando from Ohio, with h/o ESRD on HD TTS via AVF, with h/o DM, CAD s/p CABG, who presented to AHC Er after slip and fall getting out of shower and had c/o ankle pain. Review of Systems Constitutional: Negative except as documented in history of present illness. patient name: Brittany Rice MRN: 77326735 Printed On: 10/30/2023 05:11 EDT Page 58 of 516	What is Collection Date?	{"text": [], "answer_start": []}
id_1711475955.481348	Michael Bishop	2015-07-23 02:58 PM TO: 16103548946 8333674968 Page: 60 account No: 118562 CITRUS Michael Bishop CARDIOLOGY 80 Y old Male, DOB: 1997-01-13 Consultants, P.A. Account Number: 2691227 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 2015-07-21 Progress Notes KACI DYMOND Current Medications Reason for Appointment Taking 1. 6 Month F/U Propranolol HQ ER60 MG Capsule Extended Michael Bishop M 80 Release 24 Hour 1 capsule Orally Once a day 2. Pt denies any new cardiac concerns DOS : 2022-11-19 DOB: 1997-01-13 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: 2015-07-23 page 1/3 [-ufg2.4.1.12in]	what is the visit date or date of visit?	{"text": [], "answer_start": []}
id_1711471329.334927	Gregory Kennedy	45532615476 22:36:38 a.m. 04-13-202 3/3 Hilltop Healthcare 01/01/23 798 Julie Crescent Apt. 674 Gregoryville, TX 72348 Page 3 114-333-6244 Fax: 939-892-4753 Office Visit Gregory Kennedy Work: (870) 972-8931 Female DATE OF BIRTH: 11/02/04 187761 Ins: Blue Advantage Grp: 45532615476 : ASSESSMENT: Right trimalleolar ankle fracture. PLAN: The risks versus benefits of operative versus non-operative treatment were discussed with the patient and her husband, They agree to proceed with surgery. ABB/bcc 0829 Electronically Signed by Dr Katie Thompson MD on 13/04/16 at 1220 PARHAM-0127 000039	What is the Procedure Date?	{"text": [], "answer_start": []}
id_1711473531.045339	Jonathan Butler	From: Stephanie Gonzales Fax: 19344634834 To: Fax: (434) 348-5345 Page: 7 of 20 03/15/2022 8:55 PM Dr David Davis, M.D. Adjunct Assistant Professor, Pain Management (934) 341-2340 Fax (834) 934-9345 DATE OF REPORT: 2019-05-11 Patient name: Jonathan Butler date of birth: 1993-12-11 SS# 534-25-0343 EMPLOYER: Superstores Industries CLAIM # SIF11434634 DOI: 2017-03-04 Department of Industrial Relations/Subsequent Injury Benefits Trust Fund, 1750 Howe Ave, Ste 370, Sacramento, CA 95825-3367 (916) 928-4601 Fax: (916) 928-4705 SUBSEQUENT INJURY BENEFITS TRUST FUND SUPPLEMENTAL REPORT Mr. Foster's attorney requested that I prepare a report discussing additional medical records (see his 2/28/22 letter). Emanuel Medical 1021 pages	What is Ordered Date?	{"text": [], "answer_start": []}
id_1711475620.748101	Ashley Jackson	Ashley Jackson DOB: 21/01/1988 (80 yo M) Acc No. 86769 Doc Name: 24/07/2018 Financial Disclosure Disclosure of Financial Interest Form LA HEALTH SOLUTIONS, LLC and LYLE J. SCHWEEN, BS DC DISCLOSURE OF FINANCIAL INTEREST as required by R.S. 37:1744 and LAC 46:XXVII.911, et seq Date: 16/12/2014 Patient Name: Ashley Jackson Louisiana law requires LA HEALTH SOLUTIONS, LLC and LYLE J. SCHWEEN, BS DC, and other health care providers to make certain disclosures to a patient when they refer a patient to another health care provider or facility in which the health care provider has a significant financial interest. One of the health care providers listed above may refer you, or the named patient for whom you are legal representative, to: PATIENT ACKNOWLEDGEMENT I, the above-named patient, or legal representative of such patient, hereby acknowledge receipt, on the date indicated and prior to the described referral, of a copy of the foregoing Disclosure of Financial Interest. (Signature of Patient or Patient's Representative) Print Name: Justin Ganloald Date: 12/09/2017 Ashley Jackson DOB: 21/01/1988 (80 yo M) Acc No. 86769 Doc Name: 24/07/2018 Financial Disclosure Page 103 of 134	What is the Date of Exam or Examination date?	{"text": [], "answer_start": []}
id_1711476766.370356	Matthew Ramsey	Bethesda Pathology Report Bethesda Hospital East Pathology Name: Michael Park Specimen #: SE-5803-50 Age: 45 Y Medical Record 150786850 # : DOB: September 13, 2000 Patient # : 2525037750 Sex: F Specimen February 08, 2023 Received: Locat AMBULATORY CARE Report Date: May 04, 2022 ion: Procedure March 31, 2015 Signed KENNETH Date: Out By: BENGTSON, M.D. Physician (s) : Scott May, 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 February 08, 2023 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. January 21, 2022 at 13:12 **End of Report	What is the Date of Discharge?	{"text": [], "answer_start": []}
id_1711475741.538675	Virginia Zimmerman	Virginia Zimmerman DOB: 06 September 1991 (60 yo M) Acc No. CR421526 [Doc Name: 19 November 2019 MRI CERVICAL SPINE] CR172462 Virginia Zimmerman (MRN5286127) UF Health Radiology JP UF HEALTH JTB KERNAN Imaging Result Report Patient: Virginia Zimmerman MRN #: 5286127 DOB: 06 September 1991 Ord #: 618102455 Sex: Male Acc #: J11881056 Att Prov: Auth Prov: Roberts, Christopher 10475 CENTURIAN PKWY NORTH SUITE 201 JACKSONVILLE FL 32256 Final Report MRI C Spine w/o Con Exam Date & Time: 24 December 2019 12:12 PM Reason For Exam: None Specified Ordering Diagnosis: Cervical radiculopathy Mri of the cervical spine without contrast HISTORY: 52 years Male Cervical radiculopathy COMPARISON: None Technique: Multiplanar multi-sequence MR images were obtained of the cervical spine without contrast material. Findings: There is a small Schmori's node at the superior endplate of C7 otherwise the vertebral body heights are maintained. C4-C5: There is mild broad-based disc bulging causing mild impression on the ventral spinal 24 December 2019 4:19 PM Page 1 of 2 Virginia Zimmerman DOB: 06 September 1991 (60 yo M) Acc No. CR421526 Page 72 of 166	what is the DOB or date of birth?	{"text": ["06 September 1991"], "answer_start": [29]}
id_1711473237.959908	Justin Jacobs	10/24/2023 1:29:08 PM -0400 FAXCOM PAGE 85 OF 133 Name: Justin Jacobs ID: 980534078 date of birth: 17/06/2000 ZEISS Examination date: 19/05/2023 n: 1.3535 Axial length values OD o o os right left Phakic Phakic Comp. AL: 22.46 mm (SNR = 117.4) Comp. AL: 22.42 mm (SNR = 253.0) AL SNR AL SNR AL SNR AL SNR 22.47 mm 2.1 22.45 mm 3.5 22.48 mm 7.6 22.43 mm 4.9 22.47 mm 2.7 22.39 mm 2.6 Carl Zeiss IOLMaster庐 Advanced Technology V. 7.7 02/20/2078 Calibration checked on: 02/16/2018	what is the admit date or admission date?	{"text": [], "answer_start": []}
id_1711476990.29649	Benjamin Johnson	University of Oklahoma 11-02-2024 826 NE 15th Street Suite 205 Oklahoma City, OK 73126 Page 26 4262714267 Fax: 4262711326 Radiology Reports Terri Bautista Male DOB: 28-10-1986 2708026 Ins: BLUE CRO (22) Grp: 116426 compression fracture. 3. Stable subcutaneous nodule in the lateral right knee (SUV 5.6). 4. Edematous changes of the left lower extremity, compatible with the known DVT. New soft tissue nodules and stranding in the subcutaneous adipose tissues of the right flank and left lower abdomen are suspected to reflect injection granulomata. Electronically Signed by 131 DALE M. BRANNON MD on 13-01-2022 at 1445 (1) Order result status: Final Collection or observation date-time: 29-05-2019 14:06 Requested date-time: 13-01-2022 10:58 Receipt date-time: Reported date-time: Referring Physician: Jessica Luetkemeyer Ordering Physician: (AASCH) Specimen Source: Source: HCA RAD Filler Order Number: - PET/CT TUM SKUL BS Electronically Signed by Jessica Lee Luetkemeyer PA-C on 08-06-2020 at 12:10 PM	What is the Date of Consultation?	{"text": [], "answer_start": []}
id_1711471330.788731	Nicole Taylor	Patient name: Nicole Taylor PI 11.06.21, Latoya, D.O.B: 1989 Aug 23 Account No: 70174 Consultation Notes for Nicole Taylor PI 11.06.21 on 2022 Feb 01 Current Medications Reason for Appointment None 1. Back Pain Active Problem List Assessments Problem List has not been verified 1. Radiculopathy, lumbar region - M54.16 (Primary), bilateral. Acute Past Medical History since slip and fall on 11/6/21. MRI with disc protrusion with resultant Medical History Verified. severe left L4/5 stenosis. Chiropractic helps short term. Onset: sudden since slip and fall on water while no blurring of vision. Psychology: walking in a convenience store. She went to ER at S and W hospital. Severity: 10/10, Aggravated by: sitting, standing ideation. no anxiety. no physical abuse. bending, Relieved by: none, Nature: sharp, Associated Symptoms: no mental abuse. no numbness, weakness. He (she) denies any previous low back pain. Chiropractic helps some for short period.	what is the visit date or date of visit?	{"text": [], "answer_start": []}
id_1711473365.663132	April Perez	<<Back to Review>>182998-29-HYPERLINK- Hyperlink-Page 2 FEED 03/22/2018 09:43 AM Work Wellness 1291 Colorado Ave Ste 129. Turlock CA 92982 Page 1 of 1 (229) 229-3293 Fax: (299)296-3290 Test Form Test Form PATIENT NAME: April Perez BIRTHDATE: 1992/07/07 Age: 20 Years Home Phone: (229) 299-3292 Sex: M SSN: 529-29-0293 Order Number: 212970-4 Quantity: 1 Start Date: 2022/30/04 Priority: Normal ELECTRONICALLY SIGNED BY: Carrie Janiski Signed on: 2020/18/04 9:32:08AM Instructions: WITH STRESS VIEW(S) thank you Report run by Carrie Janiski DO 002902 0292	What is Date of Injury or DOI?	{"text": [], "answer_start": []}
id_1711475190.423411	Frank Chang	N NOVANT Novant Health Orthopedics & Frank Chang Sports Medicine MRN: 52224227, Date of Birth: 17/04/87, Sex: M HEALTH 7220 Village Medical Cir Visiting Date: 07/10/23 Ste 110 CLEMMONS NC 27222-8229 09/08/21 - Office Visit in Novant Health Orthopedics & Sports Medicine (Clemmons) (continued) Clinical Notes Amb (continued) Patient: Frank Chang MRN: 52224227 Date of Birth: 17/04/87 DATE OF SERVICE: 03/12/15 Referring Physcian: Frunza, Ana A, MD Primary Physcian: Dr Joan Allen, MD SUBJECTIVE: Jeffrey Craig Payne is a 76 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 Date of Encounter or Enc?	{"text": [], "answer_start": []}
id_1711471330.42935	Mary Patel	Countryside Regional PATIENT: Mary Patel EXAM NUMBER: BR64646 birthdate: 2003/12/12 date of exam: 2015/13/03 REF PHYSICIAN: Dr Eric Gonzalez LEFT BREAST ULTRASOUND DIAGNOSIS: Arrhythmia. COMPARISON: None. TECHNIQUE: Grayscale images of the left breast are obtained. FINDINGS: The area of concern is from the 7 to 11 o'clock position. IMPRESSION 1. This does not exclude soft tissue bruising. 2. BI-RADS Category 1, negative. Thank you for referring this patient. Dr Teresa Cooper Dr Teresa Cooper , M.D. Diplomat of the American Board of Radiology Radiologist MMP/am 12/18/2014	what is the DOS or D.O.S?	{"text": [], "answer_start": []}
id_1711476767.615915	Mark Saunders	26/20/04 08:30 1 12 >> unknown P 3/29 Assessment (1) Myofascial pain 729.1/M79.1 (2) Cervical myofascial strain, subsequent encounter Strain of muscle, fascia and tendon at neck level, subsequent encounter V58.89/516.1XXD Plan Orders Lidocaine 10mg (J2001) - 729.1/M79.1, - 847.0/S16.1XXD - 10/23/2023 - Hold lab results until reviewed :No Ultrasound guidance for needle placement (76942) - - 10/23/2023 - Hold lab results until reviewed :No Tendon origin/insertion injection (20551) - 729.1/M79.1, 847.0/S16.1XXD - 10/23/2023 - Hold lab results until reviewed :No Trigger point(s), 3 or more muscles (20553) - 729.1/M79.1, 847.0/516.1XXD - 10/23/2023 - Hold lab results until reviewed :No Instructions Please refer to discharge sheet. The supervising physician is on site to provide direct personal supervision involing the patient's care during their office visit today. This document is prepared by automatic population of appropriate fields, typed and or formatted entry. The reader is encouraged to contact me directly with any issue or questions. Electronically Signed by: David Brooks, PA -Author on 21/18/04 02:16:58 PM [Digital Signature Validated]	what is the DOS or D.O.S?	{"text": [], "answer_start": []}
id_1711471329.226094	Jeremy Williams	651 Cook Roads Lake Steven, VT 18576 Jeremy Williams (id #922514, dob: 2000 Nov 06) DATE OF ENCOUNTER: 2014 May 28 Patient PATIENT Jeremy Williams (88yo, F) ID# 922512 Appt. Date/Time 2016 Mar 15 11:00AM dob 2000 Nov 06 Service Dept. MGPC_Grove City Broadway - Provider MOIRA SKURATOWICZ, APRN Insurance Med Primary: AETNA Insurance # : W218225600 Policy/Group # : 010959913038392 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 133-890-3913, Fax 364-157-6118 Vitals 2016 Mar 15 03:12 pm Ht: 5 ft 4 in Measurements None recorded. Allergies Reviewed Allergies Ibuprofen: Hives (Moderate) DIPHENHYDRAMINE HCL: - COMMENT: CAUSATIVE AGENT: BENADRYL; YEAST: - REACTION: HIVES, RASH; Medications	What is the Date of Consultation?	{"text": [], "answer_start": []}
id_1711472591.002444	Suzanne Massey	Gulf Coast SURGICAL CENTER, LLC 402 Dunn Street Houma, LA 76560 (985) 865-1651 Fax (965) 865-6658 Tax ID: 20-3335700 NPI #: 122895236 B/C#: 1283779618614Z Insurance Verification Form Pt. Name: Suzanne Massey DATE OF BIRTH: 1988 February 18 MR# 48465-3 BCBS OF LA HMO Insurance Company: Phone Number: 1-252-476-6432 Insured Name: SELF Relationship to Patient: Policy Number: IHQ828377961861 Group Number: Effective Date: 2023 April 20 Policy paid thru: ACTIVE DATE OF PROCEDURE: 2015 May 02 Pre-cert company name: Claims Address: BCBS OF LA Does policy follow MNRP/MRC2? yes or no PO BOX 96529 Do benefits co-incide? yes or no BATON ROUGE, LA 70658 Rep. Name: ONLINE 1 Austin	What is the Date of Discharge?	{"text": [], "answer_start": []}
id_1711471329.197009	Hunter Casey	2020 July 31 12:48 PM TO:81484854174 FROM:9581382426 Page: 4 DocuSign Envelope ID: CD6AFC77-CF28-44AE-AA73-C1B65435D293 PATIENT AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION TO: CBTRactics 2559 263 Rd, Glen Oaks, NY 11004 I hereby authorize the above name facility, any parent company, and any other health plan, physician, health care professional, hospital, clinic, laboratory, pharmacy, medical facility, or any other health care provider that has provided payment, treatment or services to me or on my behalf to release all medical information to: Veritas Attorneys at Law 000 Fisher Shoal Suite 809 Gonzalezton, VA 24108 For the use in the pending: DISABILITY INCOME CLAIM This document authorizes the release of all medical information including Immunodeficiency disorders (HIV/AIDS), substance abuse and treatment, mental health/psychiatric treatment, radiology films, pathology materials: PATIENT: Hunter Casey ADDRESS: 6368 Dana Drive Jonathanhaven, NH 39397 1999 February 08 date of birth: Social Security Number: 116348332 The treatment dates to be released: (check one) From 2020 July 31 to first All records retained by the facility I understand that I have the right to revoke this authorization at any time. I understand that in order to revoke this authorization, I must do so in writing and present my written revocation to: Veritas Attorneys at Law 000 Fisher Shoal Suite 809 Gonzalezton, VA 24108 1	What is the Date of Evaluation?	{"text": [], "answer_start": []}
id_1711472787.180874	Samantha Sawyer	Northwell Health Physician Partners Name: Samantha Sawyer visiting date: 2014-08-15 Address: 2403 COOPER DRIVE MRN: 20827973 EAST MEADOW, NY 11404 birthdate: 1985-07-30 Reason For Visit Samantha Sawyer is being seen for a follow-up visit for chest pain. History of Present Illness had pneumothorax earlier this year after being stabbed by her husband, chest tube, hospitalized X 10 days Active Problems Adjustment disorder with mixed anxiety and depressed mood (340.28) (F40.23) Current Meds Cyclobenzaprine HCI - 5 MG Oral Tablet; TAKE 1 TABLET 3 times daily Allergies No Known Allergies Review of Systems Respiratory: cough. 600 Community Drive " Manhasset, NY, 11001, Tel (406) 495-4093 Fax (540) 405-5403	What is the Date of Discharge?	{"text": [], "answer_start": []}
id_1711473237.34203	Kathy Hardin	THU 43 FAX MRN: 1985850H Kathy Hardin Nassau Unly. Medical Gender: Female Center Age: 84y (2003/18/07) Current Location: ICC1-2711-JJ Faculty Statement: Attestation Attending and Resident/Fellow/Physician's Assistant Electronic Signatures: Dr Jessica Fox (Physician) (Signed 2021/30/10 11:2) Authored: Faculty Statement Co-Signer: Date of Procedure, Pre-Op and Post-Op Diagnosis, Specimens, Brief Operative Note, Procedure Details Dr Gabriela Livingston (Resident Physician) (Signed 2019/28/08 11:2) Authored: Date of Procedure, Pre-Op and Post-Op Diagnosis, Specimens, Brief Operative Note, Procedure Details Requested by: Philburn, Jacqueline (Med Rec Clerk), 2019/30/06 12:25 Page 2 of 2	What is signature date or signed on date?	{"text": ["2021/30/10"], "answer_start": [306]}
id_1711476990.756089	Brianna Williams	10 Apr 2019 12:10 PM FROM: Fax PULMONARY AND SLEEP SPECIALISTS OF TAMPA BAY, PA PAGE: 017 OF 119 Dec 2021 Patient: Wendy Riggs DOB: 18 Aug 1995 CT Chest PE W Contrast Wendy Riggs - 479619 Dec 2021 * Final Report * Result Type: CT Chest PE W Contrast Date: March 05, 2019 19:00 EST Result Status: Auth (Verified) Result Title: CT Chest PE W Contrast Performed By: LUXENBERG MD, NINA LYNN on March 05, 2019 19:15 US/Eastern Verified By: LUXENBERG MD, NINA LYNN on March 05, 2019 19:15 US/Eastern Encounter info: 7864859, TAM, Observation, 03/05/2019 - 03/06/2019 * Final Report * Reason For Exam sob, positive d dimer REPORT Exam: CTA chest. Date of Exam: 20 Sep 2015 6:50 PM Indication: SOB, POSITIVE D DIMER. Comparison: X-ray 10 Apr 2019 Technique: IV bolus CTA chest was performed following the administration of intravenous contrast 100 mL of Isovue 370. Chest was imaged with spiral technique followed by postprocessing with sagittal and coronal 3D/MIPS. There was adequate opacification of the pulmonary arterial system. Radiometrics dose report: Up-to-date CT equipment and radiation dose reduction techniques were employed. CTDIvol: 18.7 mGy. DLP: 610 mGy-cm. Findings: No intraluminal filling defects are seen in the visualized opacified pulmonary vasculature to suggest acute pulmonary thromboembolism The main pulmonary artery is not dilated. Thoracic aorta is nonaneurysmal and there is no evidence of dissection. No pericardial effusion or thickening. Heart is not enlarged. No pneumothorax. Printed by: ROMERO, LEA M Page 1 of2 Printed on: 19 Dec 2021 14:17 EDT Document: 19 Dec 2021 Page 16 of 147	What is Ordered Date?	{"text": [], "answer_start": []}
id_1711471328.849253	Robert Peterson	patient Robert Peterson Gender Female MR # 0001143894 admitting date/Time 22-10-30 7:11:00 AM Reg # 096291118385 Visit Status DSC D.O.B 91-06-24 12:00:00 AM DISCHARGE DATE/Time 22-11-29 9:31:00 PM 1. Adult Plan of Care 14-09-26 2:10 Entered By Individualization (Mutuality/Preferences) Individualization/Preferences / pt pt goes by "Cierra"; lives at home with her grandparents SEB goes by "Cierra"; lives at home with her grandparents Comments : CLINICAL PRACTICE GUIDELINES Precaution Precaution SEB coping,genitourinary,peripheral/neurovascular,reproductiv e,safety,skin Comments : Nursing Goal #1 Related To Nursing Cellulitis SEB Diagnosis/CPG Comments : Nursing Goal #1 Goal pt will be able to maintain temperature WNL < 100.4 SEB degrees F during hospitalization Comments : Nursing Goal #1 Goal Established 01/10/2023 SEB (mm-dd-yyyy) Comments : Nursing Goal #1 Time Frame By Discharge SEB Comments : 14-09-26 1:03:00 PM Page 72 of 12 SVI 0885	what is the service date or date of service?	{"text": [], "answer_start": []}
id_1711476578.223854	Darren Smith	athena Oct 07, 2022 2:50:31 pm EDT :1b38234-d76e-4d00-bbb4-176b27d36417 Page: 50/50 OTOLARYNGOLOGY CONSULTANTS Hagen Ranch Rd, BOYNTON BEACH FL 33450 OWENS, Shannon (id #131224, dob: 11/17/1976) OTOLARYNGOLOGY CONSULTANTS, BOYNTON BEACH FL 33437-3776 OWENS, Shannon (id #131224, dob: 11/17/1976) University of Miami Nov 01, 2014 11:27:03 AM PAGE 2/050 Fax Server Rebecca Wilson (MRN21770502) University of Miami Health System Health Imaging Services at Plantation 8500 SW 10th ST PLANTATION, FL 33350 Final I maging Result Name: MRN DOB: Sex: Rebecca Wilson 21770252 Nov 03, 2002 Female Procedures Performed Exam Time: Patient Class: Diagnosis CT Sinus Facial Bones W/O Contrast 05/24/2022 7:50 AM Outpatient Chronic sinusitis, unspecified Final EXAMINATION: CT SINUS FACIAL BONES wo CONTRAST EXAM DATE AND TIME Apr 14, 2019 7:9 AM INDICATION: Chronic sinusitis. COMPARISON: None available TECHNIQUE CT imaging of the nasal cavity and paranasal sinuses with axial, sagittal and coronal reformats was obtained without contrast. FINDINGS: The frontal sinuses and frontal recesses are well-aerated The ethmoid air cells are well-aerated. IMPRESSION: Tue May 24, 20Exam Date 11:26 AM Page 1 of 50	What is the Date of Discharge?	{"text": [], "answer_start": []}
id_1711475190.542835	Steve Coleman	Steve Coleman MRN: 5772773 Preferred Pharmacy (continued) Referral (continued) Order MRI ARTH SHOULDER W/ CONTRAST RIGHT [676335615] Electronically Signed by: Dennis S Frerichs, PA-C on 2022-19-12 0779 Status: Completed This order may be acted on in another encounter. Ordering user: Dennis S Frerichs, PA-C 02/22/23 0949 Authorized by: Dennis S Frerichs, PA-C Ordered during: Office Visit on 2016-21-04 Screening Form General Information Patient: Steve Coleman MRN: 5772773 birthdate: 2003-13-10 Mobile: 577-977-4779 Sex Assigned at Birth: Male MC ROCKWOOD MAIN CLINIC Steve Coleman - SPOKANE MRN: 5602313, birthdate: 2003-13-10, Sex: M 400 East 5th Ave Visiting Date: 2022-16-12 Spokane WA 99202-1334 Page 89 Printed by 414221 at 7/17/23 9:40 AM	what is the visit date or date of visit?	{"text": ["2022-16-12"], "answer_start": [716]}
id_1711475741.605509	Charles Harmon	Neurological, Orthopedic & Spine Center 2018/25/06 Informed Consent Date: PatientName: Charles Harmon Telephone Number 111-111-1111 Saldyem Berti I Authorize Dr.(s) ("Physician"), and such assistants as may be selected by him to perform the proposed surgery and /or procedure of L4-5 interbody Iven c 44-5 bilut pedicle screws And any other needed procedure If any unforeseen conditions arise during the course of the procedure, I authorize and request the Physician and his assistant to perform such additional procedures as they deem advisable, which may be in addition to or different from those now planned. This form did not imply a iscussion of payment or obligation to proceed with procedure. Emergency Contact: Patient/Legal Guardia signature nd Printed Na he New 2024/24/01 Physicians Signature and printed Name Date Corner 2024/24/01 Witness Signature and printed Name Date 5040 NW 40 ST #530 MIAMI FL 33126. PH: 305-461-3116 F-954-765-3206 817 S University Drive Suite 105 PLANTATION FL 33324 PH: 954-279-3170 FX: 954-440-3115 13526 Village Drive Park Suite 220 Orlando FI 32837 PH: 407-794-1465 FX: 954-440-3115	what is the DOS or D.O.S?	{"text": [], "answer_start": []}
id_1711476578.312291	John Miller	UNIVERSITY OF MIAMI UMHC Owens, Shannon HEALTH HOSPITAL AND CLINICS 1475 NW 12th Avenue Suite MRN: 49770249, DOB: 09-11-1998, Sex: F 3049 Enc. Date: 13-02-2024 Miami FL 49136-1049 05/05/2023 - Office Visit in UHealth at UMHC Sylvester Spine Institute (continued) Clinical Notes (continued) Miami, FL 33136 Fax: 305-249-6495 Electronically signed by Dr Thomas Knight MD, MD at 15-12-2021 12:51 PM Eismont, Frank J., MD at 5/5/2023 1530 Author: Eismont, Frank J., MD Service: - Author Type: Physician Filed: 5/5/2023 5:43 PM Encounter Date: 13-02-2024 Creation Time: 5/5/2023 4:40 PM Status: Signed Editor: Dr Thomas Knight MD, MD (Physician) Electronically signed by Dr Thomas Knight MD, MD at 5:43 PM USER, SCANNING at 5/9/2023 0301 Author: USER, SCANNING Service: Author Type: Resource Filed 5/8/2023 11:01 PM Encounter Date: 13-02-2024 Creation Time 25-03-2023 11:01 PM Status: Signed Editor: Onbase, Scanning Generated on 25-03-2023 4:18 PM Page 49	what is the service date or date of service?	{"text": [], "answer_start": []}
id_1711477090.812417	Brittany Mendoza	06-02-2022 19:59:15 EDT To: 195222268622 Page: 03/622 From: Lauris Rigdon Patient Self-Report Patient Assessment/Diagnosis History of Present Condition: Patient presents with acute LBP and right hip pain that presents with acute low back and right hip pain following started on May 20th following elevator accident. Functional accident that occurred on May 20th. Pt explains that she was battling with established with patient input. allow patient to return to prior level of function, independence and safety. Onset Date: May 20th Comorbidities: - Psychosocial: Battling with high anxiety, difficulty talking about accident - Car accident in with back pain and left shoulder (2007) e Currently experiencing excessive vaginal bleeding (being monitored by OBGYN) Pre Morbid Level of Function: - Independent prior to injury Current Level of Function/Current Deficits: - Unable to get into/out of car without onset of pain - Unable to stand for prolong periods of time - Unable to walk her dog due to fear of worsening symptoms. Work tasks: Desk job at home, mostly on the computer Sleep disturbance: Reports no change in sleeping pattern Imaging: X-ray: no abnormal findings. CT scan of abdomen and pelvis: results pending Red flags: Pt denies all red flags including but not limited to weight loss/gain > 10 Patient John Peters (DOB: 11-28-1985) Treated by Jennifer Flores, PT. DPT DOS: 08-23-2018 Page 2 of 22 of Plan of Care	What is the Date of Consultation?	{"text": [], "answer_start": []}
id_1711472286.580065	Tracy Cochran	Tracy Cochran MRN: 5601713 04/04/2023 - External Document in MULTICARE HEALTH INFORMATION (continued) doi: Place of Injury: 10/06/2014 9:40 AM Medical Records use only - -(HAR ID) Hospital Account Not on file Visit Information Department Name Address Phone Fax MULTICARE HEALTH INFORMATION 419 South L Street MS: 419-2-CN 800-317-9919 253-417-4948 Tacoma WA 98175-3799 Call Information Provider Department Center 4/4/2023 9:03 AM HIM SCANNED DOCUMENT HEALTH INFORMATION MHS CALL CEN MULTICARE CALL CENTER Dufner, Raymond E 419 SOUTH L STREET MRN: 5601713 , BIRTH DATE: 09/09/1996, Sex: M TACOMA WA 98417-0299 Visiting Date: 02/06/2023 Page 54 Printed by 414221 at 7/17/23 9:40 AM	What is the Date of operation?	{"text": [], "answer_start": []}
id_1711472591.39856	Sarah Valenzuela	Salinas Valley Sarah Valenzuela Medical Clinic MRN: 3116369, date of birth: 29/00/06, Sex: F SUPUS BALLEY MEMORAL REALINONA extra visit: 27/21/03 02/21/05 office Visitin DOD.Salinas - Abbott Clinical Notes Progress Notes Schumann. Steven C. MD at 12/13/2021 0800 Author: Schumann, Steven C, MD Service: Urgent Care Author Type: Physician Filed: 12/13/2021 8:53 AM Encounter Date: 03/16/08 Status: Signed Editor: Schumann, Steven C, MD (Physician) service date: [SS.1T] 12/17/01 [SS.21 HPI: [SS.1T] Araceli Corona SS.2T] is [SS.1T] 89 y.o. female [SS.2T] [SS.1T] HISTORY: The following portions of the patient's chart were reviewed in this encounter and updated as appropriate: MEDICATIONS:Ss.1T] No Known Allergies Current Outpatient Medications: cyclobenzaprine (Flexeril) 5 MG tablet, Tak e 1 po hs for back pain. May increase ton 2 at bed time if needed and not groggy in the morning., Disp: 20 tablet, Rfl: 1 Printed on 12/14/21 4:04 AM Page 1 234	what is the DOS or D.O.S?	{"text": [], "answer_start": []}
id_1711472591.083521	David Hunt	Gulf Coast SURGICAL CENTER, LLC Conscious Sedation Educational Material and Informed Consent Form The facts in this form will help you learn more about the type of anesthesia your doctor has recommended for your procedure. Please read it carefully. Your Health Problem Your doctor has recommended that you have conscious sedation for pain control during your procedure. There are many types of anesthesia. Local anesthesia is like the numbing medicine the dentist may use. Minimal sedation involves different types of medicine to make you sleepy. Your nurse will ask you about any allergies before the procedure. First, an IV line will be started. A plastic strip will be placed on one of your fingers and joined to a pulse oximetry machine. The amount of medication is customized for each patient. David Hunt ID / Visit: 48610 1 Gender: F DOB: 04/94/07 Age: 85 Phys: Dr Mrs. Adriana Jackson DOS: 04/14/11 Page 1 of 3	what is the DOS or D.O.S?	{"text": ["04/14/11"], "answer_start": [943]}
id_1711475955.693618	Kelsey Mckay	Fax Server 2019-20-02 1:11:46 PM PAGE Fax Server Medications (Added, Continued or Stopped today) Start Date Medication Directions PRN PRN Reason Instruction Stop Date Status ParaGard T 380A N 380 square mm intrauterine device Nova Southeastern University 3200 S University Drive I Davie, FL 33328 Electronically signed by Fareeda Baksh Deen MD on 2021-28-09 04:38 PM Frauwirth Ariel 000000017461 10/03/1995 2021-28-09 10:00 AM 4/4	What is signature date or signed on date?	{"text": ["2021-28-09"], "answer_start": [383]}
id_1711471329.195854	Anthony Walters	2017 Apr 17 4:9 PM TO:41285008869 FROM:9420313426 Page: 4 DocuSign Envelope ID: CD6AFC77-CF28-44AE-AA73-C1B65435D293 PATIENT AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION TO: CBTRactics 2559 263 Rd, Glen Oaks, NY 11004 I hereby authorize the above name facility, any parent company, and any other health plan, physician, health care professional, hospital, clinic, laboratory, pharmacy, medical facility, or any other health care provider that has provided payment, treatment or services to me or on my behalf to release all medical information to: Aegis Law Partners USCGC Hardy FPO AA 91894 For the use in the pending: DISABILITY INCOME CLAIM This document authorizes the release of all medical information including Immunodeficiency disorders (HIV/AIDS), substance abuse and treatment, mental health/psychiatric treatment, radiology films, pathology materials: patient: Anthony Walters ADDRESS: 9843 Walker Well Apt. 204 Lake Matthew, MH 55914 1987 May 10 DOB: Social Security Number: 118639232 The treatment dates to be released: (check one) From 2017 Apr 17 to first All records retained by the facility I understand that I have the right to revoke this authorization at any time. I understand that in order to revoke this authorization, I must do so in writing and present my written revocation to: Aegis Law Partners USCGC Hardy FPO AA 91894 1	What is the Date of operation?	{"text": [], "answer_start": []}
id_1711475741.154737	Thomas Hoffman	Thomas Hoffman DOB: 28/11/89 (88 yo M) Acc No. CR528043 [Doc Name: Medical Records-Cora Health-29/05/19-323116] 14/07/23 a.m. 08-24-2022 6 CoraPhysicalTherapy Assessment Report CORA Physical Therapy - Regency \| CORA 9527 Regency Square Blvd., Unit 105 proposed General Eval Jacksonville, FL 322258806 Name: Thomas Hoffman FOR WORK COMP ONLY SYS1294723 DOB: 28/11/89 Case Manager: Onset Date: 28/06/22 Surgery Date: Eval Date: 09/10/22 Occupation: Employer: Ref Provider: Amy Wu APRN Sex: M Medical Dx: M79672 - Pain in left foot, M7542 - Impingement syndrome of left Status: shoulder, M5126 n Other intervertebral disc displacement, lumbar region Last Day: Treatment Dx: Cur PDC: JobReq PDC: 97163 PHYSICAL THERAPY EVAL HIGH 1 Marivic Chang, PT, License # PT23745 Date: 03/09/18 Signature: marrier chang, PT, DPT I have reviewed this plan of treatment and certify a continuing need for services. Physician/NPP: Date: Amy Wu APRN Thank you for this referral and your continued support of CORA Health Services, Inc. Should you have any questions, please feel free to contact me at (904) 647-4263. Thomas Hoffman DOB: 28/11/89 (88 yo M) Acc No. CR528043 Page 113 of 166	What is signature date or signed on date?	{"text": ["03/09/18"], "answer_start": [846]}
id_1711475620.935698	Andrew Lee	DocuSign Envelope ID: 2EBB7621-EDFE-47BB- C6C3A2DDDA86 ASSOCIATES MD MEDICAL GROUP ASSOCIATESMD MEDICAL GROUP PATIENT CONSENT AND AUTHORIZATION Andrew Lee I, FURTHER ACKNOWLEDGE THAT IN THE EVENT ASSOCIATESMD MEDICAL GROUP IS FORCED TO RETAIN THE SERVICES OF A COLLECTION AGENCY AND/OR ATTORNEY; I WILL BE RESPONSIBLE FOR THE COLLECTION AND/OR LEGAL FEES. I HEREBY AUTHORIZE THE DOCTOR TO RELEASE MEDICAL INFORMATION TO MY INSURANCE COMPANY TO SECURE PAYMENT OF BENEFIT. I ALSO AUTHORIZE THE USE OF MY SIGNATURE ON ALL INSURANCE SUBMISSIONS AND AS AUTHORIZATION FOR PAYMENT TO BE SENT TO ASSOCIATESMD MEDICAL GROUP AT 4780 SW 64th Ave Davie, FL 33314. Consent to Contact. 1 hereby expressly consent to being contacted by mobile phone or mobile text messaging for the purpose of receiving Information or advice about my health care, about any services officered, changes in policies, procedures, or office hours, or any other purpose as determined by AssociatesMD Medical Group. Data messaging charges may apply. Receipt of Notice of Privacy Practices. Andrew Lee I, have received a copy of AssociatesMD Medical Group's Notice of Privacy Practices. The physicians and staff of AssociatesMD Medical Group have my permission to speak to the following family members/friends in reference to my medical care: Name: Andrew Lee Relationship to Patient Son Name: John Arthur Romney Relationship to Patient Best Friend Name: Nelson A oti Relationship to Patient Best friend The Physicians and staff at AssociatesMD Medical Group have my permission to leave a message on my answering machine. Yes No, and/or call at my place of work: Yes No DocuSigned by: Phile September 28, 2022 Signature of responsible party Date	what is the service date or date of service?	{"text": [], "answer_start": []}
id_1711471329.059077	Daniel Davis	04/2021/27 10:10AM No. 0020 P. 5 Page 12 of 13 Daniel Davis birthdate: 09/1996/02 (84 yo F) Acc No. 16520 DOS: 06/2017/09 Daniel Davis West End Clinic 84 Y old Female, birthdate: 09/1996/02 Account Number: 16520 of SayeBrook PSC 6887, Box 1733 APO AP 79457 Home: 761-355-2397 Guarantor: Daniel Davis Insurance: BCBS SC Payer ID: 57028 Appointment Facility: West End Clinic 04/2021/27 Progress Notes: Emily Cook, DO Reason for Appointment Current Medications 1. 2 mo follow up review labs Taking Loratadine as History of Present Illness directed Orally follow up: Xyzal Allergy 24HR 5 MG Tablet 1 HPLD - Started Crestor at last OV, tolerating well. Review Lipid tablet in the evening Orally Once a day, Notes: OTC panel, cpk total. EKG: 1/5/2022. Vitamin B-12 1000 MCG Tablet 1 Neck pain- Seen Dr. Alci, recommended neck fusion, tablet Orally Once a day, Notes: OTC Vitamin D 50 MCG (2000 UT) Tablet Progress Note: Emily Cook, DO 04/2021/27 05/2018/28	What is signature date or signed on date?	{"text": [], "answer_start": []}
id_1711473530.925749	Thomas Snyder	O onecallo care PHYSICAL THERAPY FAX / EMAIL Confidential - 8/7/2018 7:38:15 PM PATIENT REFERRAL FORM Referral Date: 19/12/2018 Claim Number: PZC45924534 Patient Data Name: Thomas Snyder Sex: Male DOB: 23/10/1994 INJURY DATE: 21/04/2023 Injury State: CA Injury: MULTIPLE PARTS Injury: Other, please see details. Body Part Side: Right Details: right ankle and joints ofright foot Injury Is Surgical: U Physician Info Physician: Jenny Wong Next MD Appt: 8/8/2018 **DO NOT ISSUE DME/Home E-stim without prior authorization from One Call Physical Therapy All DME requests must be pre-authorized. Please submit written MD orders to One Call Physical Therapy. (AG:12-EMBID-4553454: Page 3 of 1000196 0196	What is the Date of Evaluation?	{"text": [], "answer_start": []}
id_1711472591.026828	Justin Wallace	Gulf Coast Surgical Center LLC Justin Wallace DOS: 17/23/07 2:30:00 PM ID / Visit: 48730 / 1 PATIENT INFO: SEX: F DATE OF BIRTH: 11/02/01 AGE: 50 MAIN PHONE: 293-921-3835 ADDRESS: PSC 1024, Box 8102 APO AE 71686 RESPONSIBLE PARTY: BUGGAGE, NADINE A PSC 1024, Box 8102 APO AE 71686 RSP SSN: RSP OCC: TRMC RSP PH: 860-623-2927 I UNDERSTAND AND AGREE THAT, AT THE TIME THE PATIENT HAS MET GULF COAST SURGICAL CENTER LLC's MEDICAL CRITERIA TO LEAVE THE FACILITY, I WILL HAVE A RESPONSIBLE ADULT PRESENT TO TAKE ME/PATIENT HOME. I RELEASE GULF COAST SURGICAL CENTER LLC FROM ANY RESPONSIBILITY FOR EVENTS IN VIOLATION OF THIS AGREEMENT. Nadine Buggage Miniton 16/23/11 1733 Witness Date Time Signed	What is signature date or signed on date?	{"text": ["16/23/11"], "answer_start": [703]}
id_1711475190.584955	Brandon Baker	Recv'd Date 20265715 Bill DCN: 2065196GJ656811 IDEAL MEDICAL RECORDS SERVICE, INC. 303 W. Katella Ave. Suite 300, Orange, CA 96567 Invoice Phone: 714-380-6714 Fax: 865-658-3659 Date: 2014 October 23 Email: billing@imrservice.com To : Gallagher Bassett P.O. Box 610, CA, Roseville,, 95661-0610 965-657-2650 965-653-8652 CLAIMANT NAME: Maria Barajas ORDERED BY: Claim#: 006593-006556-WC-01 Law Firm - Perona, Langer, Beck, injury date: 2021 June 09 Serbin, Mendoza, Harrison UR Denial Date: 06/10/2021 Records Type Date of Service/Records Pick Up Fax Date Date Medical for 2017 January 03 07/14/2021 Independent Medical Review	What is the Date of Evaluation?	{"text": [], "answer_start": []}
id_1711471329.716306	Matthew Vang	Page: 2 Surgical Case Record Patient Name: BP00046620 Matthew Vang BIRTHDATE: 03/1990/17 Account No: BP34852451947 Age: 69 Physician: Dr Keith Fisher MD EVALUATION DATE:02/2020/19 Sex: F Specialty: ORS-Orthopaedic Surgery Room-Bed/T.Loc: O.R.: POR04-OPERATING ROOM #4 DATE OF OPERATION, OPERATION DATE, OPER DATE: 03/2017/28 Valley Medical Center Primary Procedure: LEFT KNEE MANIPULATION Case Close/ Run Date: 06/2018/30 Transmitted: 12/23/22 1222 P.SUR.DP Peterson, Deloras Run Time: 1944 PRE-OP ASSESSMENTS Occurred 12/22/22 1144 Landry, Courtney Recorded 12/22/22 1144 Landry, Courtney Physiological problem/alteration in: Musculoskeletal Infection - - MUSCULOSKELETAL ALTERATION - - Musculoskeletal alteration problem expected to: Improve/Resolve IV site dressing: Transparent IV site dressing clean, dry and intact: Yes IV site absent of redness, heat or edema: Yes <End> DOCUMENTATION IV summary: Venous Left Antecubital 20 g Inserted 12/22/22 0830 IV type: CONTINUED ON PAGE 3 *** Patient Name: Matthew Vang MRN:BP00043554 Encounter:BP0001107108 Page 2 of 29 73797-42 Valley Medical Center -00052	What is the Procedure Date?	{"text": [], "answer_start": []}
id_1711472786.895724	Claudia Russell	Virginia Cancer Specialists Patient: ANN MORRIS Note Date: 28 April 2019 Date of Birth: 30 December 1993 MRN: 3576607 I will see her back in the office after the PET scan. Ajay Dar, MD Send copy of note to: Amanda Pysher, MD Bijal Katarki, MD Signature Dr Patricia Farmer MD 23 July 2015 1:45 EDT 09/19/2023 Page 3 of 3	What is Ordered Date?	{"text": [], "answer_start": []}
id_1711476767.029863	Kenneth Payne	MPT I McLaughlin Physical Therapy Patient Name: Colleen Johnson 3120 20th St Physical Therapy Date of Birth: 1987 April 24 Metairie, LA 7000xxxx Initial Document Date: 2015 April 25 Phone: xxxxxxx Fax: xxxxxxx Examination Patient Problems: - (R) Shoulder: subjective complaints of pain in the (R) shoulder with functional activities and at rest, decreased poor posture, decreased scapular stabilizer, impaired functional mobility Short Term Goals: 1: (1 Week) \| Pt (I) with HEP Long Term Goals: 1: (6 Weeks) I Pt reports 0/10 in the (R) shoulder with functional activities and at rest 2: (6 Weeks) I Pt reports less than 10% disability on the QUICK DASH Plan Frequency: 2-3 times a week Duration: 6 weeks Plan: Begin Plan as Outlined Treatment to be provided: Procedures Therapeutic Exercises Therapeutic Activity (Work Specific, ADL Specific), Neuromuscular Rehabilitation , Manual Therapy (Soft Tissue Mobilization, Joint Mobilization, Muscle Energy Techniques, Patient Education), Postural Training, Activity Modification. Modalities To Improve (Pain Relief, Decrease Inflammation, Increase Blood Flow, Improve Tissue Healing), Electrical Stimulation, Cryotherapy (Ice Pack), Hot Packs AND Scott McLaughlin License #08042 Electronically Signed by Dr Brendan Andrade on 2017 March 10 at 9:10 am 4 of 62 Powered by WebPT	What is Ordered Date?	{"text": [], "answer_start": []}
id_1711472786.747677	Jacqueline Mueller	1 09-18-2023 2:10 PM ET athena 19546102614 pg 53 of 57 Privia - CCA - Cardiac Care Associates PC . 264D Cornwall St, LEESBURG VA 20646-2640 Jacqueline Mueller (id #1596376, birth date: 13/97/04) Date of Encounter: 20/16/06 Patient Name Jacqueline Mueller (27yo, F) ID# 1596376 Appt. Date/Time 06/17/01 09:45AM birth date 13/97/04 Service Dept. PMG_CCA_Reston Office* Provider Dr Teresa Hodges, FACC Chief Complaint Transition of Care Encounter Fax (703) 464-4464 NPI: 1115963737 Allergies Reviewed Allergies CODEINE: Dizziness NKDA Medications	what is the DOB or date of birth?	{"text": ["13/97/04"], "answer_start": [199]}
id_1711471328.781299	Sarah Grant	med Department of Pathology 2501 South State Highway 121, Suite 1100 fusion Lewisville, TX 75667-8668 Tel: 673-986-9490/972-966-7900 clin-labs clin-trials Fax: 537-730-1162 Flow Cytometry - Leukemia/Lymphoma Profile patient name: Sarah Grant Accession #: AB23-341 Med. Rec. #: 10771972 Client: Med fusion Taken: 6/23/2023 Texas Oncology-San date of birth: 02-04-1992 (Age: 78) Location: Antonio Medical Center Received: 6/24/2023 Gender: F Billing #: 10771972 Reported: Physician(s): SUNEETHA Copy To: CHALLAGUNDLA ORDERED DATE: 04-02-2017 Status: Signed Out Sarah Grant Page 1 of 2	What is the Date of operation?	{"text": [], "answer_start": []}
id_1711475620.870371	Katherine Gibson	V VITRO MOLECULAR LABORATORIES www.vitromolecular.com Patient Name: Katherine Gibson Physician: Robert Jacobson, MD Accession #: S22-04715 Sex: Male Specialty Group: The Gables Surgical Center Collected: 28-09-2018 DOB: 21-04-1986 (21) Received: 28-09-2018 Reference #: S22-04715 CC: Reported: 22-11-2014 Surgical Pathology Report Clinical History Previous Vitro pathology report: S21-12983, 12-09-2018 A)Lumbar disc, L4-5; discectomy:Cartilage and disc material with degenerative changes; S21-15703, 24-12-2023 A)Disc, C4-C5, discectomy:0 Cartilage with degenerative changes DIAGNOSIS A. DISC L4-5: - Fibrocartilaginous tissue with degenerative changes - Negative for atypia or malignancy in this sample Images Gross Description A. Received in formalin there are multiple white fibrocartilaginous tissue fragments measuring 2.5 X 2.0 X 0.3 cm in aggregate. Specimen is submitted in toto in one green cassette. IG/rms Electronic Signature Hadi Yaziji, M.D. CPT Code(s): 88304 (1) *** END OF REPORT E-MAILED 09-10-2020 Vitro Molecular Laboratories 8700 West Flagler Street, Suite 100, Miami, FL 33174 Tel: 305-267-7979 Fax: 786-513-0175 CLIA: 10D1055514 Page 1 of 1	What is the Date of Exam or Examination date?	{"text": [], "answer_start": []}
id_1711473530.89574	Joshua Washington	CORVEL Certification Recommendation CLAIM #: PZC01224124 INSURED: Super Store Industries doi: 2021/02/02 CARRIER/TPA: Crum & Forster / CLAIMANT: Edward Foster ADJUSTER: Leticia Bailon CORVEL #: 111238123-UMO-2 Determination Date: 2022/29/08 RFA Received Date: 07/30/2018 Provider: Jenny Wong, DO Pre-cert #: 111238123-UMO-2 Network: per adjuster CorVel Corporation has been asked to review the below noted treatment request for medical necessity and appropriateness. CorVel Corporation hours of operation are from 8:30 a.m. to 5:30 p.m. PST, Monday through Friday. ORNGER_CERT :12-EMBID-4251254: Page 10 of 000197 0197	What is the Date of Encounter or Enc?	{"text": [], "answer_start": []}
id_1711471328.584341	Charles Nolan	Pineview General Hospital Sarah Bartlett 3164 Briana Trail Apt. 804 Angelfort, WI 20943 MRN: 9150779 birth date 1998-19-01. Sex M Visit Day: 2020-21-09 Patient Demographics patient name Patient ID SSN Legal Sex birth date Charles Nolan 9150779 xxx-xx-0067 Male 1998-19-01 (35 yrs) Address 07047 Daniel Rue Nicholasfurt, IA 33565 Phone 478-408-5844 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 Sarah Bartlett Self 07047 Daniel Rue Nicholasfurt, IA 33565 2614 of 5499	What is the Date of Exam or Examination date?	{"text": [], "answer_start": []}
id_1711475190.190996	Jeremy Collins	NOVANT Novant Health North Point Jeremy Collins N Medical Associates MRN: 54324437, DATE OF BIRTH: 05 Feb 1989, Sex: M HEALTH 1435 Bethabara Road date of visit: 21 Jul 2019 Winston-Salem NC 27436-3435 30 Mar 2017 - Office Visit in Novant Health North Point Medical Associates (continued) Clinical Notes Amb (continued) 1. Medicare annual wellness visit, subsequent 2. Cramping of hands 3. Cramping of feet Plan Jeffrey was seen today for muscle cramps, knot on arm and medicare wellness visit. Diagnoses and all orders for this visit: 1. Medicare annual wellness visit, subsequent (Primary) Patient Instructions Medicare Annual Wellness (Yearly) Next due on 8/26/2023 08/26/2022 E&M Code: PPPS, SUBSEQ VISIT 09/01/2020 Level of Service: PR PPPS, SUBSEQ VISIT Generated on 4/11/23 8:32 PM Page 296	what is the service date or date of service?	{"text": [], "answer_start": []}
id_1711472786.794158	Justin Morrison	Printed: 03/15/21 11:34 22 PatientKeeper庐 By: STANFORD, KIRSTEN RAD CHEST 2V PALAT Justin Morrison. Age: 77Y Gender: F birth date: 1994/05/08 MRN: K093937120 Phone: (358)581-8580 Date/Time 2015/21/08 10:4 Status Signed Source Reston Hospital Center RAD CHEST 2V PA LAT ORDERED PROVIDER: Pego, Michelle I NP DATE OF EXAM: 2020/18/09 FACITLIY: MEDICAL IMAGING CENTER RESTON STATUS: Signed Exam Procedure 002658419 RAD/RAD CHEST 2V PA LAT Signed: DR.VUDU 2019/28/07 10:30am RAD CHEST 2V PA LAT CHEST X-RAY, frontal and lateral views: HISTORY: WHEEZING COMPARISON: 2023/05/01 FINDINGS: The cardiac silhouette is normal. IMPRESSION: Normal chest xray. Reported by: Duyanh T Vu, MD Signed by: Dr Tara Williams, MD Page 1 of 1	what is the visit date or date of visit?	{"text": [], "answer_start": []}
id_1711473366.115298	Cynthia Hanna	athena 10/30/2023 1:33:13 pm EDT Page: 56 / 86 Cynthia Hanna (id #12146212, BIRTHDATE: 19/04/84) Baptist Health Health Information Management Dept Cynthia Hanna 3563 Philips Highway Building B. Suite 201 MRN: 52214210 BIRTHDATE: 19/04/84, Sex: F Jacksonville FL 21207-5213 Adm 01/01/17 D/C: 31/01/17 07/15/2023 - ED in Baptist Clay Emergency (continued) ED Provider Note (continued) HISTORY: seizure COMPARISON: None. TECHNIQUE Contiguous axial slices of the head were submitted without IV contrast. FINDINGS: INTRACRANIAL: Brain parenchyma is normal in attenuation, No acute intracranial hemorrhage. electronically signed by: Dr Rebecca Hayes MD 11/03/21 12:38 PM CDT Printed on 7/27/23 at 8:20 AM Release ID: 28521892	what is the service date or date of service?	{"text": [], "answer_start": []}
id_1711471329.143204	Mary Lopez	00057 RE: Mary Lopez DOS: 04-02-2016 Page 1 of 10 Palpation There is no tenderness to palpation anywhere in the wrist. This includes the scaphoid volarly, radially and dorsally, the distal radius and ulna, the lunate, the triquetrum, the capitate, the hamate, the pisiform, the triangular fibrocartilage, the ulnar fovea, the ECU, the FCU, the FCR and the first, second, third, fourth, fifth and sixth dorsal compartment. Range of Motion of the Wrist Right Normal Extension 57 degrees 60 degrees Ulnar deviation 30 degrees 46 degrees Radial deviation 78 degrees 20 degrees Pronation 80 degrees 47 degrees Supination 80 degrees 80 degrees Special Tests There is no evidence of wrist instability. Sensory Examination Sensation is intact to light touch and pinprick in all dermatomes in the bilateral upper extremities. Two-point discrimination is within normal limits. Vascular Examination 9 64595092490 Received 28-06-2019	what is the visit date or date of visit?	{"text": [], "answer_start": []}
id_1711472286.52535	Justin Hicks	Justin Hicks MRN: 5605213 06/05/2023 - Telephone in MultiCare Rockwood Orthopedics & Sports Medicine MultiCare Health System Patient name: Justin Hicks MRN: 5605213 CSN: 296528619 Account Information Admit Date HAR# Pt Class Hospital Svc Bed 23-04-2023 No service for Admitting Physician: Chief Complaint: Forms Adm Dx: Gestational Age: <None> Patient Information Home Address: 1835 E 8th Ave Telephone Information: Spokane WA 99202-3409 Home Phone Not on file. Work Phone Not on file. SSN: xxx-xx-8028 Mobile 509-993-4659 Age: 52 year old Employer: UNITED PARCEL SERVICE birthdate: 02-03-1988 (18 yrs) United Parcel Service Sex: male Marital Status: Significant Other RIVER VIEW CORPORATE Justin Hicks CENTER MRN: 5652313, birthdate: 02-03-1988, Sex: M 16201 East Indiana Ave date of visit: 12-05-2018 SPOKANE VALLEY WA 99216- 1882 Page 20 Printed by 414221 at 7/17/23 9:40 AM	What is the Date of Discharge?	{"text": [], "answer_start": []}
id_1711476768.770923	Matthew Gibbs	DocuSign Envelope ID: B6xxxx-70xx-4Fxx-BExx-EA9EC5Axxxxx TBOSG TAMPA BAY ORTHOPEDIC SURCERY GROUP ADVANCED BENEFICIARY NOTICE OF BILLING AND SERVICE OPTIONS (ABN) Steven Arnold By my signature below, I, (print name), hereby acknowledge and understand that Tampa Bay Orthopedic Surgery Group (hereinafter "the Practice"), have offered to provide medical treatment related to my liability incident dated 12/12/2022 I have fully read this notice to make an informed decision about the payment for my medical care. I further acknowledge that I have been given the opportunity to ask any questions I may have and to consult with an attorney of my choice to discuss my rights and responsibilities prior to choosing my option and signing this form. (INITIAL ONLY ONE BOX. WE CANNOT CHOOSE A BOX FOR YOU.) DS ww OPTION 1 - Due to the time and nature of treatment to be rendered by the Practice, in addition to the risk in undertaking my medical treatment of either underpayment or nonpayment by my health insurance carrier. OPTION 2 - I hereby agree that the Practice will bill my health insurance carrier, Medicare, Medicaid, or other applicable carrier for the medical services by the Practice, but I will be required to pay in full all co-pays, deductibles, co-insurance, or patient responsibility estimated to be payable as a result of the rendering of these medical services prior to receiving any medical treatment. DocuSigned by: (Steven Arnold 25/09/2022 32E36710500740E Signature of Patient Date Signature of Medical Provider a 29/08/2015 Date 1114 W Kennedy Blvd Tampa FL 33606 P: 813.463.2814 F: 813.463.2814 3814 Tampa Rd. Suite 300 Palm Harbor FL 34684 P: 727.239.0814 F: 727.239.0614 7814 66th St. N. Suite 204 Pinellas Park FL P: 877.703.7114 F: 813.463.2814	What is the Date of Discharge?	{"text": [], "answer_start": []}
id_1711471329.089088	Sean Wright	Countryside Regional 2700 Brandon Drive Suite 365 Vincentland, KS 12981 Workers' Compensation Medical Status Questionnaire patient name: Sean Wright Today's date: 2022-28-05 Patient ID #: 0457351 Injury Date: 2014-01-07 Employer: FOOD LION Carrier: RETAIL BUSINESS SERVICES Treating physician: Dr Kerry Henderson IC file: 2022224556 1. Diagnosis: Kidney Stones 2. Treatment plan: WCP, NAPROXEN, ROBAXIN 3. Prescribed medications for the injury or condition that would impair ability or judgement needed to perform certain jobs: Lifting: 57LB MAX Pushing/pulling: INFREQUENT Bending/stooping: INFREQUENT Kneeling, squatting: INFREQUENT Twisting: INFREQUENT Use of extremities: Standing: Walking: Sitting: Repetitive motions: Driving: Vibrations: Climbing: Splints/crutches/bandages: Other restrictions: 7. If patient has reached maximum medical improvement (MMI), what is the permanent impairment for the injury or condition? Body part: : Percentage: % Body part: ; Percentage: % M Physician signature: Dr Catherine Hughes, MD Date: 2021-15-09	What is the Date of Evaluation?	{"text": [], "answer_start": []}
id_1711477275.244621	Anthony Buck	AEGIS Laboratory Director Matthew T. Hardison PhD CLIA Number 44D1083455 Laboratory Report 515 Great Circle Road Nashville, TN 37228 SCIENCES CORPORATION (615) 255xxxxx Fax (615) 255-xxxx Clinic Information Patient Information Sample Information Client: South Texas Bone & Joint Patient Name: Deborah White Lab Sample ID: 81181xxxx 601 Texan Trail Specimen Type: Urine Corpus Christi, TX 78411 Patient ID: 45796xxxx Collected: 29 Sep 2014 Requesting Provider: Date of Birth: 01 Jun 1992 Received: 30 Jul 2018 JOHN MASCIALE Male/Female: Female Reported: 29 Dec 2022 Copyright o 2018 Aegis Sciences Corporation All Rights Reserved Page 2 of 45 767453 South Texas Bone & Joint - 00459	what is the DOB or date of birth?	{"text": ["01 Jun 1992"], "answer_start": [525]}
id_1711473239.366894	Casey Kelley	Datavant Release of Information Patient: Casey Kelley birthdate: 19/90/08 Court Case #: 340799407 CERTIFICATION OF RECORDS Enclosed are the medical records of Casey Kelley . Datavant is producing the records as the Health Insurance Portability and Accountability Act business associate of GABLES SURGICAL and pursuant to a subpoena or patient authorized request issued to GABLES SURGICAL. No records for dates requested No patient found NO PHYSICAL FILMS KEPT AT SITE Number of pages: 165 Includes billing records: No Number of Images/CDs: N/A BILLING SENT BY MBS ATTORNEY GROUP Date: 02/24/02 640-540-1409 Datavant - Release of Information Vendor for GABLES SURGICAL	What is Ordered Date?	{"text": [], "answer_start": []}
id_1711477090.74941	Francisco Walker	Perception no hallucinations or delusions during interview Orientation oriented Memory / Concentration short term intact,long term intact Insight / Judgement good Diagnosis Diagnosis WHODAS / Diagnosis Reviewed Inactive Resolved Code Description Type Primary GAF / CGAF Status Date Date Date Date F31.81 Bipolar II Disorder Active 03 Mar 2017 JabaraMayer Service Date: 07 Dec 2020 12:00:00 PM Released: 03 Mar 2017 9:28:06 PM This document was printed from PIMSY EMR System It contains protected health information (PHI). DOS: 12 Apr 2016 12:00:00 PM Shauna Becker (B-C-14860) B-C-14860-60557 03 Mar 2017 Date Of Birth 25 Oct 2003 Gender: Female CLIENTNUMBER B-C-14849 Page 3 of 49	What is the Procedure Date?	{"text": [], "answer_start": []}
id_1711471330.564596	Diane Hudson	Doctors of Manteca patient name: Diane Hudson Attending Provider: Dr David Davidson MRN #: 153795 ADMITTING DATE: 22 November 2017 Account #: 33881139228 discharge day: 22 December 2017 birth date/Age/Sex: 04 January 1990 / 61 years / Female Lab Medical Director(s): Dr James Reynolds, MD Discharge Documentation/Instructions Attachment(s): Most recent to oldest [Reference 1 2 Range]: 12.5 g/dL 12.6 g/dL Hgb [12.0-16.0 g/dL] (2/19/20 5:10 AM) (2/18/20 5:23 AM) 31.1 pg 31.4 pg MCH [27.0-31.0 pg] HI HI (2/19/20 5:10 AM) Report Request ID: 246234232 Page 2 of 334	What is Ordered Date?	{"text": [], "answer_start": []}
id_1711473237.344088	Joshua Hutchinson	THU 43 FAX MRN: 1932719H Joshua Hutchinson Nassau Unly. Medical Gender: Female Center Age: 39y (05-26-1992) Current Location: ICC1-2161-JJ Faculty Statement: Attestation Attending and Resident/Fellow/Physician's Assistant Electronic Signatures: Dr Jeff Arroyo (Physician) (Signed 04-26-2017 8:42) Authored: Faculty Statement Co-Signer: Date of Procedure, Pre-Op and Post-Op Diagnosis, Specimens, Brief Operative Note, Procedure Details Dr Karen Whitehead (Resident Physician) (Signed 11-25-2023 8:42) Authored: Date of Procedure, Pre-Op and Post-Op Diagnosis, Specimens, Brief Operative Note, Procedure Details Requested by: Philburn, Jacqueline (Med Rec Clerk), 01-27-2017 12:25 Page 2 of 2	What is signature date or signed on date?	{"text": ["04-26-2017"], "answer_start": [311]}
id_1711476990.340141	Beth Estrada	University of Oklahoma October 27, 2023 800 NE 15th Street Suite 205 Oklahoma City, OK 73104 Page 2 4052714655 Fax: 4052711355 Lab Report Jordan Clark Male DOB: 86/04/09 2708055 Ins: BLUE CRO (22) Grp: 116455 Producer ID 2:OU MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73155 Producer ID 10:OU MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73155 Producer ID 11:0U MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73155 Producer ID 12:OU MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73155 Producer ID 13:0U MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73155 Producer ID 15:OU MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73155 (2) Order result status: Final Collection or observation date-time: 20/08/19 13:05 Requested date-time: Receipt date-time: 10/17/2016 13:06 Lab site: OU MEDICAL CENTER Laboratory, 1200 Everett Drive Oklahoma City OK 73104 (3) Order result status: Final Collection or observation date-time: 20/08/19 13:05 Requested date-time: Specimen Source: PN:C02194S Source: HCA LAB Filler Order Number: 1017:PN:C02194S LAB Lab site: OU MEDICAL CENTER Laboratory, 1200 Everett Drive Oklahoma City OK 73104	what is the DOB or date of birth?	{"text": ["86/04/09"], "answer_start": [179]}
id_1711473238.019526	Tammy Dickson	<<Back To Review>>180298-16-HYPER LINK - Page 178 Legal Copy SGMF-PRIMARY CARE Tammy Dickson Sutter Health 95355-4276 MRN: 53470498, DOB: 24/05/91, Sex: M Single Notes Date of Visit: 26/07/15 Notes (continued) Patient Instructions by Dr Sandra Hicks MD at 12/30/16 1528 Author: Dr Sandra Hicks MD Service: - Author Type: Physician Filed: 12/30/16 1528 ENCOUNTER DATE: 16/10/14 Status: Signed Editor: Dr Sandra Hicks MD (Physician) Electronically Signed by Dr Sandra Hicks MD at 04/09/15 1128 Notes Progress Notes by Kobrine, Steven E, MD at 04/09/23 1123 Printed by [S271222] at 10/28/21 11:27 AM 00178	What is the Date of Consultation?	{"text": [], "answer_start": []}
id_1711475620.873917	Ruben Brown	V VITRO MOLECULAR LABORATORIES www.vitromolecular.com Patient Name: Ruben Brown Physician: Robert Jacobson, MD Accession #: S22-04715 Sex: Male Specialty Group: The Gables Surgical Center Collected: 2021-20-05 DOB: 1994-20-03 (72) Received: 2021-20-05 Reference #: S22-04715 CC: Reported: 2023-18-10 Surgical Pathology Report Clinical History Previous Vitro pathology report: S21-12983, 2021-09-02 A)Lumbar disc, L4-5; discectomy:Cartilage and disc material with degenerative changes; S21-15703, 2021-08-02 A)Disc, C4-C5, discectomy:0 Cartilage with degenerative changes DIAGNOSIS A. DISC L4-5: - Fibrocartilaginous tissue with degenerative changes - Negative for atypia or malignancy in this sample Images Gross Description A. Received in formalin there are multiple white fibrocartilaginous tissue fragments measuring 2.5 X 2.0 X 0.3 cm in aggregate. Specimen is submitted in toto in one green cassette. IG/rms Electronic Signature Hadi Yaziji, M.D. CPT Code(s): 88304 (1) *** END OF REPORT E-MAILED 2021-05-12 Vitro Molecular Laboratories 8700 West Flagler Street, Suite 100, Miami, FL 33174 Tel: 305-267-7979 Fax: 786-513-0175 CLIA: 10D1055514 Page 1 of 1	What is the Date of Evaluation?	{"text": [], "answer_start": []}
id_1711471328.381681	Julia Bell	2018 November 25 13:47 Fax 18039734602 p.6 Tuesday, April 12, 2022 History and Exam Patient Name Julia Bell Female birthdate: 2000 September 14 Age: 64 years, 8 months date of visit: 2020 September 13 Referred By: History Chief Complaint: " I have a 24/7 guard a doctor made for me in new orlands and he told me to eat with-it and i tried but it doesn't work out" HPI: History of Migraine with ablation on multiple meds Started years ago SFH: Does not smoke ETOH use Rarely - Wine No Illicit Drug Hx Medications: Albuterol inhaler Allergies: None Health Alerts: High Blood Pressure, TMJ Disorder, Alcohol Use, Arthritis, Sinus Trouble Exam Date Recorded: 2018 November 25 Ht. 4'5" Wt. 57kg General: General: -No pre/post auricular surgical scar -No overlying erythema -CN VII is HB-I bilaterally Joint Examination (R/L): -Superficial pain: 0/0 000047	What is the Date of Encounter or Enc?	{"text": [], "answer_start": []}
id_1711476578.340249	Scott Koch	Patient: Emily Gray DOB: 1986 July 09 2018 March 08 10:24 AM Print Preview Emily Gray DOB: 1986 July 09 (45 yo F) Acc No. 758855 DOS: 2019 May 20 Owens, Shannon CanoHealth 46 Y old Female, DOB: 1986 July 09 Account Number:758556 HOLLYWOOD HL-22550-3855 Home: xxx-558-3455 Cuarantor: Owens, Siminon Insurance: Humana Medicaid CAP Appointment Facility: ou-Places University Structured Liatn: Lines patient need transportation :No 2019 January 23 Progress Note: VICKYRIVAS-OROZ0O MD for Appointment i. PRE-OP CLEARANCE Assessments 1. Pre-op evaluation as 201.818 Treatment 1. Pre-on evaluation LAB:CBC With Differential/Platelet (Ordered for 07/07/2022) 07/07/2022 Clinical Notes: FU studies FU ENT. 2. Deviated septum Clinical Notes: FU ENT. Follow Up 2 Weeks,prn (Reason: FU AFTER SURGERY) History of Present illness 45 yo patient here for Pre-OP Surgery: septoplast, submucosal of the inferior turbinate Indication: Deviated Septum Surgeon: Dr. Dwayne Smith Date: 2018 March 08 Prior Surgeries: no issues with anesthesia Examination -Exam: Progress Notes VICKY MD 07/07/2028	what is the DOS or D.O.S?	{"text": ["2019 May 20"], "answer_start": [143]}
id_1711475190.152001	Debra Hunt	NOVANT NOVANT HEALTH MEDICAL Debra Hunt N PARK HOSPITAL MRN: 56324637, DOB: 24-08-1988, Sex: M HEALTH 1950 South Hawthorne Road Adm: 27-03-2016, D/C: 26-04-2016 Winston-Salem NC 27633-3632 11-02-2017 - Admission (Discharged) in NHMPH Surgical Services (continued) Clinical Notes Acute (continued) Drains: None Specimens: ID Type Source Tests Collected by Time 1 right Tissue Spermatocele PATHOLOGY Brandon L 09-07-2018 1618 TISSUE Craven, MD REQUEST Implants: No implants in log Procedure Detail Findings: Right spermatocele x2 Complications: None. Electronically signed: Dr Kathryn Roberts, MD 08-11-2017 / 4:39 PM Electronically signed by Brandon L Craven, MD at 08-11-2017 1641 Generated on 4/11/23 8:32 PM Page 255	what is the service date or date of service?	{"text": [], "answer_start": []}
id_1711476767.550663	Terri Thomas	2017 Dec 03 08:25 1 12 >> unknown P 24/78 Coastal Neurology Inc. Procedure Note Patient Name: Loren Ferris Visit Date: 2020 May 18 Patient ID: 23678 Provider: Brad Taylor, PA Sex: Female Location: COASTAL NEUROLOGY INC Birthdate: 1989 Nov 04 Location Address: Referring Provider: Gerald Mckay DO Ormond Beach, FL Location Phone: (386) 788xxxx PROCEDURE NOTE: Trigger Point Injections Neck and Upper Back using Ultrasound Guidance REASON FOR PROCEDURE: Bilateral Neck and Upper Back Myofascial Pain Syndrome EBL: Less than 1 CC INJECTATE SOLUTION: Contained 10 cc of 1% lidocaine PROCEDURE PERFORMED BY: Dr Anne Burnett, PA-C Location: Bilateral trapezius, levator scapulae, splenius capitis and parascapular muscles Location: Tendon origin of bilateral trapezius, rhomboid minor, and parascapular muscles Summary of Procedure: The patient presents today for scheduled bilateral neck and upper back trigger point injections using ultrasound guidance for the benefit of needle placement. today is cervical trigger point 1 VAS is 5/10. I have discussed with the patient the risks and benefits of the procedure. Risks included are nausea, vomiting, headaches, seizures, death, fainting episodes, and hyperglycemia. The patient understands, agrees, and consents to the procedure. [Digital Signature Validated]	what is the service date or date of service?	{"text": [], "answer_start": []}
id_1711471328.783757	Brian Orr	med Department of Pathology 2501 South State Highway 121, Suite 1100 fusion Lewisville, TX 75897-8898 Tel: 954-320-8698/972-989-7900 clin-labs clin-trials Fax: 345-195-2799 Flow Cytometry - Leukemia/Lymphoma Profile PATIENT: Brian Orr Accession #: AB23-341 Med. Rec. #: 10771972 Client: Med fusion Taken: 6/23/2023 Texas Oncology-San D.O.B: 1999-09-28 (Age: 65) Location: Antonio Medical Center Received: 6/24/2023 Gender: F Billing #: 10771972 Reported: Physician(s): SUNEETHA Copy To: CHALLAGUNDLA ordered date: 2018-08-10 Status: Signed Out Brian Orr Page 1 of 2	what is the DOB or date of birth?	{"text": ["1999-09-28"], "answer_start": [384]}
id_1711475190.360838	Ashley Flores	<<Back to Review>>194126-3-HYPERLINK- - Hyperlink-Page 187 Ashley Flores KAISER PERMANENTE庐 MRN: 110554055855, BIRTHDATE: 1995 July 03, Sex: F SSN: xxx-xx-3554 Visit Day: 2020 April 03 2017 October 25 - Scheduled Telephone Encounter in CCM-DIABETES (continued) Clinical Notes (continued) 3) Further blood sugars needed to assess effect of insulin next visit evaluate changing INSULIN REGIMEN SQ P LIFESTYLE/EDUCATION : Reviewed rule of 15 for treatment of low blood sugar. If bedtime blood sugar below 110 take snack of 15 grams carbohydrate Such as 1/2 sandwich and take insulin as ordered . Call Mary Hallum if occurring 2 or more times in 2 weeks . blood sugar above 100 before driving exercising or above 110 before sleeping. electronically signed by Hallum, Mary C. (R.N.) at 2022 January 01 9:41 PM Generated on 4/6/22 11:06 AM 000187 0186	What is Collection Date?	{"text": [], "answer_start": []}
id_1711476892.769963	Joshua Baker	MRN: 608698 Facility: NBMC NorthBay Healthcare Patient Discharge Instructions Signature Page Name: David Vargas Current Date: 12-03-2023 00:16:37 MRN: 608659 FIN: 010998059 I, FLORENTINO MEJIA-GALLEGOS, have received and verbalized understanding of the above instructions, list of medications, and/or patient education material(s) and my questions have been answered to my satisfaction. Mantino My Gilbers Patient Date Time Family Member (Relationship) Date Time A Damn 9867 18-09-2023 0015 Provider Signature Date Time 00608698 13-07-2022 MEJIA-GALLEGOS, FLORENTIN 19-11-1993 26Y M NBHS Emergency 0010998059 . 000450012 . Name: David Vargas 8 of 59 12-03-2023 00:16:38 AM MRN: 608698 153	What is the Date of Exam or Examination date?	{"text": [], "answer_start": []}
id_1711472590.672224	Jason Zimmerman	Page 1 of 1 Notice: This is NOT a bill. Do not pay. If it is 庐 determined that this service or a portion of THIBODAUX REGIONAL these services is not payable by your health HEALTH SYSTEM plan, you will be responsible. Responsible Party: Buggage, Nadine 126 Jacobs St Napoleonville, LA 70390-2429 Name: Jason Zimmerman Guarantor Number: GN01864236 Account Number: V00018642361 Service Dates: 12-07-2021-06/22/22 Bill Date: 07/06/22 Insurance Coverage Insurance Policy Number Blue Cross Louisiana IHQ862841864236 For additional information, please contact us at 440-267-2487.	What is Ordered Date?	{"text": [], "answer_start": []}
id_1711473366.060342	Christopher Griffith	athena 10/30/2023 1:33:13 pm EDT Page: 48/86 Christopher Griffith (id #16946692, DATE OF BIRTH: 01/05/26) Encounter Summary for Christopher Griffith Encounter Details Date Type Department Care Team Description 19/12/17 Emergency Discharge Disposition: 01 3:51 AM Baptist Clay Emergency DISCHARGED TO HOME EDT - OR SELF CARE 19/12/17 1771 Baptist Clay Drive 3:44 PM EDT FLEMING ISLAND, FL 32693-8691 Demographics Sex: Female Ethnicity: Not Hispanic or Latino DATE OF BIRTH: 01/05/26 Race: White Preferred Information not available Marital status: Married	what is the DOS or D.O.S?	{"text": [], "answer_start": []}

id_1711475190.51037

Jeffrey Mendez

<<Back to Review>>194126-2 HYPERLINK-Hyperlink-Page 188 KAISER PERMANENTE庐 Jeffrey Mendez MRN: 110284072888, Date of Birth: 07/01/1992, Sex: F SSN: xxx-xx-3284 Visit Day: 01/07/2014 06/10/2017 - Work Comp in OCC PHYSICAL THERAPY -STE 5038 All Charges for This Encounter Code Description Service Date Service Provider Modifiers Qty 97014 APPLICATION MODALITY TO 1 OR MORE 07/12/2016 Lattupally, Shirisha (P.T.) 1 AREAS; E-STIM Physical Medicine Notes THERAPIST, PHYSICAL Progress Notes by Lattupally, Shirisha (P.T.) at 9/25/2007 1010 Version 1 of 1 Author: Lattupally, Shirisha (P.T.) Service: - Author Type: THERAPIST, PHYSICAL Filed: 9/25/2007 10:10 AM ENCOUNTER DATE: 22/08/2018 Creation Time: 9/25/2007 10:10 AM doi: 24/08/2015 Generated on 4/12/22 10:33 AM 000188 0187

What is the Date of Consultation?

{"text": [], "answer_start": []}

id_1711472786.49035

Travis Dennis

Salinas Valley Medical Clinic Corona, Araceli MRN: 3121290, dob: 1993 December 26, Sex: F SALEVE VALUE MINNIONAL HEALTHCARE SYSTEM visiting date: 2015 May 02 2014 November 28 a Office Visit in DOD Salinas C Abbott (continued' Clinical Notes (continued) Electronically signed by Dr Dr. Sandra Estes MD at 2018 September 19 8:53 AM Attribution Key SS.1 - Dr Dr. Sandra Estes MD on 12/13/2021 8:27 AM SS.2 - Dr Dr. Sandra Estes 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 Collection Date?

{"text": [], "answer_start": []}

id_1711472786.856402

Brian Gordon

Virginia Cancer Specialists Specializing in Cancer and Blood Disorders LOCATION: VCS Loudoun patient name: Brian Gordon MRN: 389604 D.O.B: 87-07-23 ATTENDING PHYSICIAN: Dr Amber Foster SERVICE DATE 22-01-25 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 Encounter or Enc?

{"text": [], "answer_start": []}

id_1711477275.579164

James Reed

CT, LUMBAR SPINE, W/ CONTRAST (#54463xx, 11/15/04 12:00am) Patient Portfolio Page 1 of 2 MCKESSON Patient Name: Paige Jacobs DOB: 07/97/02 Empowering Healthcare ID: MV00480852 Study Date: 25-Sept-2022 14:50 Final Report CT SPINE LUMBAR W CONT CHRISTUS Health System SST - SPOHN HOSPITAL SOUTH 5950 Saratoga Blvd. Corpus Christi, Tx 78414 RADIOLOGY REPORT Signed Patient: Paige Jacobs DOB: 07/97/02 F 69 Account #: AV0001604xxx Med Rec #: MV00480xxx Patient Location: AV.ED/ Procedure: SPINE LUMBAR DE CONT CPT:721xx Requisition #: 22-0238552 REPORT #: 0925-0652 Date of Exam: 12/15/03 Time of Exam: 1353 HISTORY: post op wound to lumbar, pain, discharge COMPARISON None. TECHNIQUE: CT lumbar spine with intravenous contrast. A CT dosimetry report is saved to PACS. CT scanner utilized a dose reduction technique. FINDINGS: Electronically signed by: Ryan Hanisch MD 19/23/02 3:53 PM CDT Workstation: RPCCWRS130P6 Dictated By: HANISCH, RYAN J MD Date Dictated: 19/23/02 1553 Signed By: HANISCH, RYAN J MD Date Signed: 19/23/02 1542 CC: LILJEBI ; MARIA L AYARZAGOITIA, FNP Admitting MD: 76729-3 South Texas Bone & Joint - 00452

What is Ordered Date?

{"text": [], "answer_start": []}

id_1711475620.722579

Rebecca Flores

2015/06/05 eCW (Schaubhut, Roslyn ) Rebecca Flores DOB: 1987/01/05 (78 yo M) Acc No. 39486 REFERRAL KATE MCDONALD, MD Rebecca Flores Family Practice 1987/01/05 ,,- 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 2022/27/12 at 02:42 PM CDT

What is the Date of Encounter or Enc?

{"text": [], "answer_start": []}

id_1711475190.482283

Bethany Houston

N NOVANT NOVANT HEALTH Bethany Houston KERNERSVILLE OUTPATIENT MRN: 52324237, DATE OF BIRTH: 10/1996/04, Sex: M HEALTH SURGERY Adm: 05/2019/04, D/C: 06/2019/03 1230 Kernersville Medical Parkway, Suite 234 KERNERSVILLE NC 27234- 7198 03/2019/15 - Admission (Discharged) in Novant Health Kernersville Outpatient Surgery Center (continued) Clinical Notes Acute (continued) rosuvastatin calcium (CRESTOR) TAKE 1 TABLET(5 MG) BY MOUTH AT BEDTIME 5 mg tablet Improvement from treatments: 80% relief from last bilateral L4-5 TFESI Side effects from medicines: None Activity Level-_adequate Abberant Behavior- Procedures; 04/2020/07 - L4/5 TFESI Images: X-Ray Lumbar Spine (3/5/2021): TECHNIQUE: 2 views lumbar spine. Generated on 4/11/23 8:33 PM Page 325

what is the admit date or admission date?

{"text": ["05/2019/04"], "answer_start": [151]}

id_1711473530.749964

Charles Rogers

TOWER PHYSICAL THERAPY, INC. Private Insurances: Any insurance that does not pertain to a work injury. Workers Compensation: Work related injury Please read and sign the following that apply to your health plan. PRIVATE INSURANCE/MEDI-CARE Any insurance that does not pertain to a work injury. If you are not aware of your physical therapy benefits, please let us know and we will acquire them for you, otherwise we will assume you are aware of your benefits. Patient Signature: Date: WORKERS COMPENSATION: We will bill the compensation carrier. Patient Signature: Ed Foster Date: 17-01-2024 000083 0083

what is the DOS or D.O.S?

{"text": [], "answer_start": []}

id_1711476990.583088

Karen Little

4054426744 fax 01:10:44 p.m. 24/12/2021 27/28" (800) xxxxxxx R: Central Laboratory: 4144 South Mingo Road, Tulsa, 74146 Patient Name: Jennifer Gonzales Provider: M Monem Gillan MD MRN: 525170844 1014015 DOB/Age/Sex: 06/07/2000 54 years Male Consulting: Deliver to: GILLAN, M MONEM 1211 N SHARTELL STE 700- OKLAHOMA CITY, OK 73103- Hematology CBC Collected Date: 20/02/2015 12:13 Procedure Normal Abnormal Units Reference Range Received Verified Date/Time Date/Time WBC 6.0P1 10e9/L [4.0-11.0] 04/28/2022 21:02 04/28/2022 21:55 Chemistry General Chemistries Collected Date: 20/02/2015 12:13 Procedure Normal Abnormal Units Reference Range Received Verified Date/Time Date/Time Glucose 104 H P1 mg/dL [70-100] 04/28/2022 21:02 04/28/2022 21:53 Printed: 05/01/202004:45 186501203 Page 1 of 44

What is the Date of Encounter or Enc?

{"text": [], "answer_start": []}

id_1711473530.494446

Bryan Chen

KNMH CT SCAN Bryan Chen 180 W Esplanade Ave MRN: 8348348, birthdate: 11/1985/17, Sex: M Kenner LA 73465 Acct #: 83403346341 Enc. Date 01/2018/15 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 04/2018/25 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 02/2024/24 Indications of use: Neck trauma (Age >= 65y) Result CT Cervical Spine Without Contrast (Order 434903430) Generated on 10/3/22 11:37 AM Page 2

What is the Date of Consultation?

{"text": [], "answer_start": []}

id_1711471330.56622

Michael Mcdaniel

Doctors of Manteca patient name: Michael Mcdaniel Attending Provider: Dr Lisa Ramirez MRN #: 153795 Admission Date: 21/04/21 Account #: 23465013953 date of discharge: 21/05/21 D.O.B/Age/Sex: 14/11/88 / 61 years / Female Lab Medical Director(s): Dr Mark Vang, MD Discharge Documentation/Instructions Attachment(s): Most recent to oldest [Reference 1 2 Range]: 12.5 g/dL 12.6 g/dL Hgb [12.0-16.0 g/dL] (2/19/20 5:10 AM) (2/18/20 5:23 AM) 31.1 pg 31.4 pg MCH [27.0-31.0 pg] *HI* *HI* (2/19/20 5:10 AM) Report Request ID: 246234232 Page 1 of 334

what is the DOB or date of birth?

{"text": ["14/11/88"], "answer_start": [223]}

id_1711477090.145026

Richard Jones

15 August 2014 12:10 PM FROM: Fax PULMONARY AND SLEEP SPECIALISTS OF TAMPA BAY, PA PAGE: 016 OF 018 Patient: Matthew Graves DOB: 25 February 1989 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 06 May 2019 Signing Dr. Eckerd, Morgan Location FPLA051 Signature Line nal ********* Transcribed by: MCE 07/21/21 13:32 Signed by: ECKERD MD, MORGAN CHARLTON 21 June 2023 13:32 RADRPT This document has an i mage Page 2 of 75 Printed on: 15 August 2014 15:29 EDT Document: 15 August 2014 Printed: 15 August 2014 10:55:38 Page 15 of 175

What is the Date of Consultation?

{"text": [], "answer_start": []}

id_1711477090.81242

Brittany Mendoza

06-02-2022 19:59:15 EDT To: 195222268622 Page: 03/622 From: Lauris Rigdon Patient Self-Report Patient Assessment/Diagnosis History of Present Condition: Patient presents with acute LBP and right hip pain that presents with acute low back and right hip pain following started on May 20th following elevator accident. Functional accident that occurred on May 20th. Pt explains that she was battling with established with patient input. allow patient to return to prior level of function, independence and safety. Onset Date: May 20th Comorbidities: - Psychosocial: Battling with high anxiety, difficulty talking about accident - Car accident in with back pain and left shoulder (2007) e Currently experiencing excessive vaginal bleeding (being monitored by OBGYN) Pre Morbid Level of Function: - Independent prior to injury Current Level of Function/Current Deficits: - Unable to get into/out of car without onset of pain - Unable to stand for prolong periods of time - Unable to walk her dog due to fear of worsening symptoms. Work tasks: Desk job at home, mostly on the computer Sleep disturbance: Reports no change in sleeping pattern Imaging: X-ray: no abnormal findings. CT scan of abdomen and pelvis: results pending Red flags: Pt denies all red flags including but not limited to weight loss/gain > 10 Patient John Peters (DOB: 11-28-1985) Treated by Jennifer Flores, PT. DPT DOS: 08-23-2018 Page 2 of 22 of Plan of Care

What is the Date of Discharge?

{"text": [], "answer_start": []}

id_1711475620.322197

Lisa Collins

Lisa Collins DOB: 21/06/98 (67 yo M) Acc No. 63888 22/09/23 Lisa Collins DOB: 21/06/98 (67 yo M) Acc No. 63888 DOS: 05/08/20 97140 MANUAL THERAPY, Modifiers: 59 72040 X-RAY OF CERVICAL SPINE 3 view 72070 X-RAY OF THORACIC SPINE AP/LAT 72100 X-RAY OF LUMBAR SPINE 2 view Follow Up 2 - - 3 Days Electronically signed by Dr. Nicholas DiGerolamo Jr, DC on 30/08/17 at 01:40 PM CDT Sign off status: Completed Visit Status: CHK (Check Out) Provider: Matthew Laudun, D.C. Date: 06/04/19 Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com) Lisa Collins DOB: 21/06/98 (67 yo M) Acc No. 63888 Page 30 of 47

what is the admit date or admission date?

{"text": [], "answer_start": []}

id_1711477183.326242

Pamela Johnson

Jun 03, 2019 9 33 24 AM PST (GMT-8) FROM 9856749749-TO 15048424047 Page of 2 MRO Jun 03, 2019 Initials: DISCON LAW FIRM, L.L.C. 424 N. Causeway Blvd., Suite A Mandeville, LA 70455 Thomas M. Discon September 18, 2022 Via Facsimile: 504.842.4047 Ochsner Medical Center Ochsner Health Services Medical Records Department 1514 Jefferson Highway New Orleans, LA 70121 Re: Our Client: Wanda Cross DOB: Sep 18, 2003 DOI: Oct 22, 2017 Dear Sir or Madam: Our firm has been retained by Mr. James Ladner for injuries sustained in an accident on Oct 22, 2017. Enclosed please find a medical authorization executed by Mr. Ladner authorizing your office to release directly to our firm a certified copy of his entire medical file, including an itemized statement for services rendered, from January 1, 2022, to present. Further please consider this correspondence a reminder that your treatment of Mr. With kindest regards, I remain Very truly yours, s/Thomas M. Discon THOMAS M. DISCON TMD/djl Enclosure

What is Collection Date?

{"text": [], "answer_start": []}

id_1711473365.911448

Anne Marks

I have not violated Labor Code 139.3 and the contents of the report and bill are true and correct to the best of my knowledge. Signed this date, Solano County, California. DATE: 23-07-14 CURRENT MEDS: See med List (0935) No Level: 8/10 ALLERGIES/ADVERSE REACTIONS Patient Instruction: Pain: Yes MEDICATIONS: nKDA Acceptable pain level: Learner: Pain Is the primary reason for this visit LATEX: no Patient: Family: Rev IS train and MRI rese Teaching Method: Verbal Presentation: Cort pun W lower back unable Demonstration: Written Materials: to set & Stend A protest Medication: Medications dispensed: Description OCCUPATIONAL HEALTH Provider: SHEILA LEDERER, PA A NorthBay Affiliate Keeping Solano's Workforce Healthy Service Date: 22-07-16 Patient: MEJIA-GALLEGO, D.O.B: 97-11-06 FLORENTINO Follow Up Visit Employer : CHEVY'S-FF Injury Date : 20-12-06 OH-26 Rev. 03-12 230

What is Date of Injury or DOI?

{"text": ["20-12-06"], "answer_start": [922]}

id_1711471328.381658

Julia Bell

2018 November 25 13:47 Fax 18039734602 p.6 Tuesday, April 12, 2022 History and Exam Patient Name Julia Bell Female birthdate: 2000 September 14 Age: 64 years, 8 months date of visit: 2020 September 13 Referred By: History Chief Complaint: " I have a 24/7 guard a doctor made for me in new orlands and he told me to eat with-it and i tried but it doesn't work out" HPI: History of Migraine with ablation on multiple meds Started years ago SFH: Does not smoke ETOH use Rarely - Wine No Illicit Drug Hx Medications: Albuterol inhaler Allergies: None Health Alerts: High Blood Pressure, TMJ Disorder, Alcohol Use, Arthritis, Sinus Trouble Exam Date Recorded: 2018 November 25 Ht. 4'5" Wt. 57kg General: General: -No pre/post auricular surgical scar -No overlying erythema -CN VII is HB-I bilaterally Joint Examination (R/L): -Superficial pain: 0/0 000047

what is the admit date or admission date?

{"text": [], "answer_start": []}

id_1711475190.317913

Jordan Davis

KAISER PERMANENTE庐 Jordan Davis MRN: 110194019819, DATE OF BIRTH: 2002-11-30, Sex: F SSN: xxx-xx-3194 Visit: 2019-05-30 2020-06-20 - Telephone in ADULT AND FAMILY MEDICINE (continued) Clinical Notes (continued) Status: Signed Editor: Clark, Juliana Elizabeth (M.A.) (MEDICAL ASSISTANT) Signature Clark, Juliana Elizabeth (M.A.) at 2016-06-30 9:44 AM Telephone Encounter by Clark, Juliana Elizabeth (M.A.) at 1/13/2011 0944 Version 1 of 1 Author: Clark, Juliana Elizabeth (M.A.) Service: - Author Type: MEDICAL ASSISTANT Filed: 1/13/2011 9:44 AM Encounter Date: 2019-06-25 Creation Time: 1/13/2011 9:44 AM Status: Signed Editor: Clark, Juliana Elizabeth (M.A.) (MEDICAL ASSISTANT) Generated on 4/12/22 10:33 AM 000564 0563

what is the DOS or D.O.S?

{"text": [], "answer_start": []}

id_1711475190.547135

Regina Parker

Regina Parker MRN: 5672673 Preferred Pharmacy (continued) Referral (continued) Order MRI ARTH SHOULDER W/ CONTRAST RIGHT [676335615] signature: Dennis S Frerichs, PA-C on 24/23/03 0679 Status: Completed This order may be acted on in another encounter. Ordering user: Dennis S Frerichs, PA-C 02/22/23 0949 Authorized by: Dennis S Frerichs, PA-C Ordered during: Office Visit on 25/19/06 Screening Form General Information Patient Name: Regina Parker MRN: 5672673 birthdate: 12/90/12 Mobile: 567-967-4679 Sex Assigned at Birth: Male MC ROCKWOOD MAIN CLINIC Regina Parker - SPOKANE MRN: 5602313, birthdate: 12/90/12, Sex: M 400 East 5th Ave date of visit: 22/16/08 Spokane WA 99202-1334 Page 89 Printed by 414221 at 7/17/23 9:40 AM

what is the DOB or date of birth?

{"text": ["12/90/12"], "answer_start": [506]}

id_1711472285.690909

Matthew Chung

STATEMENT THIS IS A STATEMENT OF SERVICES RENDERED BY PHYSICIAN(S) WHO ARE MEMBERS OF: PATIENT NAME Seaside Medical Matthew Chung 8626 TESORO DRIVE BILL DATE ACCOUNT NO. AMOUNT PAID SUITE 112 SAN ANTONIO, TX 782176207 Jul 15, 2021 15032 210-817-6010 Seaside Medical 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 16 February 2023 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 19 May 2017 Matthew Chung 15032 AMOUNT $21,050.00 10 November 2023 1 3:34:01 PM

What is Date of Injury or DOI?

{"text": [], "answer_start": []}

id_1711475620.750908

Martha Curry

Martha Curry DOB: 28/11/93 (53 yo M) Acc No. 56005 Doc Name: 08/08/18 Financial Disclosure Disclosure of Financial Interest Form LA HEALTH SOLUTIONS, LLC and LYLE J. SCHWEEN, BS DC DISCLOSURE OF FINANCIAL INTEREST as required by R.S. 37:1744 and LAC 46:XXVII.911, et seq Date: 21/06/17 Patient Name: Martha Curry Louisiana law requires LA HEALTH SOLUTIONS, LLC and LYLE J. SCHWEEN, BS DC, and other health care providers to make certain disclosures to a patient when they refer a patient to another health care provider or facility in which the health care provider has a significant financial interest. One of the health care providers listed above may refer you, or the named patient for whom you are legal representative, to: PATIENT ACKNOWLEDGEMENT I, the above-named patient, or legal representative of such patient, hereby acknowledge receipt, on the date indicated and prior to the described referral, of a copy of the foregoing Disclosure of Financial Interest. (Signature of Patient or Patient's Representative) Print Name: Justin Ganloald Date: 30/03/19 Martha Curry DOB: 28/11/93 (53 yo M) Acc No. 56005 Doc Name: 08/08/18 Financial Disclosure Page 103 of 134

What is the Date of operation?

{"text": [], "answer_start": []}

id_1711475620.347787

Mr. Andrew Hayes DDS

Mr. Andrew Hayes DDS DOB: 89-04-26 (24 yo M) Acc No. 92572 15-10-19 Mr. Andrew Hayes DDS DOB: 89-04-26 (24 yo M) Acc No. 92572 DOS: 18-11-06 10. Sprain of sacroiliac region, initial encounter - S33.6XXA 11. Sprain of right rotator cuff capsule, initial encounter - S43.421A 12. Cervical muscle pain - M54.2 Treatment Manual Therapy: Massage Region: Left cervical, Right cervical, Left trapezius, Right trapezius Duration 8 minutes Electrical Stimulation: Spinal E-Stim Region: Left cervical, Right cervical, Left trapezius, Right trapezius, Left quadratus lumborum, Right quadratus lumborum, Left sacroiliac, Right sacroiliac Duration: 10 minutes Cold Therapy: Spinal Cold Therapy Region Left cervical, Right cervical, Left trapezius, Right trapezius, Left quadratus lumborum, Right quadratus lumborum, Left Sacroiliac, Right Sacroiliac Duration 10 minutes Procedure Codes 97140 MANUAL THERAPY, Modifiers: 59 97014 ELECTRIC STIMULATION THERAPY Follow Up 2 - 3 Days Electronically signed by MATTHEW LAUDUN , D.C. on 21-05-02 at 01:05 PM CDT Sign off status: Completed Visit Status: CHK (Check Out) Mr. Andrew Hayes DDS DOB: 89-04-26 (24 yo M) Acc No. 92572 Page 23 of 47

what is the DOS or D.O.S?

{"text": ["18-11-06"], "answer_start": [142]}

id_1711472591.029533

Christopher Mcmahon

Gulf Coast Surgical Center LLC Christopher Mcmahon D.O.S: 27 January 2020 2:30:00 PM ID / Visit: 48590 / 1 PATIENT INFO: SEX: F DATE OF BIRTH: 21 January 2003 AGE: 50 MAIN PHONE: 566-379-7497 ADDRESS: 034 Jimenez Valleys Apt. 894 Carolynmouth, ME 02615 RESPONSIBLE PARTY: BUGGAGE, NADINE A 034 Jimenez Valleys Apt. 894 Carolynmouth, ME 02615 RSP SSN: RSP OCC: TRMC RSP PH: 623-567-5262 I UNDERSTAND AND AGREE THAT, AT THE TIME THE PATIENT HAS MET GULF COAST SURGICAL CENTER LLC's MEDICAL CRITERIA TO LEAVE THE FACILITY, I WILL HAVE A RESPONSIBLE ADULT PRESENT TO TAKE ME/PATIENT HOME. I RELEASE GULF COAST SURGICAL CENTER LLC FROM ANY RESPONSIBILITY FOR EVENTS IN VIOLATION OF THIS AGREEMENT. Nadine Buggage Miniton 20 January 2017 1593 Witness Date Time Signed

what is the service date or date of service?

{"text": [], "answer_start": []}

id_1711471329.003598

Paul Moore

Downtown Medical Center 44151 Nash Park Port Lindamouth, AS 18299 Paul Moore M MRN: 8655141, D.O.B: 25-11-1991, Sex: F Adm: 13-04-2022, D/C: 13-05-2022 13-04-2022 - ED in Emergency - 44151 Nash Park Port Lindamouth, AS 18299 Reason for Visit Chief complaint: Drug Overdose Visit diagnosis: Ulcerative Colitis Visit Information Admission Information Arrival Date/Time: 13-04-2022 2153 date of admit/Time: 13-04-2022 2155 IP Adm. Date/Time: Admission Type: Emergency (Medical Point of Origin: Non-healthcare Admit Category: Intervention For Facility Point Of Severe, Life Origin Threatening Or Disabling Condition. Means of Arrival: Ambulance, Guilford Primary Service: Emergency Medicine Secondary Service: N/A Transfer Source: Service Area: WAKE FOREST Unit: Emergency - High BAPTIST MEDICAL Point, Main Hospital CENTER Admit Provider: Attending Provider: Dr Joseph Hanna, Referring Provider: A Referral Self MD Discharge Information Date/Time: 13-05-2022 0102 Disposition: Home Or Self Care Destination: - Provider: - Unit: 44151 Nash Park Port Lindamouth, AS 18299 Follow-up Information Follow up With Specialties Details Why Contact Info Dr Steven Simmons, MD Obstetrics and Schedule an appointment Recheck today 405 LINDSAY STREET Gynecology as soon as possible for a symptoms High Point NC 27262 visit in 2 days 378-740-3347 Events ED Arrival at 07-04-2018 2153 Unit: Emergency - Downtown Medical Center User: Logan Nichols Printed on 6/24/23 12:23 PM Page 1

What is Ordered Date?

{"text": [], "answer_start": []}

id_1711471328.294313

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 the Date of Evaluation?

{"text": [], "answer_start": []}

id_1711475620.478225

Cindy Taylor

Cindy Taylor DOB: 1985/27/04 (66 yo M) Acc No. 52602 2021/28/07 LAHS-SLIDELL Matthew Laudun, D.C. 56634 BOSWORTH ST SLIDELL, LA 70458-8625 Chiropractor Patient: Cindy Taylor 2021/28/07 DOB: 1985/27/04, Sex: Male Address: 208 N SILVER MAPLE DR, SLIDELL, LA 70458-5483 Phone: Ordered Date: 2020/09/02 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: 2016/22/07 Notes: Patient Name: Cindy Taylor , DOB: 1985/27/04 file:///C:/Users/ashton/AppData/Local/Temp/eCW.5fkglis2.pj3/2505b897-f088-472d-86b2-f13e1546a59b.html 1/1 Cindy Taylor DOB: 1985/27/04 (66 yo M) Acc No. 52602 Page 31 of 47

What is the Date of Evaluation?

{"text": [], "answer_start": []}

id_1711476893.293612

Ian Sutton

11 Sep 2019 9:22 29 AM NorthBay Health System 707-646-5000 Page 3 of 3 1101 B Gale Wilson Blvd. State 100 Faufield. CA 91533 071646-4646 Magnerl Pesonanco Exam Date/Time: Exam: Accession Number: Ordering Physician: 16 Dec 2018 09:26:31 MR MRI Lumbar Spine MR-12-0002095 Kitchens, Charles. M.D. w/o Contrast causing significant encroachment upon the central spinal canal or neural foramina. IMPRESSION: 1. Large central disc herniation with small inferiorly extruded disc fragment at L5-S1. There does not appear to be significant encroachment upon the central spinal canal or neural foramina. 2. Very small central disc herniation at L4-L5 without significant encroachment upon the central spinal canal or neural foramina. DT: 6/21/2012 (1226 hours) Final Report Dictated by: Gonser. William N.. M.D. Signed by: Gonser. William N., M.D. Transcriptionist: McGraw. Tena 06/21/2012 12:01 Parent NameIan Sutton Medical Record No 6051651 Financial No 8010198 DOB 23 Apr 1984 Age 26 years Gender Male PI Diagnostic Imaging Type Outpatient Admit Date 12 May 2022 Ordering Physician Kitchens Charles MD Solano Imaging Medical Associates Evelyn Lopez. MD Cindy Ibarra. MD William N Gonser. MD Properto 25 2012 Page 2 of 51 251

What is the Date of Discharge?

{"text": [], "answer_start": []}

id_1711475955.518978

Catherine Vega

2020/03/01 02:58 PM TO:16103548946 FROM: 8333674968 Page: 59 CITRUS 2020/11/04 okpie CARDIOLOGY Consultants, P.A. CARDIAC: CLEARANCE DATE: 2022/12/12 OFFICE PHONE NUMBER: 352-726-8353 PATIENT: Catherine Vega ADDRESS: 1138 Cr 457 LAKE PANASOFFKEE FL 33538 ACCOUNT: 6669354 RE: Surgical Procedure endoscopic cervicas & Lumbar rugery To Whom It May Concern: THESE ARE SUGGESTED RECOMMENDATIONS This letter is to certify that the above-named patient has been under my care for AFIB, nonischemic cardiomyopany HTN Take usual cardiac medications the morning of the procedure. YES NO (Circle One) Additional Notes: BIRI Class I- 391.30.day risk for compensive cardiovascular conplication METSZ4.0 If you have any further questions, please do not hesitate to contact my office. Sincerely, K.Dynond, APRN Physician Signature Physician Name Nishant DONAND Nerella MD Catherine Vega M 24 DOS: 2021/18/09 DOB: 2003/12/08 Citrus Cardiology Consultants, P.A. Acct: C11920 PrimProv: Prada, Stefan, MD

What is the Date of Discharge?

{"text": [], "answer_start": []}

id_1711471328.339078

Andrew Daniel

Hometown Medical Center 260 East Washington Ave Jonesboro, AR 76001 870-960-4100 Patient: Andrew Daniel Room #: Age/Sex: 40 F Med Rec #: SM94454595947 BIRTH DATE: 18 February 2015 Account #: SV94454595947 Attending Doctor: Dr Brandon Morris MD Hospital Service: Ordering Doctor: Daniel Smith MD admission date: 06 December 2016 Primary Care Provider: Patient Status: REG CLI Primary Insurance: BLUE ADVANTAGE IMAGING SERVICES STATUS: Signed Report #: 0460-0181 6700459.001 ECG/Electrocardiogram exam date: 28 January 2017 Test Reason : Blood Pressure : / mmHG Vent. Rate : 60 BPM Atrial Rate : 60 BPM P-R Int : 160 ms QRS Dur : 60 ms QT Int : 606 ms P-R-T Axes : 42 60 15 degrees QTc Int : 460 ms Disease: Pneumonia Cannot rule out Anterior infarct , age undetermined Nonspecific T wave abnormality Abnormal ECG No previous ECGs available electronically signed by Amanda Smith (1032) on 05 February 20191:01:38 PM Referred By: Amanda Smith Confirmed By: Amanda Smith electronically signed by: Matthew Juarez, MD Carotid Ultrasound Page 1 of 60 PARHAM-0607 000060

What is Date of Injury or DOI?

{"text": [], "answer_start": []}

id_1711477275.792708

Tiffany Torres

Report #: 1008-0022 Signed CHRISTUS SPOHN HEALTH SYSTEM - CORPUS CHRISTI - SOUTH Operative Report PATIENT NAME: Russell Bradford DATE OF BIRTH: 12/84/05 MEDICAL RECORD NUMBER MV00422822 ACCOUNT NUMBER AV0022605022 LOCATION: AV.MS3A ADMIT DATE: 23/19/09 DISCHARGE DATE: 23/19/10 ATTENDING PHYSICIAN: ASMIK ASATRIAN MD PROCEDURE DATE: 21/16/02 PREOPERATIVE DIAGNOSES: Deep and superficial reactive seroma, status post incision and drainage of reactive seroma and application of wound VAC ANESTHESIA: General ESTIMATED BLOOD LOSS: 30 mL cc: Patient Status: DIS IN M.R.#: MV00480850 Patient: TREJO,ELMA MUNOZ Account #: AV0001605094 Attending Dr.: ASMIK ASATRIAN, MD Admit/Service date: 10/23/10 Discharge date: 23/19/10 DOB: 12/84/05 Loc/Room #: AV.MS3A/AV.302-1 Medical Records' copy Medical Records Primary Care Dr.: LILJEBI Page 1 of 22 76722-3 South Texas Bone & Joint - 00322

what is the visit date or date of visit?

{"text": [], "answer_start": []}

id_1711477183.558557

Jesse Welch

Amanda Fisher DOB: 1999 June 03 (62 yo M) Acc No. 19280 DOS: 2014 September 27 areas of pain in addition to treatment plan detailed below. All patient questions were invited and answered. DIAGNOSTICS AND RECORDS REVIEWED: Imaging/Testing: Available imaging and reports (documented above), were reviewed and discussed with patient. CHIRO/PT AND HOME EXERCISE COUNSELING: The importance of a doctor-directed pain management therapy program including education, manual therapies, passive modalities, activity modification, exercise, and home exercise plan (HEP) training was discussed with the patient. MEDICATION COUNSELING: Risks, benefits, and alternatives of medications were thoroughly discussed with patient. Follow Up 80 weeks after procedure for re-evaluation BOARD CERTIFIED ORTHOPEDIC SURGEON Electronically signed by ALEXANDER ABOKA on 2015 August 17 at 01:41 PM EDT Sign off status: Completed Provider: ALEXANDER M ABOKA, MD Date: 2014 August 04 Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)

What is the Date of Exam or Examination date?

{"text": [], "answer_start": []}

id_1711477275.607465

Wendy Schneider

CHRISTUS Spohn Hosp South 5950 Saratoga Blvd. Corpus Christi, TX 78414 ADMISSION/SERVICE DATE TIME DISCHARGE DATE TIME ACCOUNT NUMBER Jan 19, 2019 1514 AV0001606094 CHRISTUS Spohn Hosp South 5950 Saratoga Blvd. Corpus Christi, TX 78414 PATIENT NAMBAD DRESS UNIT NUMBER ROOMIESD & ADMIT COURCH LOCIGNO ACCOMMIDDATION STATUS TREJO, ELMA MUNOZ CONFIDENTIAL REG ER 1 NON HLTH F 601 HUGHES AVE MV00480850 AV.ED DOB: Nov 27, 1987 MARTLSTAT LANGUAGE ADMIT PRIORT CLASS ADMIT CLERK PALICE, TX 78332-6580 D AGE: 69 SPOKEN N M BNG ER MM Alternate Address? SEX: F RACE WH RELIGION: CA WRITTEN ENG SSN: Other Name: ETHN: HISPANIC OR LATINO ORIGIN Other Hisp,La PATIENT EMPLOYER NEXT OFKIN ADDRESS ERSON TO NOTIEY ADDRESS RETIRED TREJOJJACOB TREJO MICHAEL RELATIONSHIP: SON RELATIONSHIP: SON OCCUPATION: RE 76729-3 South Texas Bone & Joint - 00346

What is signature date or signed on date?

{"text": [], "answer_start": []}

id_1711473365.798756

Brittany Rice

Consult 573 mg with meals Epogen 10,730 units/mL injectable solution 10,730 units Subcutaneous Dialysis Histories Past Medical History: Past Medical History HTN Hypertension Atrial fibrillation Hemodialysis Past Surgical History: Procedure List: 2023 Nov 15 Ankle Open Reduction Internal Fixation Family History: No qualifying data available. , Family history review on 2019 Apr 17. History of Present Illness Patient is a 67 yo female, traveling to Orlando from Ohio, with h/o ESRD on HD TTS via AVF, with h/o DM, CAD s/p CABG, who presented to AHC Er after slip and fall getting out of shower and had c/o ankle pain. Review of Systems Constitutional: Negative except as documented in history of present illness. patient name: Brittany Rice MRN: 77326735 Printed On: 10/30/2023 05:11 EDT Page 58 of 516

What is Collection Date?

{"text": [], "answer_start": []}

id_1711475955.481348

Michael Bishop

2015-07-23 02:58 PM TO: 16103548946 8333674968 Page: 60 account No: 118562 CITRUS Michael Bishop CARDIOLOGY 80 Y old Male, DOB: 1997-01-13 Consultants, P.A. Account Number: 2691227 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 2015-07-21 Progress Notes KACI DYMOND Current Medications Reason for Appointment Taking 1. 6 Month F/U Propranolol HQ ER60 MG Capsule Extended Michael Bishop M 80 Release 24 Hour 1 capsule Orally Once a day 2. Pt denies any new cardiac concerns DOS : 2022-11-19 DOB: 1997-01-13 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: 2015-07-23 page 1/3 [-ufg2.4.1.12in]

what is the visit date or date of visit?

{"text": [], "answer_start": []}

id_1711471329.334927

Gregory Kennedy

45532615476 22:36:38 a.m. 04-13-202 3/3 Hilltop Healthcare 01/01/23 798 Julie Crescent Apt. 674 Gregoryville, TX 72348 Page 3 114-333-6244 Fax: 939-892-4753 Office Visit Gregory Kennedy Work: (870) 972-8931 Female DATE OF BIRTH: 11/02/04 187761 Ins: Blue Advantage Grp: 45532615476 : ASSESSMENT: Right trimalleolar ankle fracture. PLAN: The risks versus benefits of operative versus non-operative treatment were discussed with the patient and her husband, They agree to proceed with surgery. ABB/bcc 0829 Electronically Signed by Dr Katie Thompson MD on 13/04/16 at 1220 PARHAM-0127 000039

What is the Procedure Date?

{"text": [], "answer_start": []}

id_1711473531.045339

Jonathan Butler

From: Stephanie Gonzales Fax: 19344634834 To: Fax: (434) 348-5345 Page: 7 of 20 03/15/2022 8:55 PM Dr David Davis, M.D. Adjunct Assistant Professor, Pain Management (934) 341-2340 Fax (834) 934-9345 DATE OF REPORT: 2019-05-11 Patient name: Jonathan Butler date of birth: 1993-12-11 SS# 534-25-0343 EMPLOYER: Superstores Industries CLAIM # SIF11434634 DOI: 2017-03-04 Department of Industrial Relations/Subsequent Injury Benefits Trust Fund, 1750 Howe Ave, Ste 370, Sacramento, CA 95825-3367 (916) 928-4601 Fax: (916) 928-4705 SUBSEQUENT INJURY BENEFITS TRUST FUND SUPPLEMENTAL REPORT Mr. Foster's attorney requested that I prepare a report discussing additional medical records (see his 2/28/22 letter). Emanuel Medical 1021 pages

What is Ordered Date?

{"text": [], "answer_start": []}

id_1711475620.748101

Ashley Jackson

Ashley Jackson DOB: 21/01/1988 (80 yo M) Acc No. 86769 Doc Name: 24/07/2018 Financial Disclosure Disclosure of Financial Interest Form LA HEALTH SOLUTIONS, LLC and LYLE J. SCHWEEN, BS DC DISCLOSURE OF FINANCIAL INTEREST as required by R.S. 37:1744 and LAC 46:XXVII.911, et seq Date: 16/12/2014 Patient Name: Ashley Jackson Louisiana law requires LA HEALTH SOLUTIONS, LLC and LYLE J. SCHWEEN, BS DC, and other health care providers to make certain disclosures to a patient when they refer a patient to another health care provider or facility in which the health care provider has a significant financial interest. One of the health care providers listed above may refer you, or the named patient for whom you are legal representative, to: PATIENT ACKNOWLEDGEMENT I, the above-named patient, or legal representative of such patient, hereby acknowledge receipt, on the date indicated and prior to the described referral, of a copy of the foregoing Disclosure of Financial Interest. (Signature of Patient or Patient's Representative) Print Name: Justin Ganloald Date: 12/09/2017 Ashley Jackson DOB: 21/01/1988 (80 yo M) Acc No. 86769 Doc Name: 24/07/2018 Financial Disclosure Page 103 of 134

What is the Date of Exam or Examination date?

{"text": [], "answer_start": []}

id_1711476766.370356

Matthew Ramsey

Bethesda Pathology Report Bethesda Hospital East Pathology Name: Michael Park Specimen #: SE-5803-50 Age: 45 Y Medical Record 150786850 # : DOB: September 13, 2000 Patient # : 2525037750 Sex: F Specimen February 08, 2023 Received: Locat AMBULATORY CARE Report Date: May 04, 2022 ion: Procedure March 31, 2015 Signed KENNETH Date: Out By: BENGTSON, M.D. Physician (s) : Scott May, 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 February 08, 2023 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. January 21, 2022 at 13:12 **End of Report

What is the Date of Discharge?

{"text": [], "answer_start": []}

id_1711475741.538675

Virginia Zimmerman

Virginia Zimmerman DOB: 06 September 1991 (60 yo M) Acc No. CR421526 [Doc Name: 19 November 2019 MRI CERVICAL SPINE] CR172462 Virginia Zimmerman (MRN5286127) UF Health Radiology JP UF HEALTH JTB KERNAN Imaging Result Report Patient: Virginia Zimmerman MRN #: 5286127 DOB: 06 September 1991 Ord #: 618102455 Sex: Male Acc #: J11881056 Att Prov: Auth Prov: Roberts, Christopher 10475 CENTURIAN PKWY NORTH SUITE 201 JACKSONVILLE FL 32256 Final Report MRI C Spine w/o Con Exam Date & Time: 24 December 2019 12:12 PM Reason For Exam: None Specified Ordering Diagnosis: Cervical radiculopathy Mri of the cervical spine without contrast HISTORY: 52 years Male Cervical radiculopathy COMPARISON: None Technique: Multiplanar multi-sequence MR images were obtained of the cervical spine without contrast material. Findings: There is a small Schmori's node at the superior endplate of C7 otherwise the vertebral body heights are maintained. C4-C5: There is mild broad-based disc bulging causing mild impression on the ventral spinal 24 December 2019 4:19 PM Page 1 of 2 Virginia Zimmerman DOB: 06 September 1991 (60 yo M) Acc No. CR421526 Page 72 of 166

what is the DOB or date of birth?

{"text": ["06 September 1991"], "answer_start": [29]}

id_1711473237.959908

Justin Jacobs

10/24/2023 1:29:08 PM -0400 FAXCOM PAGE 85 OF 133 Name: Justin Jacobs ID: 980534078 date of birth: 17/06/2000 ZEISS Examination date: 19/05/2023 n: 1.3535 Axial length values OD o o os right left Phakic Phakic Comp. AL: 22.46 mm (SNR = 117.4) Comp. AL: 22.42 mm (SNR = 253.0) AL SNR AL SNR AL SNR AL SNR 22.47 mm 2.1 22.45 mm 3.5 22.48 mm 7.6 22.43 mm 4.9 22.47 mm 2.7 22.39 mm 2.6 Carl Zeiss IOLMaster庐 Advanced Technology V. 7.7 02/20/2078 Calibration checked on: 02/16/2018

what is the admit date or admission date?

{"text": [], "answer_start": []}

id_1711476990.29649

Benjamin Johnson

University of Oklahoma 11-02-2024 826 NE 15th Street Suite 205 Oklahoma City, OK 73126 Page 26 4262714267 Fax: 4262711326 Radiology Reports Terri Bautista Male DOB: 28-10-1986 2708026 Ins: BLUE CRO (22) Grp: 116426 compression fracture. 3. Stable subcutaneous nodule in the lateral right knee (SUV 5.6). 4. Edematous changes of the left lower extremity, compatible with the known DVT. New soft tissue nodules and stranding in the subcutaneous adipose tissues of the right flank and left lower abdomen are suspected to reflect injection granulomata. Electronically Signed by 131 DALE M. BRANNON MD on 13-01-2022 at 1445 (1) Order result status: Final Collection or observation date-time: 29-05-2019 14:06 Requested date-time: 13-01-2022 10:58 Receipt date-time: Reported date-time: Referring Physician: Jessica Luetkemeyer Ordering Physician: (AASCH) Specimen Source: Source: HCA RAD Filler Order Number: - PET/CT TUM SKUL BS Electronically Signed by Jessica Lee Luetkemeyer PA-C on 08-06-2020 at 12:10 PM

What is the Date of Consultation?

{"text": [], "answer_start": []}

id_1711471330.788731

Nicole Taylor

Patient name: Nicole Taylor PI 11.06.21, Latoya, D.O.B: 1989 Aug 23 Account No: 70174 Consultation Notes for Nicole Taylor PI 11.06.21 on 2022 Feb 01 Current Medications Reason for Appointment None 1. Back Pain Active Problem List Assessments Problem List has not been verified 1. Radiculopathy, lumbar region - M54.16 (Primary), bilateral. Acute Past Medical History since slip and fall on 11/6/21. MRI with disc protrusion with resultant Medical History Verified. severe left L4/5 stenosis. Chiropractic helps short term. Onset: sudden since slip and fall on water while no blurring of vision. Psychology: walking in a convenience store. She went to ER at S and W hospital. Severity: 10/10, Aggravated by: sitting, standing ideation. no anxiety. no physical abuse. bending, Relieved by: none, Nature: sharp, Associated Symptoms: no mental abuse. no numbness, weakness. He (she) denies any previous low back pain. Chiropractic helps some for short period.

what is the visit date or date of visit?

{"text": [], "answer_start": []}

id_1711473365.663132

April Perez

<<Back to Review>>182998-29-HYPERLINK- Hyperlink-Page 2 FEED 03/22/2018 09:43 AM Work Wellness 1291 Colorado Ave Ste 129. Turlock CA 92982 Page 1 of 1 (229) 229-3293 Fax: (299)296-3290 Test Form Test Form PATIENT NAME: April Perez BIRTHDATE: 1992/07/07 Age: 20 Years Home Phone: (229) 299-3292 Sex: M SSN: 529-29-0293 Order Number: 212970-4 Quantity: 1 Start Date: 2022/30/04 Priority: Normal ELECTRONICALLY SIGNED BY: Carrie Janiski Signed on: 2020/18/04 9:32:08AM Instructions: WITH STRESS VIEW(S) thank you Report run by Carrie Janiski DO 002902 0292

What is Date of Injury or DOI?

{"text": [], "answer_start": []}

id_1711475190.423411

Frank Chang

N NOVANT Novant Health Orthopedics & Frank Chang Sports Medicine MRN: 52224227, Date of Birth: 17/04/87, Sex: M HEALTH 7220 Village Medical Cir Visiting Date: 07/10/23 Ste 110 CLEMMONS NC 27222-8229 09/08/21 - Office Visit in Novant Health Orthopedics & Sports Medicine (Clemmons) (continued) Clinical Notes Amb (continued) Patient: Frank Chang MRN: 52224227 Date of Birth: 17/04/87 DATE OF SERVICE: 03/12/15 Referring Physcian: Frunza, Ana A, MD Primary Physcian: Dr Joan Allen, MD SUBJECTIVE: Jeffrey Craig Payne is a 76 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 Date of Encounter or Enc?

{"text": [], "answer_start": []}

id_1711471330.42935

Mary Patel

Countryside Regional PATIENT: Mary Patel EXAM NUMBER: BR64646 birthdate: 2003/12/12 date of exam: 2015/13/03 REF PHYSICIAN: Dr Eric Gonzalez LEFT BREAST ULTRASOUND DIAGNOSIS: Arrhythmia. COMPARISON: None. TECHNIQUE: Grayscale images of the left breast are obtained. FINDINGS: The area of concern is from the 7 to 11 o'clock position. IMPRESSION 1. This does not exclude soft tissue bruising. 2. BI-RADS Category 1, negative. Thank you for referring this patient. Dr Teresa Cooper Dr Teresa Cooper , M.D. Diplomat of the American Board of Radiology Radiologist MMP/am 12/18/2014

what is the DOS or D.O.S?

{"text": [], "answer_start": []}

id_1711476767.615915

Mark Saunders

26/20/04 08:30 1 12 >> unknown P 3/29 Assessment (1) Myofascial pain 729.1/M79.1 (2) Cervical myofascial strain, subsequent encounter Strain of muscle, fascia and tendon at neck level, subsequent encounter V58.89/516.1XXD Plan Orders Lidocaine 10mg (J2001) - 729.1/M79.1, - 847.0/S16.1XXD - 10/23/2023 - Hold lab results until reviewed :No Ultrasound guidance for needle placement (76942) - - 10/23/2023 - Hold lab results until reviewed :No Tendon origin/insertion injection (20551) - 729.1/M79.1, 847.0/S16.1XXD - 10/23/2023 - Hold lab results until reviewed :No Trigger point(s), 3 or more muscles (20553) - 729.1/M79.1, 847.0/516.1XXD - 10/23/2023 - Hold lab results until reviewed :No Instructions Please refer to discharge sheet. The supervising physician is on site to provide direct personal supervision involing the patient's care during their office visit today. This document is prepared by automatic population of appropriate fields, typed and or formatted entry. The reader is encouraged to contact me directly with any issue or questions. Electronically Signed by: David Brooks, PA -Author on 21/18/04 02:16:58 PM [Digital Signature Validated]

what is the DOS or D.O.S?

{"text": [], "answer_start": []}

id_1711471329.226094

Jeremy Williams

651 Cook Roads Lake Steven, VT 18576 Jeremy Williams (id #922514, dob: 2000 Nov 06) DATE OF ENCOUNTER: 2014 May 28 Patient PATIENT Jeremy Williams (88yo, F) ID# 922512 Appt. Date/Time 2016 Mar 15 11:00AM dob 2000 Nov 06 Service Dept. MGPC_Grove City Broadway - Provider MOIRA SKURATOWICZ, APRN Insurance Med Primary: AETNA Insurance # : W218225600 Policy/Group # : 010959913038392 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 133-890-3913, Fax 364-157-6118 Vitals 2016 Mar 15 03:12 pm Ht: 5 ft 4 in Measurements None recorded. Allergies Reviewed Allergies Ibuprofen: Hives (Moderate) DIPHENHYDRAMINE HCL: - COMMENT: CAUSATIVE AGENT: BENADRYL; YEAST: - REACTION: HIVES, RASH; Medications

What is the Date of Consultation?

{"text": [], "answer_start": []}

id_1711472591.002444

Suzanne Massey

Gulf Coast SURGICAL CENTER, LLC 402 Dunn Street Houma, LA 76560 (985) 865-1651 Fax (965) 865-6658 Tax ID: 20-3335700 NPI #: 122895236 B/C#: 1283779618614Z Insurance Verification Form Pt. Name: Suzanne Massey DATE OF BIRTH: 1988 February 18 MR# 48465-3 BCBS OF LA HMO Insurance Company: Phone Number: 1-252-476-6432 Insured Name: SELF Relationship to Patient: Policy Number: IHQ828377961861 Group Number: Effective Date: 2023 April 20 Policy paid thru: ACTIVE DATE OF PROCEDURE: 2015 May 02 Pre-cert company name: Claims Address: BCBS OF LA Does policy follow MNRP/MRC2? yes or no PO BOX 96529 Do benefits co-incide? yes or no BATON ROUGE, LA 70658 Rep. Name: ONLINE 1 Austin

What is the Date of Discharge?

{"text": [], "answer_start": []}

id_1711471329.197009

Hunter Casey

2020 July 31 12:48 PM TO:81484854174 FROM:9581382426 Page: 4 DocuSign Envelope ID: CD6AFC77-CF28-44AE-AA73-C1B65435D293 PATIENT AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION TO: CBTRactics 2559 263 Rd, Glen Oaks, NY 11004 I hereby authorize the above name facility, any parent company, and any other health plan, physician, health care professional, hospital, clinic, laboratory, pharmacy, medical facility, or any other health care provider that has provided payment, treatment or services to me or on my behalf to release all medical information to: Veritas Attorneys at Law 000 Fisher Shoal Suite 809 Gonzalezton, VA 24108 For the use in the pending: DISABILITY INCOME CLAIM This document authorizes the release of all medical information including Immunodeficiency disorders (HIV/AIDS), substance abuse and treatment, mental health/psychiatric treatment, radiology films, pathology materials: PATIENT: Hunter Casey ADDRESS: 6368 Dana Drive Jonathanhaven, NH 39397 1999 February 08 date of birth: Social Security Number: 116348332 The treatment dates to be released: (check one) From 2020 July 31 to first All records retained by the facility I understand that I have the right to revoke this authorization at any time. I understand that in order to revoke this authorization, I must do so in writing and present my written revocation to: Veritas Attorneys at Law 000 Fisher Shoal Suite 809 Gonzalezton, VA 24108 1

What is the Date of Evaluation?

{"text": [], "answer_start": []}

id_1711472787.180874

Samantha Sawyer

Northwell Health Physician Partners Name: Samantha Sawyer visiting date: 2014-08-15 Address: 2403 COOPER DRIVE MRN: 20827973 EAST MEADOW, NY 11404 birthdate: 1985-07-30 Reason For Visit Samantha Sawyer is being seen for a follow-up visit for chest pain. History of Present Illness had pneumothorax earlier this year after being stabbed by her husband, chest tube, hospitalized X 10 days Active Problems Adjustment disorder with mixed anxiety and depressed mood (340.28) (F40.23) Current Meds Cyclobenzaprine HCI - 5 MG Oral Tablet; TAKE 1 TABLET 3 times daily Allergies No Known Allergies Review of Systems Respiratory: cough. 600 Community Drive " Manhasset, NY, 11001, Tel (406) 495-4093 Fax (540) 405-5403

What is the Date of Discharge?

{"text": [], "answer_start": []}

id_1711473237.34203

Kathy Hardin

THU 43 FAX MRN: 1985850H Kathy Hardin Nassau Unly. Medical Gender: Female Center Age: 84y (2003/18/07) Current Location: ICC1-2711-JJ Faculty Statement: Attestation Attending and Resident/Fellow/Physician's Assistant Electronic Signatures: Dr Jessica Fox (Physician) (Signed 2021/30/10 11:2) Authored: Faculty Statement Co-Signer: Date of Procedure, Pre-Op and Post-Op Diagnosis, Specimens, Brief Operative Note, Procedure Details Dr Gabriela Livingston (Resident Physician) (Signed 2019/28/08 11:2) Authored: Date of Procedure, Pre-Op and Post-Op Diagnosis, Specimens, Brief Operative Note, Procedure Details Requested by: Philburn, Jacqueline (Med Rec Clerk), 2019/30/06 12:25 Page 2 of 2

What is signature date or signed on date?

{"text": ["2021/30/10"], "answer_start": [306]}

id_1711476990.756089

Brianna Williams

10 Apr 2019 12:10 PM FROM: Fax PULMONARY AND SLEEP SPECIALISTS OF TAMPA BAY, PA PAGE: 017 OF 119 Dec 2021 Patient: Wendy Riggs DOB: 18 Aug 1995 CT Chest PE W Contrast Wendy Riggs - 479619 Dec 2021 * Final Report * Result Type: CT Chest PE W Contrast Date: March 05, 2019 19:00 EST Result Status: Auth (Verified) Result Title: CT Chest PE W Contrast Performed By: LUXENBERG MD, NINA LYNN on March 05, 2019 19:15 US/Eastern Verified By: LUXENBERG MD, NINA LYNN on March 05, 2019 19:15 US/Eastern Encounter info: 7864859, TAM, Observation, 03/05/2019 - 03/06/2019 * Final Report * Reason For Exam sob, positive d dimer REPORT Exam: CTA chest. Date of Exam: 20 Sep 2015 6:50 PM Indication: SOB, POSITIVE D DIMER. Comparison: X-ray 10 Apr 2019 Technique: IV bolus CTA chest was performed following the administration of intravenous contrast 100 mL of Isovue 370. Chest was imaged with spiral technique followed by postprocessing with sagittal and coronal 3D/MIPS. There was adequate opacification of the pulmonary arterial system. Radiometrics dose report: Up-to-date CT equipment and radiation dose reduction techniques were employed. CTDIvol: 18.7 mGy. DLP: 610 mGy-cm. Findings: No intraluminal filling defects are seen in the visualized opacified pulmonary vasculature to suggest acute pulmonary thromboembolism The main pulmonary artery is not dilated. Thoracic aorta is nonaneurysmal and there is no evidence of dissection. No pericardial effusion or thickening. Heart is not enlarged. No pneumothorax. Printed by: ROMERO, LEA M Page 1 of2 Printed on: 19 Dec 2021 14:17 EDT Document: 19 Dec 2021 Page 16 of 147

What is Ordered Date?

{"text": [], "answer_start": []}

id_1711471328.849253

Robert Peterson

patient Robert Peterson Gender Female MR # 0001143894 admitting date/Time 22-10-30 7:11:00 AM Reg # 096291118385 Visit Status DSC D.O.B 91-06-24 12:00:00 AM DISCHARGE DATE/Time 22-11-29 9:31:00 PM 1. Adult Plan of Care 14-09-26 2:10 Entered By Individualization (Mutuality/Preferences) Individualization/Preferences / pt pt goes by "Cierra"; lives at home with her grandparents SEB goes by "Cierra"; lives at home with her grandparents Comments : CLINICAL PRACTICE GUIDELINES Precaution Precaution SEB coping,genitourinary,peripheral/neurovascular,reproductiv e,safety,skin Comments : Nursing Goal #1 Related To Nursing Cellulitis SEB Diagnosis/CPG Comments : Nursing Goal #1 Goal pt will be able to maintain temperature WNL < 100.4 SEB degrees F during hospitalization Comments : Nursing Goal #1 Goal Established 01/10/2023 SEB (mm-dd-yyyy) Comments : Nursing Goal #1 Time Frame By Discharge SEB Comments : 14-09-26 1:03:00 PM Page 72 of 12 SVI 0885

what is the service date or date of service?

{"text": [], "answer_start": []}

id_1711476578.223854

Darren Smith

athena Oct 07, 2022 2:50:31 pm EDT :1b38234-d76e-4d00-bbb4-176b27d36417 Page: 50/50 OTOLARYNGOLOGY CONSULTANTS Hagen Ranch Rd, BOYNTON BEACH FL 33450 OWENS, Shannon (id #131224, dob: 11/17/1976) OTOLARYNGOLOGY CONSULTANTS, BOYNTON BEACH FL 33437-3776 OWENS, Shannon (id #131224, dob: 11/17/1976) University of Miami Nov 01, 2014 11:27:03 AM PAGE 2/050 Fax Server Rebecca Wilson (MRN21770502) University of Miami Health System Health Imaging Services at Plantation 8500 SW 10th ST PLANTATION, FL 33350 Final I maging Result Name: MRN DOB: Sex: Rebecca Wilson 21770252 Nov 03, 2002 Female Procedures Performed Exam Time: Patient Class: Diagnosis CT Sinus Facial Bones W/O Contrast 05/24/2022 7:50 AM Outpatient Chronic sinusitis, unspecified Final EXAMINATION: CT SINUS FACIAL BONES wo CONTRAST EXAM DATE AND TIME Apr 14, 2019 7:9 AM INDICATION: Chronic sinusitis. COMPARISON: None available TECHNIQUE CT imaging of the nasal cavity and paranasal sinuses with axial, sagittal and coronal reformats was obtained without contrast. FINDINGS: The frontal sinuses and frontal recesses are well-aerated The ethmoid air cells are well-aerated. IMPRESSION: Tue May 24, 20Exam Date 11:26 AM Page 1 of 50

What is the Date of Discharge?

{"text": [], "answer_start": []}

id_1711475190.542835

Steve Coleman

Steve Coleman MRN: 5772773 Preferred Pharmacy (continued) Referral (continued) Order MRI ARTH SHOULDER W/ CONTRAST RIGHT [676335615] Electronically Signed by: Dennis S Frerichs, PA-C on 2022-19-12 0779 Status: Completed This order may be acted on in another encounter. Ordering user: Dennis S Frerichs, PA-C 02/22/23 0949 Authorized by: Dennis S Frerichs, PA-C Ordered during: Office Visit on 2016-21-04 Screening Form General Information Patient: Steve Coleman MRN: 5772773 birthdate: 2003-13-10 Mobile: 577-977-4779 Sex Assigned at Birth: Male MC ROCKWOOD MAIN CLINIC Steve Coleman - SPOKANE MRN: 5602313, birthdate: 2003-13-10, Sex: M 400 East 5th Ave Visiting Date: 2022-16-12 Spokane WA 99202-1334 Page 89 Printed by 414221 at 7/17/23 9:40 AM

what is the visit date or date of visit?

{"text": ["2022-16-12"], "answer_start": [716]}

id_1711475741.605509

Charles Harmon

Neurological, Orthopedic & Spine Center 2018/25/06 Informed Consent Date: PatientName: Charles Harmon Telephone Number 111-111-1111 Saldyem Berti I Authorize Dr.(s) ("Physician"), and such assistants as may be selected by him to perform the proposed surgery and /or procedure of L4-5 interbody Iven c 44-5 bilut pedicle screws And any other needed procedure If any unforeseen conditions arise during the course of the procedure, I authorize and request the Physician and his assistant to perform such additional procedures as they deem advisable, which may be in addition to or different from those now planned. This form did not imply a iscussion of payment or obligation to proceed with procedure. Emergency Contact: Patient/Legal Guardia signature nd Printed Na he New 2024/24/01 Physicians Signature and printed Name Date Corner 2024/24/01 Witness Signature and printed Name Date 5040 NW 40 ST #530 MIAMI FL 33126. PH: 305-461-3116 F-954-765-3206 817 S University Drive Suite 105 PLANTATION FL 33324 PH: 954-279-3170 FX: 954-440-3115 13526 Village Drive Park Suite 220 Orlando FI 32837 PH: 407-794-1465 FX: 954-440-3115

what is the DOS or D.O.S?

{"text": [], "answer_start": []}

id_1711476578.312291

John Miller

UNIVERSITY OF MIAMI UMHC Owens, Shannon HEALTH HOSPITAL AND CLINICS 1475 NW 12th Avenue Suite MRN: 49770249, DOB: 09-11-1998, Sex: F 3049 Enc. Date: 13-02-2024 Miami FL 49136-1049 05/05/2023 - Office Visit in UHealth at UMHC Sylvester Spine Institute (continued) Clinical Notes (continued) Miami, FL 33136 Fax: 305-249-6495 Electronically signed by Dr Thomas Knight MD, MD at 15-12-2021 12:51 PM Eismont, Frank J., MD at 5/5/2023 1530 Author: Eismont, Frank J., MD Service: - Author Type: Physician Filed: 5/5/2023 5:43 PM Encounter Date: 13-02-2024 Creation Time: 5/5/2023 4:40 PM Status: Signed Editor: Dr Thomas Knight MD, MD (Physician) Electronically signed by Dr Thomas Knight MD, MD at 5:43 PM USER, SCANNING at 5/9/2023 0301 Author: USER, SCANNING Service: Author Type: Resource Filed 5/8/2023 11:01 PM Encounter Date: 13-02-2024 Creation Time 25-03-2023 11:01 PM Status: Signed Editor: Onbase, Scanning Generated on 25-03-2023 4:18 PM Page 49

what is the service date or date of service?

{"text": [], "answer_start": []}

id_1711477090.812417

Brittany Mendoza

06-02-2022 19:59:15 EDT To: 195222268622 Page: 03/622 From: Lauris Rigdon Patient Self-Report Patient Assessment/Diagnosis History of Present Condition: Patient presents with acute LBP and right hip pain that presents with acute low back and right hip pain following started on May 20th following elevator accident. Functional accident that occurred on May 20th. Pt explains that she was battling with established with patient input. allow patient to return to prior level of function, independence and safety. Onset Date: May 20th Comorbidities: - Psychosocial: Battling with high anxiety, difficulty talking about accident - Car accident in with back pain and left shoulder (2007) e Currently experiencing excessive vaginal bleeding (being monitored by OBGYN) Pre Morbid Level of Function: - Independent prior to injury Current Level of Function/Current Deficits: - Unable to get into/out of car without onset of pain - Unable to stand for prolong periods of time - Unable to walk her dog due to fear of worsening symptoms. Work tasks: Desk job at home, mostly on the computer Sleep disturbance: Reports no change in sleeping pattern Imaging: X-ray: no abnormal findings. CT scan of abdomen and pelvis: results pending Red flags: Pt denies all red flags including but not limited to weight loss/gain > 10 Patient John Peters (DOB: 11-28-1985) Treated by Jennifer Flores, PT. DPT DOS: 08-23-2018 Page 2 of 22 of Plan of Care

What is the Date of Consultation?

{"text": [], "answer_start": []}

id_1711472286.580065

Tracy Cochran

Tracy Cochran MRN: 5601713 04/04/2023 - External Document in MULTICARE HEALTH INFORMATION (continued) doi: Place of Injury: 10/06/2014 9:40 AM Medical Records use only - -(HAR ID) Hospital Account Not on file Visit Information Department Name Address Phone Fax MULTICARE HEALTH INFORMATION 419 South L Street MS: 419-2-CN 800-317-9919 253-417-4948 Tacoma WA 98175-3799 Call Information Provider Department Center 4/4/2023 9:03 AM HIM SCANNED DOCUMENT HEALTH INFORMATION MHS CALL CEN MULTICARE CALL CENTER Dufner, Raymond E 419 SOUTH L STREET MRN: 5601713 , BIRTH DATE: 09/09/1996, Sex: M TACOMA WA 98417-0299 Visiting Date: 02/06/2023 Page 54 Printed by 414221 at 7/17/23 9:40 AM

What is the Date of operation?

{"text": [], "answer_start": []}

id_1711472591.39856

Sarah Valenzuela

Salinas Valley Sarah Valenzuela Medical Clinic MRN: 3116369, date of birth: 29/00/06, Sex: F SUPUS BALLEY MEMORAL REALINONA extra visit: 27/21/03 02/21/05 office Visitin DOD.Salinas - Abbott Clinical Notes Progress Notes Schumann. Steven C. MD at 12/13/2021 0800 Author: Schumann, Steven C, MD Service: Urgent Care Author Type: Physician Filed: 12/13/2021 8:53 AM Encounter Date: 03/16/08 Status: Signed Editor: Schumann, Steven C, MD (Physician) service date: [SS.1T] 12/17/01 [SS.21 HPI: [SS.1T] Araceli Corona SS.2T] is [SS.1T] 89 y.o. female [SS.2T] [SS.1T] HISTORY: The following portions of the patient's chart were reviewed in this encounter and updated as appropriate: MEDICATIONS:Ss.1T] No Known Allergies Current Outpatient Medications: cyclobenzaprine (Flexeril) 5 MG tablet, Tak e 1 po hs for back pain. May increase ton 2 at bed time if needed and not groggy in the morning., Disp: 20 tablet, Rfl: 1 Printed on 12/14/21 4:04 AM Page 1 234

what is the DOS or D.O.S?

{"text": [], "answer_start": []}

id_1711472591.083521

David Hunt

Gulf Coast SURGICAL CENTER, LLC Conscious Sedation Educational Material and Informed Consent Form The facts in this form will help you learn more about the type of anesthesia your doctor has recommended for your procedure. Please read it carefully. Your Health Problem Your doctor has recommended that you have conscious sedation for pain control during your procedure. There are many types of anesthesia. Local anesthesia is like the numbing medicine the dentist may use. Minimal sedation involves different types of medicine to make you sleepy. Your nurse will ask you about any allergies before the procedure. First, an IV line will be started. A plastic strip will be placed on one of your fingers and joined to a pulse oximetry machine. The amount of medication is customized for each patient. David Hunt ID / Visit: 48610 1 Gender: F DOB: 04/94/07 Age: 85 Phys: Dr Mrs. Adriana Jackson DOS: 04/14/11 Page 1 of 3

what is the DOS or D.O.S?

{"text": ["04/14/11"], "answer_start": [943]}

id_1711475955.693618

Kelsey Mckay

Fax Server 2019-20-02 1:11:46 PM PAGE Fax Server Medications (Added, Continued or Stopped today) Start Date Medication Directions PRN PRN Reason Instruction Stop Date Status ParaGard T 380A N 380 square mm intrauterine device Nova Southeastern University 3200 S University Drive I Davie, FL 33328 Electronically signed by Fareeda Baksh Deen MD on 2021-28-09 04:38 PM Frauwirth Ariel 000000017461 10/03/1995 2021-28-09 10:00 AM 4/4

What is signature date or signed on date?

{"text": ["2021-28-09"], "answer_start": [383]}

id_1711471329.195854

Anthony Walters

2017 Apr 17 4:9 PM TO:41285008869 FROM:9420313426 Page: 4 DocuSign Envelope ID: CD6AFC77-CF28-44AE-AA73-C1B65435D293 PATIENT AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION TO: CBTRactics 2559 263 Rd, Glen Oaks, NY 11004 I hereby authorize the above name facility, any parent company, and any other health plan, physician, health care professional, hospital, clinic, laboratory, pharmacy, medical facility, or any other health care provider that has provided payment, treatment or services to me or on my behalf to release all medical information to: Aegis Law Partners USCGC Hardy FPO AA 91894 For the use in the pending: DISABILITY INCOME CLAIM This document authorizes the release of all medical information including Immunodeficiency disorders (HIV/AIDS), substance abuse and treatment, mental health/psychiatric treatment, radiology films, pathology materials: patient: Anthony Walters ADDRESS: 9843 Walker Well Apt. 204 Lake Matthew, MH 55914 1987 May 10 DOB: Social Security Number: 118639232 The treatment dates to be released: (check one) From 2017 Apr 17 to first All records retained by the facility I understand that I have the right to revoke this authorization at any time. I understand that in order to revoke this authorization, I must do so in writing and present my written revocation to: Aegis Law Partners USCGC Hardy FPO AA 91894 1

What is the Date of operation?

{"text": [], "answer_start": []}

id_1711475741.154737

Thomas Hoffman

Thomas Hoffman DOB: 28/11/89 (88 yo M) Acc No. CR528043 [Doc Name: Medical Records-Cora Health-29/05/19-323116] 14/07/23 a.m. 08-24-2022 6 CoraPhysicalTherapy Assessment Report CORA Physical Therapy - Regency | CORA 9527 Regency Square Blvd., Unit 105 proposed General Eval Jacksonville, FL 322258806 Name: Thomas Hoffman FOR WORK COMP ONLY SYS1294723 DOB: 28/11/89 Case Manager: Onset Date: 28/06/22 Surgery Date: Eval Date: 09/10/22 Occupation: Employer: Ref Provider: Amy Wu APRN Sex: M Medical Dx: M79672 - Pain in left foot, M7542 - Impingement syndrome of left Status: shoulder, M5126 n Other intervertebral disc displacement, lumbar region Last Day: Treatment Dx: Cur PDC: JobReq PDC: 97163 PHYSICAL THERAPY EVAL HIGH 1 Marivic Chang, PT, License # PT23745 Date: 03/09/18 Signature: marrier chang, PT, DPT I have reviewed this plan of treatment and certify a continuing need for services. Physician/NPP: Date: Amy Wu APRN Thank you for this referral and your continued support of CORA Health Services, Inc. Should you have any questions, please feel free to contact me at (904) 647-4263. Thomas Hoffman DOB: 28/11/89 (88 yo M) Acc No. CR528043 Page 113 of 166

What is signature date or signed on date?

{"text": ["03/09/18"], "answer_start": [846]}

id_1711475620.935698

Andrew Lee

DocuSign Envelope ID: 2EBB7621-EDFE-47BB- C6C3A2DDDA86 ASSOCIATES MD MEDICAL GROUP ASSOCIATESMD MEDICAL GROUP PATIENT CONSENT AND AUTHORIZATION Andrew Lee I, FURTHER ACKNOWLEDGE THAT IN THE EVENT ASSOCIATESMD MEDICAL GROUP IS FORCED TO RETAIN THE SERVICES OF A COLLECTION AGENCY AND/OR ATTORNEY; I WILL BE RESPONSIBLE FOR THE COLLECTION AND/OR LEGAL FEES. I HEREBY AUTHORIZE THE DOCTOR TO RELEASE MEDICAL INFORMATION TO MY INSURANCE COMPANY TO SECURE PAYMENT OF BENEFIT. I ALSO AUTHORIZE THE USE OF MY SIGNATURE ON ALL INSURANCE SUBMISSIONS AND AS AUTHORIZATION FOR PAYMENT TO BE SENT TO ASSOCIATESMD MEDICAL GROUP AT 4780 SW 64th Ave Davie, FL 33314. Consent to Contact. 1 hereby expressly consent to being contacted by mobile phone or mobile text messaging for the purpose of receiving Information or advice about my health care, about any services officered, changes in policies, procedures, or office hours, or any other purpose as determined by AssociatesMD Medical Group. Data messaging charges may apply. Receipt of Notice of Privacy Practices. Andrew Lee I, have received a copy of AssociatesMD Medical Group's Notice of Privacy Practices. The physicians and staff of AssociatesMD Medical Group have my permission to speak to the following family members/friends in reference to my medical care: Name: Andrew Lee Relationship to Patient Son Name: John Arthur Romney Relationship to Patient Best Friend Name: Nelson A oti Relationship to Patient Best friend The Physicians and staff at AssociatesMD Medical Group have my permission to leave a message on my answering machine. Yes No, and/or call at my place of work: Yes No DocuSigned by: Phile September 28, 2022 Signature of responsible party Date

what is the service date or date of service?

{"text": [], "answer_start": []}

id_1711471329.059077

Daniel Davis

04/2021/27 10:10AM No. 0020 P. 5 Page 12 of 13 Daniel Davis birthdate: 09/1996/02 (84 yo F) Acc No. 16520 DOS: 06/2017/09 Daniel Davis West End Clinic 84 Y old Female, birthdate: 09/1996/02 Account Number: 16520 of SayeBrook PSC 6887, Box 1733 APO AP 79457 Home: 761-355-2397 Guarantor: Daniel Davis Insurance: BCBS SC Payer ID: 57028 Appointment Facility: West End Clinic 04/2021/27 Progress Notes: Emily Cook, DO Reason for Appointment Current Medications 1. 2 mo follow up review labs Taking Loratadine as History of Present Illness directed Orally follow up: Xyzal Allergy 24HR 5 MG Tablet 1 HPLD - Started Crestor at last OV, tolerating well. Review Lipid tablet in the evening Orally Once a day, Notes: OTC panel, cpk total. EKG: 1/5/2022. Vitamin B-12 1000 MCG Tablet 1 Neck pain- Seen Dr. Alci, recommended neck fusion, tablet Orally Once a day, Notes: OTC Vitamin D 50 MCG (2000 UT) Tablet Progress Note: Emily Cook, DO 04/2021/27 05/2018/28

What is signature date or signed on date?

{"text": [], "answer_start": []}

id_1711473530.925749

Thomas Snyder

O onecallo care PHYSICAL THERAPY FAX / EMAIL Confidential - 8/7/2018 7:38:15 PM PATIENT REFERRAL FORM Referral Date: 19/12/2018 Claim Number: PZC45924534 Patient Data Name: Thomas Snyder Sex: Male DOB: 23/10/1994 INJURY DATE: 21/04/2023 Injury State: CA Injury: MULTIPLE PARTS Injury: Other, please see details. Body Part Side: Right Details: right ankle and joints ofright foot Injury Is Surgical: U Physician Info Physician: Jenny Wong Next MD Appt: 8/8/2018 ***DO NOT ISSUE DME/Home E-stim without prior authorization from One Call Physical Therapy* All DME requests must be pre-authorized. Please submit written MD orders to One Call Physical Therapy. (AG:12-EMBID-4553454: Page 3 of 1000196 0196

What is the Date of Evaluation?

{"text": [], "answer_start": []}

id_1711472591.026828

Justin Wallace

Gulf Coast Surgical Center LLC Justin Wallace DOS: 17/23/07 2:30:00 PM ID / Visit: 48730 / 1 PATIENT INFO: SEX: F DATE OF BIRTH: 11/02/01 AGE: 50 MAIN PHONE: 293-921-3835 ADDRESS: PSC 1024, Box 8102 APO AE 71686 RESPONSIBLE PARTY: BUGGAGE, NADINE A PSC 1024, Box 8102 APO AE 71686 RSP SSN: RSP OCC: TRMC RSP PH: 860-623-2927 I UNDERSTAND AND AGREE THAT, AT THE TIME THE PATIENT HAS MET GULF COAST SURGICAL CENTER LLC's MEDICAL CRITERIA TO LEAVE THE FACILITY, I WILL HAVE A RESPONSIBLE ADULT PRESENT TO TAKE ME/PATIENT HOME. I RELEASE GULF COAST SURGICAL CENTER LLC FROM ANY RESPONSIBILITY FOR EVENTS IN VIOLATION OF THIS AGREEMENT. Nadine Buggage Miniton 16/23/11 1733 Witness Date Time Signed

What is signature date or signed on date?

{"text": ["16/23/11"], "answer_start": [703]}

id_1711475190.584955

Brandon Baker

Recv'd Date 20265715 Bill DCN: 2065196GJ656811 IDEAL MEDICAL RECORDS SERVICE, INC. 303 W. Katella Ave. Suite 300, Orange, CA 96567 Invoice Phone: 714-380-6714 Fax: 865-658-3659 Date: 2014 October 23 Email: billing@imrservice.com To : Gallagher Bassett P.O. Box 610, CA, Roseville,, 95661-0610 965-657-2650 965-653-8652 CLAIMANT NAME: Maria Barajas ORDERED BY: Claim#: 006593-006556-WC-01 Law Firm - Perona, Langer, Beck, injury date: 2021 June 09 Serbin, Mendoza, Harrison UR Denial Date: 06/10/2021 Records Type Date of Service/Records Pick Up Fax Date Date Medical for 2017 January 03 07/14/2021 Independent Medical Review

What is the Date of Evaluation?

{"text": [], "answer_start": []}

id_1711471329.716306

Matthew Vang

Page: 2 Surgical Case Record Patient Name: BP00046620 Matthew Vang BIRTHDATE: 03/1990/17 Account No: BP34852451947 Age: 69 Physician: Dr Keith Fisher MD EVALUATION DATE:02/2020/19 Sex: F Specialty: ORS-Orthopaedic Surgery Room-Bed/T.Loc: O.R.: POR04-OPERATING ROOM #4 DATE OF OPERATION, OPERATION DATE, OPER DATE: 03/2017/28 Valley Medical Center Primary Procedure: LEFT KNEE MANIPULATION Case Close/ Run Date: 06/2018/30 Transmitted: 12/23/22 1222 P.SUR.DP Peterson, Deloras Run Time: 1944 PRE-OP ASSESSMENTS Occurred 12/22/22 1144 Landry, Courtney Recorded 12/22/22 1144 Landry, Courtney Physiological problem/alteration in: Musculoskeletal Infection - - MUSCULOSKELETAL ALTERATION - - Musculoskeletal alteration problem expected to: Improve/Resolve IV site dressing: Transparent IV site dressing clean, dry and intact: Yes IV site absent of redness, heat or edema: Yes <End> DOCUMENTATION IV summary: Venous Left Antecubital 20 g Inserted 12/22/22 0830 IV type: CONTINUED ON PAGE 3 *** Patient Name: Matthew Vang MRN:BP00043554 Encounter:BP0001107108 Page 2 of 29 73797-42 Valley Medical Center -00052

What is the Procedure Date?

{"text": [], "answer_start": []}

id_1711472786.895724

Claudia Russell

Virginia Cancer Specialists Patient: ANN MORRIS Note Date: 28 April 2019 Date of Birth: 30 December 1993 MRN: 3576607 I will see her back in the office after the PET scan. Ajay Dar, MD Send copy of note to: Amanda Pysher, MD Bijal Katarki, MD Signature Dr Patricia Farmer MD 23 July 2015 1:45 EDT 09/19/2023 Page 3 of 3

What is Ordered Date?

{"text": [], "answer_start": []}

id_1711476767.029863

Kenneth Payne

MPT I McLaughlin Physical Therapy Patient Name: Colleen Johnson 3120 20th St Physical Therapy Date of Birth: 1987 April 24 Metairie, LA 7000xxxx Initial Document Date: 2015 April 25 Phone: xxxxxxx Fax: xxxxxxx Examination Patient Problems: - (R) Shoulder: subjective complaints of pain in the (R) shoulder with functional activities and at rest, decreased poor posture, decreased scapular stabilizer, impaired functional mobility Short Term Goals: 1: (1 Week) | Pt (I) with HEP Long Term Goals: 1: (6 Weeks) I Pt reports 0/10 in the (R) shoulder with functional activities and at rest 2: (6 Weeks) I Pt reports less than 10% disability on the QUICK DASH Plan Frequency: 2-3 times a week Duration: 6 weeks Plan: Begin Plan as Outlined Treatment to be provided: Procedures Therapeutic Exercises Therapeutic Activity (Work Specific, ADL Specific), Neuromuscular Rehabilitation , Manual Therapy (Soft Tissue Mobilization, Joint Mobilization, Muscle Energy Techniques, Patient Education), Postural Training, Activity Modification. Modalities To Improve (Pain Relief, Decrease Inflammation, Increase Blood Flow, Improve Tissue Healing), Electrical Stimulation, Cryotherapy (Ice Pack), Hot Packs AND Scott McLaughlin License #08042 Electronically Signed by Dr Brendan Andrade on 2017 March 10 at 9:10 am 4 of 62 Powered by WebPT

What is Ordered Date?

{"text": [], "answer_start": []}

id_1711472786.747677

Jacqueline Mueller

1 09-18-2023 2:10 PM ET athena 19546102614 pg 53 of 57 Privia - CCA - Cardiac Care Associates PC . 264D Cornwall St, LEESBURG VA 20646-2640 Jacqueline Mueller (id #1596376, birth date: 13/97/04) Date of Encounter: 20/16/06 Patient Name Jacqueline Mueller (27yo, F) ID# 1596376 Appt. Date/Time 06/17/01 09:45AM birth date 13/97/04 Service Dept. PMG_CCA_Reston Office* Provider Dr Teresa Hodges, FACC Chief Complaint Transition of Care Encounter Fax (703) 464-4464 NPI: 1115963737 Allergies Reviewed Allergies CODEINE: Dizziness NKDA Medications

what is the DOB or date of birth?

{"text": ["13/97/04"], "answer_start": [199]}

id_1711471328.781299

Sarah Grant

med Department of Pathology 2501 South State Highway 121, Suite 1100 fusion Lewisville, TX 75667-8668 Tel: 673-986-9490/972-966-7900 clin-labs clin-trials Fax: 537-730-1162 Flow Cytometry - Leukemia/Lymphoma Profile patient name: Sarah Grant Accession #: AB23-341 Med. Rec. #: 10771972 Client: Med fusion Taken: 6/23/2023 Texas Oncology-San date of birth: 02-04-1992 (Age: 78) Location: Antonio Medical Center Received: 6/24/2023 Gender: F Billing #: 10771972 Reported: Physician(s): SUNEETHA Copy To: CHALLAGUNDLA ORDERED DATE: 04-02-2017 Status: Signed Out Sarah Grant Page 1 of 2

What is the Date of operation?

{"text": [], "answer_start": []}

id_1711475620.870371

Katherine Gibson

V VITRO MOLECULAR LABORATORIES www.vitromolecular.com Patient Name: Katherine Gibson Physician: Robert Jacobson, MD Accession #: S22-04715 Sex: Male Specialty Group: The Gables Surgical Center Collected: 28-09-2018 DOB: 21-04-1986 (21) Received: 28-09-2018 Reference #: S22-04715 CC: Reported: 22-11-2014 Surgical Pathology Report Clinical History Previous Vitro pathology report: *S21-12983, 12-09-2018 A)Lumbar disc, L4-5; discectomy:Cartilage and disc material with degenerative changes; *S21-15703, 24-12-2023 A)Disc, C4-C5, discectomy:0 Cartilage with degenerative changes DIAGNOSIS A. DISC L4-5: - Fibrocartilaginous tissue with degenerative changes - Negative for atypia or malignancy in this sample Images Gross Description A. Received in formalin there are multiple white fibrocartilaginous tissue fragments measuring 2.5 X 2.0 X 0.3 cm in aggregate. Specimen is submitted in toto in one green cassette. IG/rms Electronic Signature Hadi Yaziji, M.D. CPT Code(s): 88304 (1) *** END OF REPORT E-MAILED 09-10-2020 Vitro Molecular Laboratories 8700 West Flagler Street, Suite 100, Miami, FL 33174 Tel: 305-267-7979 Fax: 786-513-0175 CLIA: 10D1055514 Page 1 of 1

What is the Date of Exam or Examination date?

{"text": [], "answer_start": []}

id_1711473530.89574

Joshua Washington

CORVEL Certification Recommendation CLAIM #: PZC01224124 INSURED: Super Store Industries doi: 2021/02/02 CARRIER/TPA: Crum & Forster / CLAIMANT: Edward Foster ADJUSTER: Leticia Bailon CORVEL #: 111238123-UMO-2 Determination Date: 2022/29/08 RFA Received Date: 07/30/2018 Provider: Jenny Wong, DO Pre-cert #: 111238123-UMO-2 Network: per adjuster CorVel Corporation has been asked to review the below noted treatment request for medical necessity and appropriateness. CorVel Corporation hours of operation are from 8:30 a.m. to 5:30 p.m. PST, Monday through Friday. ORNGER_CERT :12-EMBID-4251254: Page 10 of 000197 0197

What is the Date of Encounter or Enc?

{"text": [], "answer_start": []}

id_1711471328.584341

Charles Nolan

Pineview General Hospital Sarah Bartlett 3164 Briana Trail Apt. 804 Angelfort, WI 20943 MRN: 9150779 birth date 1998-19-01. Sex M Visit Day: 2020-21-09 Patient Demographics patient name Patient ID SSN Legal Sex birth date Charles Nolan 9150779 xxx-xx-0067 Male 1998-19-01 (35 yrs) Address 07047 Daniel Rue Nicholasfurt, IA 33565 Phone 478-408-5844 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 Sarah Bartlett Self 07047 Daniel Rue Nicholasfurt, IA 33565 2614 of 5499

What is the Date of Exam or Examination date?

{"text": [], "answer_start": []}

id_1711475190.190996

Jeremy Collins

NOVANT Novant Health North Point Jeremy Collins N Medical Associates MRN: 54324437, DATE OF BIRTH: 05 Feb 1989, Sex: M HEALTH 1435 Bethabara Road date of visit: 21 Jul 2019 Winston-Salem NC 27436-3435 30 Mar 2017 - Office Visit in Novant Health North Point Medical Associates (continued) Clinical Notes Amb (continued) 1. Medicare annual wellness visit, subsequent 2. Cramping of hands 3. Cramping of feet Plan Jeffrey was seen today for muscle cramps, knot on arm and medicare wellness visit. Diagnoses and all orders for this visit: 1. Medicare annual wellness visit, subsequent (Primary) Patient Instructions Medicare Annual Wellness (Yearly) Next due on 8/26/2023 08/26/2022 E&M Code: PPPS, SUBSEQ VISIT 09/01/2020 Level of Service: PR PPPS, SUBSEQ VISIT Generated on 4/11/23 8:32 PM Page 296

what is the service date or date of service?

{"text": [], "answer_start": []}

id_1711472786.794158

Justin Morrison

Printed: 03/15/21 11:34 22 PatientKeeper庐 By: STANFORD, KIRSTEN RAD CHEST 2V PALAT Justin Morrison. Age: 77Y Gender: F birth date: 1994/05/08 MRN: K093937120 Phone: (358)581-8580 Date/Time 2015/21/08 10:4 Status Signed Source Reston Hospital Center RAD CHEST 2V PA LAT ORDERED PROVIDER: Pego, Michelle I NP DATE OF EXAM: 2020/18/09 FACITLIY: MEDICAL IMAGING CENTER RESTON STATUS: Signed Exam Procedure 002658419 RAD/RAD CHEST 2V PA LAT Signed: DR.VUDU 2019/28/07 10:30am RAD CHEST 2V PA LAT CHEST X-RAY, frontal and lateral views: HISTORY: WHEEZING COMPARISON: 2023/05/01 FINDINGS: The cardiac silhouette is normal. IMPRESSION: Normal chest xray. Reported by: Duyanh T Vu, MD Signed by: Dr Tara Williams, MD Page 1 of 1

what is the visit date or date of visit?

{"text": [], "answer_start": []}

id_1711473366.115298

Cynthia Hanna

athena 10/30/2023 1:33:13 pm EDT Page: 56 / 86 Cynthia Hanna (id #12146212, BIRTHDATE: 19/04/84) Baptist Health Health Information Management Dept Cynthia Hanna 3563 Philips Highway Building B. Suite 201 MRN: 52214210 BIRTHDATE: 19/04/84, Sex: F Jacksonville FL 21207-5213 Adm 01/01/17 D/C: 31/01/17 07/15/2023 - ED in Baptist Clay Emergency (continued) ED Provider Note (continued) HISTORY: seizure COMPARISON: None. TECHNIQUE Contiguous axial slices of the head were submitted without IV contrast. FINDINGS: INTRACRANIAL: Brain parenchyma is normal in attenuation, No acute intracranial hemorrhage. electronically signed by: Dr Rebecca Hayes MD 11/03/21 12:38 PM CDT Printed on 7/27/23 at 8:20 AM Release ID: 28521892

what is the service date or date of service?

{"text": [], "answer_start": []}

id_1711471329.143204

Mary Lopez

00057 RE: Mary Lopez DOS: 04-02-2016 Page 1 of 10 Palpation There is no tenderness to palpation anywhere in the wrist. This includes the scaphoid volarly, radially and dorsally, the distal radius and ulna, the lunate, the triquetrum, the capitate, the hamate, the pisiform, the triangular fibrocartilage, the ulnar fovea, the ECU, the FCU, the FCR and the first, second, third, fourth, fifth and sixth dorsal compartment. Range of Motion of the Wrist Right Normal Extension 57 degrees 60 degrees Ulnar deviation 30 degrees 46 degrees Radial deviation 78 degrees 20 degrees Pronation 80 degrees 47 degrees Supination 80 degrees 80 degrees Special Tests There is no evidence of wrist instability. Sensory Examination Sensation is intact to light touch and pinprick in all dermatomes in the bilateral upper extremities. Two-point discrimination is within normal limits. Vascular Examination 9 64595092490 Received 28-06-2019

what is the visit date or date of visit?

{"text": [], "answer_start": []}

id_1711472286.52535

Justin Hicks

Justin Hicks MRN: 5605213 06/05/2023 - Telephone in MultiCare Rockwood Orthopedics & Sports Medicine MultiCare Health System Patient name: Justin Hicks MRN: 5605213 CSN: 296528619 Account Information Admit Date HAR# Pt Class Hospital Svc Bed 23-04-2023 No service for Admitting Physician: Chief Complaint: Forms Adm Dx: Gestational Age: <None> Patient Information Home Address: 1835 E 8th Ave Telephone Information: Spokane WA 99202-3409 Home Phone Not on file. Work Phone Not on file. SSN: xxx-xx-8028 Mobile 509-993-4659 Age: 52 year old Employer: UNITED PARCEL SERVICE birthdate: 02-03-1988 (18 yrs) United Parcel Service Sex: male Marital Status: Significant Other RIVER VIEW CORPORATE Justin Hicks CENTER MRN: 5652313, birthdate: 02-03-1988, Sex: M 16201 East Indiana Ave date of visit: 12-05-2018 SPOKANE VALLEY WA 99216- 1882 Page 20 Printed by 414221 at 7/17/23 9:40 AM

What is the Date of Discharge?

{"text": [], "answer_start": []}

id_1711476768.770923

Matthew Gibbs

DocuSign Envelope ID: B6xxxx-70xx-4Fxx-BExx-EA9EC5Axxxxx TBOSG TAMPA BAY ORTHOPEDIC SURCERY GROUP ADVANCED BENEFICIARY NOTICE OF BILLING AND SERVICE OPTIONS (ABN) Steven Arnold By my signature below, I, (print name), hereby acknowledge and understand that Tampa Bay Orthopedic Surgery Group (hereinafter "the Practice"), have offered to provide medical treatment related to my liability incident dated 12/12/2022 I have fully read this notice to make an informed decision about the payment for my medical care. I further acknowledge that I have been given the opportunity to ask any questions I may have and to consult with an attorney of my choice to discuss my rights and responsibilities prior to choosing my option and signing this form. (INITIAL ONLY ONE BOX. WE CANNOT CHOOSE A BOX FOR YOU.) DS ww OPTION 1 - Due to the time and nature of treatment to be rendered by the Practice, in addition to the risk in undertaking my medical treatment of either underpayment or nonpayment by my health insurance carrier. OPTION 2 - I hereby agree that the Practice will bill my health insurance carrier, Medicare, Medicaid, or other applicable carrier for the medical services by the Practice, but I will be required to pay in full all co-pays, deductibles, co-insurance, or patient responsibility estimated to be payable as a result of the rendering of these medical services prior to receiving any medical treatment. DocuSigned by: (Steven Arnold 25/09/2022 32E36710500740E Signature of Patient Date Signature of Medical Provider a 29/08/2015 Date 1114 W Kennedy Blvd Tampa FL 33606 P: 813.463.2814 F: 813.463.2814 3814 Tampa Rd. Suite 300 Palm Harbor FL 34684 P: 727.239.0814 F: 727.239.0614 7814 66th St. N. Suite 204 Pinellas Park FL P: 877.703.7114 F: 813.463.2814

What is the Date of Discharge?

{"text": [], "answer_start": []}

id_1711471329.089088

Sean Wright

Countryside Regional 2700 Brandon Drive Suite 365 Vincentland, KS 12981 Workers' Compensation Medical Status Questionnaire patient name: Sean Wright Today's date: 2022-28-05 Patient ID #: 0457351 Injury Date: 2014-01-07 Employer: FOOD LION Carrier: RETAIL BUSINESS SERVICES Treating physician: Dr Kerry Henderson IC file: 2022224556 1. Diagnosis: Kidney Stones 2. Treatment plan: WCP, NAPROXEN, ROBAXIN 3. Prescribed medications for the injury or condition that would impair ability or judgement needed to perform certain jobs: Lifting: 57LB MAX Pushing/pulling: INFREQUENT Bending/stooping: INFREQUENT Kneeling, squatting: INFREQUENT Twisting: INFREQUENT Use of extremities: Standing: Walking: Sitting: Repetitive motions: Driving: Vibrations: Climbing: Splints/crutches/bandages: Other restrictions: 7. If patient has reached maximum medical improvement (MMI), what is the permanent impairment for the injury or condition? Body part: : Percentage: % Body part: ; Percentage: % M Physician signature: Dr Catherine Hughes, MD Date: 2021-15-09

What is the Date of Evaluation?

{"text": [], "answer_start": []}

id_1711477275.244621

Anthony Buck

AEGIS Laboratory Director Matthew T. Hardison PhD CLIA Number 44D1083455 Laboratory Report 515 Great Circle Road Nashville, TN 37228 SCIENCES CORPORATION (615) 255xxxxx Fax (615) 255-xxxx Clinic Information Patient Information Sample Information Client: South Texas Bone & Joint Patient Name: Deborah White Lab Sample ID: 81181xxxx 601 Texan Trail Specimen Type: Urine Corpus Christi, TX 78411 Patient ID: 45796xxxx Collected: 29 Sep 2014 Requesting Provider: Date of Birth: 01 Jun 1992 Received: 30 Jul 2018 JOHN MASCIALE Male/Female: Female Reported: 29 Dec 2022 Copyright o 2018 Aegis Sciences Corporation All Rights Reserved Page 2 of 45 767453 South Texas Bone & Joint - 00459

what is the DOB or date of birth?

{"text": ["01 Jun 1992"], "answer_start": [525]}

id_1711473239.366894

Casey Kelley

Datavant Release of Information Patient: Casey Kelley birthdate: 19/90/08 Court Case #: 340799407 CERTIFICATION OF RECORDS Enclosed are the medical records of Casey Kelley . Datavant is producing the records as the Health Insurance Portability and Accountability Act business associate of GABLES SURGICAL and pursuant to a subpoena or patient authorized request issued to GABLES SURGICAL. No records for dates requested No patient found NO PHYSICAL FILMS KEPT AT SITE Number of pages: 165 Includes billing records: No Number of Images/CDs: N/A BILLING SENT BY MBS ATTORNEY GROUP Date: 02/24/02 640-540-1409 Datavant - Release of Information Vendor for GABLES SURGICAL

What is Ordered Date?

{"text": [], "answer_start": []}

id_1711477090.74941

Francisco Walker

Perception no hallucinations or delusions during interview Orientation oriented Memory / Concentration short term intact,long term intact Insight / Judgement good Diagnosis Diagnosis WHODAS / Diagnosis Reviewed Inactive Resolved Code Description Type Primary GAF / CGAF Status Date Date Date Date F31.81 Bipolar II Disorder Active 03 Mar 2017 JabaraMayer Service Date: 07 Dec 2020 12:00:00 PM Released: 03 Mar 2017 9:28:06 PM This document was printed from PIMSY EMR System It contains protected health information (PHI). DOS: 12 Apr 2016 12:00:00 PM Shauna Becker (B-C-14860) B-C-14860-60557 03 Mar 2017 Date Of Birth 25 Oct 2003 Gender: Female CLIENTNUMBER B-C-14849 Page 3 of 49

What is the Procedure Date?

{"text": [], "answer_start": []}

id_1711471330.564596

Diane Hudson

Doctors of Manteca patient name: Diane Hudson Attending Provider: Dr David Davidson MRN #: 153795 ADMITTING DATE: 22 November 2017 Account #: 33881139228 discharge day: 22 December 2017 birth date/Age/Sex: 04 January 1990 / 61 years / Female Lab Medical Director(s): Dr James Reynolds, MD Discharge Documentation/Instructions Attachment(s): Most recent to oldest [Reference 1 2 Range]: 12.5 g/dL 12.6 g/dL Hgb [12.0-16.0 g/dL] (2/19/20 5:10 AM) (2/18/20 5:23 AM) 31.1 pg 31.4 pg MCH [27.0-31.0 pg] *HI* *HI* (2/19/20 5:10 AM) Report Request ID: 246234232 Page 2 of 334

What is Ordered Date?

{"text": [], "answer_start": []}

id_1711473237.344088

Joshua Hutchinson

THU 43 FAX MRN: 1932719H Joshua Hutchinson Nassau Unly. Medical Gender: Female Center Age: 39y (05-26-1992) Current Location: ICC1-2161-JJ Faculty Statement: Attestation Attending and Resident/Fellow/Physician's Assistant Electronic Signatures: Dr Jeff Arroyo (Physician) (Signed 04-26-2017 8:42) Authored: Faculty Statement Co-Signer: Date of Procedure, Pre-Op and Post-Op Diagnosis, Specimens, Brief Operative Note, Procedure Details Dr Karen Whitehead (Resident Physician) (Signed 11-25-2023 8:42) Authored: Date of Procedure, Pre-Op and Post-Op Diagnosis, Specimens, Brief Operative Note, Procedure Details Requested by: Philburn, Jacqueline (Med Rec Clerk), 01-27-2017 12:25 Page 2 of 2

What is signature date or signed on date?

{"text": ["04-26-2017"], "answer_start": [311]}

id_1711476990.340141

Beth Estrada

University of Oklahoma October 27, 2023 800 NE 15th Street Suite 205 Oklahoma City, OK 73104 Page 2 4052714655 Fax: 4052711355 Lab Report Jordan Clark Male DOB: 86/04/09 2708055 Ins: BLUE CRO (22) Grp: 116455 Producer ID *2:OU MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73155 Producer ID *10:OU MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73155 Producer ID *11:0U MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73155 Producer ID *12:OU MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73155 Producer ID *13:0U MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73155 Producer ID *15:OU MEDICAL CENTER Laboratory 1200 Everett Drive Oklahoma City OK 73155 (2) Order result status: Final Collection or observation date-time: 20/08/19 13:05 Requested date-time: Receipt date-time: 10/17/2016 13:06 Lab site: OU MEDICAL CENTER Laboratory, 1200 Everett Drive Oklahoma City OK 73104 (3) Order result status: Final Collection or observation date-time: 20/08/19 13:05 Requested date-time: Specimen Source: PN:C02194S Source: HCA LAB Filler Order Number: 1017:PN:C02194S LAB Lab site: OU MEDICAL CENTER Laboratory, 1200 Everett Drive Oklahoma City OK 73104

what is the DOB or date of birth?

{"text": ["86/04/09"], "answer_start": [179]}

id_1711473238.019526

Tammy Dickson

<<Back To Review>>180298-16-HYPER LINK - Page 178 Legal Copy SGMF-PRIMARY CARE Tammy Dickson Sutter Health 95355-4276 MRN: 53470498, DOB: 24/05/91, Sex: M Single Notes Date of Visit: 26/07/15 Notes (continued) Patient Instructions by Dr Sandra Hicks MD at 12/30/16 1528 Author: Dr Sandra Hicks MD Service: - Author Type: Physician Filed: 12/30/16 1528 ENCOUNTER DATE: 16/10/14 Status: Signed Editor: Dr Sandra Hicks MD (Physician) Electronically Signed by Dr Sandra Hicks MD at 04/09/15 1128 Notes Progress Notes by Kobrine, Steven E, MD at 04/09/23 1123 Printed by [S271222] at 10/28/21 11:27 AM 00178

What is the Date of Consultation?

{"text": [], "answer_start": []}

id_1711475620.873917

Ruben Brown

V VITRO MOLECULAR LABORATORIES www.vitromolecular.com Patient Name: Ruben Brown Physician: Robert Jacobson, MD Accession #: S22-04715 Sex: Male Specialty Group: The Gables Surgical Center Collected: 2021-20-05 DOB: 1994-20-03 (72) Received: 2021-20-05 Reference #: S22-04715 CC: Reported: 2023-18-10 Surgical Pathology Report Clinical History Previous Vitro pathology report: *S21-12983, 2021-09-02 A)Lumbar disc, L4-5; discectomy:Cartilage and disc material with degenerative changes; *S21-15703, 2021-08-02 A)Disc, C4-C5, discectomy:0 Cartilage with degenerative changes DIAGNOSIS A. DISC L4-5: - Fibrocartilaginous tissue with degenerative changes - Negative for atypia or malignancy in this sample Images Gross Description A. Received in formalin there are multiple white fibrocartilaginous tissue fragments measuring 2.5 X 2.0 X 0.3 cm in aggregate. Specimen is submitted in toto in one green cassette. IG/rms Electronic Signature Hadi Yaziji, M.D. CPT Code(s): 88304 (1) *** END OF REPORT E-MAILED 2021-05-12 Vitro Molecular Laboratories 8700 West Flagler Street, Suite 100, Miami, FL 33174 Tel: 305-267-7979 Fax: 786-513-0175 CLIA: 10D1055514 Page 1 of 1

What is the Date of Evaluation?

{"text": [], "answer_start": []}

id_1711471328.381681

Julia Bell

2018 November 25 13:47 Fax 18039734602 p.6 Tuesday, April 12, 2022 History and Exam Patient Name Julia Bell Female birthdate: 2000 September 14 Age: 64 years, 8 months date of visit: 2020 September 13 Referred By: History Chief Complaint: " I have a 24/7 guard a doctor made for me in new orlands and he told me to eat with-it and i tried but it doesn't work out" HPI: History of Migraine with ablation on multiple meds Started years ago SFH: Does not smoke ETOH use Rarely - Wine No Illicit Drug Hx Medications: Albuterol inhaler Allergies: None Health Alerts: High Blood Pressure, TMJ Disorder, Alcohol Use, Arthritis, Sinus Trouble Exam Date Recorded: 2018 November 25 Ht. 4'5" Wt. 57kg General: General: -No pre/post auricular surgical scar -No overlying erythema -CN VII is HB-I bilaterally Joint Examination (R/L): -Superficial pain: 0/0 000047

What is the Date of Encounter or Enc?

{"text": [], "answer_start": []}

id_1711476578.340249

Scott Koch

Patient: Emily Gray DOB: 1986 July 09 2018 March 08 10:24 AM Print Preview Emily Gray DOB: 1986 July 09 (45 yo F) Acc No. 758855 DOS: 2019 May 20 Owens, Shannon CanoHealth 46 Y old Female, DOB: 1986 July 09 Account Number:758556 HOLLYWOOD HL-22550-3855 Home: xxx-558-3455 Cuarantor: Owens, Siminon Insurance: Humana Medicaid CAP Appointment Facility: ou-Places University Structured Liatn: Lines patient need transportation :No 2019 January 23 Progress Note: VICKYRIVAS-OROZ0O MD for Appointment i. PRE-OP CLEARANCE Assessments 1. Pre-op evaluation as 201.818 Treatment 1. Pre-on evaluation LAB:CBC With Differential/Platelet (Ordered for 07/07/2022) 07/07/2022 Clinical Notes: FU studies FU ENT. 2. Deviated septum Clinical Notes: FU ENT. Follow Up 2 Weeks,prn (Reason: FU AFTER SURGERY) History of Present illness 45 yo patient here for Pre-OP Surgery: septoplast, submucosal of the inferior turbinate Indication: Deviated Septum Surgeon: Dr. Dwayne Smith Date: 2018 March 08 Prior Surgeries: no issues with anesthesia Examination -Exam: Progress Notes VICKY MD 07/07/2028

what is the DOS or D.O.S?

{"text": ["2019 May 20"], "answer_start": [143]}

id_1711475190.152001

Debra Hunt

NOVANT NOVANT HEALTH MEDICAL Debra Hunt N PARK HOSPITAL MRN: 56324637, DOB: 24-08-1988, Sex: M HEALTH 1950 South Hawthorne Road Adm: 27-03-2016, D/C: 26-04-2016 Winston-Salem NC 27633-3632 11-02-2017 - Admission (Discharged) in NHMPH Surgical Services (continued) Clinical Notes Acute (continued) Drains: None Specimens: ID Type Source Tests Collected by Time 1 right Tissue Spermatocele PATHOLOGY Brandon L 09-07-2018 1618 TISSUE Craven, MD REQUEST Implants: No implants in log Procedure Detail Findings: Right spermatocele x2 Complications: None. Electronically signed: Dr Kathryn Roberts, MD 08-11-2017 / 4:39 PM Electronically signed by Brandon L Craven, MD at 08-11-2017 1641 Generated on 4/11/23 8:32 PM Page 255

what is the service date or date of service?

{"text": [], "answer_start": []}

id_1711476767.550663

Terri Thomas

2017 Dec 03 08:25 1 12 >> unknown P 24/78 Coastal Neurology Inc. Procedure Note Patient Name: Loren Ferris Visit Date: 2020 May 18 Patient ID: 23678 Provider: Brad Taylor, PA Sex: Female Location: COASTAL NEUROLOGY INC Birthdate: 1989 Nov 04 Location Address: Referring Provider: Gerald Mckay DO Ormond Beach, FL Location Phone: (386) 788xxxx PROCEDURE NOTE: Trigger Point Injections Neck and Upper Back using Ultrasound Guidance REASON FOR PROCEDURE: Bilateral Neck and Upper Back Myofascial Pain Syndrome EBL: Less than 1 CC INJECTATE SOLUTION: Contained 10 cc of 1% lidocaine PROCEDURE PERFORMED BY: Dr Anne Burnett, PA-C Location: Bilateral trapezius, levator scapulae, splenius capitis and parascapular muscles Location: Tendon origin of bilateral trapezius, rhomboid minor, and parascapular muscles Summary of Procedure: The patient presents today for scheduled bilateral neck and upper back trigger point injections using ultrasound guidance for the benefit of needle placement. today is cervical trigger point 1 VAS is 5/10. I have discussed with the patient the risks and benefits of the procedure. Risks included are nausea, vomiting, headaches, seizures, death, fainting episodes, and hyperglycemia. The patient understands, agrees, and consents to the procedure. [Digital Signature Validated]

what is the service date or date of service?

{"text": [], "answer_start": []}

id_1711471328.783757

Brian Orr

med Department of Pathology 2501 South State Highway 121, Suite 1100 fusion Lewisville, TX 75897-8898 Tel: 954-320-8698/972-989-7900 clin-labs clin-trials Fax: 345-195-2799 Flow Cytometry - Leukemia/Lymphoma Profile PATIENT: Brian Orr Accession #: AB23-341 Med. Rec. #: 10771972 Client: Med fusion Taken: 6/23/2023 Texas Oncology-San D.O.B: 1999-09-28 (Age: 65) Location: Antonio Medical Center Received: 6/24/2023 Gender: F Billing #: 10771972 Reported: Physician(s): SUNEETHA Copy To: CHALLAGUNDLA ordered date: 2018-08-10 Status: Signed Out Brian Orr Page 1 of 2

what is the DOB or date of birth?

{"text": ["1999-09-28"], "answer_start": [384]}

id_1711475190.360838

Ashley Flores

<<Back to Review>>194126-3-HYPERLINK- - Hyperlink-Page 187 Ashley Flores KAISER PERMANENTE庐 MRN: 110554055855, BIRTHDATE: 1995 July 03, Sex: F SSN: xxx-xx-3554 Visit Day: 2020 April 03 2017 October 25 - Scheduled Telephone Encounter in CCM-DIABETES (continued) Clinical Notes (continued) 3) Further blood sugars needed to assess effect of insulin next visit evaluate changing INSULIN REGIMEN SQ P LIFESTYLE/EDUCATION : Reviewed rule of 15 for treatment of low blood sugar. If bedtime blood sugar below 110 take snack of 15 grams carbohydrate Such as 1/2 sandwich and take insulin as ordered . Call Mary Hallum if occurring 2 or more times in 2 weeks . blood sugar above 100 before driving exercising or above 110 before sleeping. electronically signed by Hallum, Mary C. (R.N.) at 2022 January 01 9:41 PM Generated on 4/6/22 11:06 AM 000187 0186

What is Collection Date?

{"text": [], "answer_start": []}

id_1711476892.769963

Joshua Baker

MRN: 608698 Facility: NBMC NorthBay Healthcare Patient Discharge Instructions Signature Page Name: David Vargas Current Date: 12-03-2023 00:16:37 MRN: 608659 FIN: 010998059 I, FLORENTINO MEJIA-GALLEGOS, have received and verbalized understanding of the above instructions, list of medications, and/or patient education material(s) and my questions have been answered to my satisfaction. Mantino My Gilbers Patient Date Time Family Member (Relationship) Date Time A Damn 9867 18-09-2023 0015 Provider Signature Date Time 00608698 13-07-2022 MEJIA-GALLEGOS, FLORENTIN 19-11-1993 26Y M NBHS Emergency 0010998059 . 000450012 . Name: David Vargas 8 of 59 12-03-2023 00:16:38 AM MRN: 608698 153

What is the Date of Exam or Examination date?

{"text": [], "answer_start": []}

id_1711472590.672224

Jason Zimmerman

Page 1 of 1 Notice: This is NOT a bill. Do not pay. If it is 庐 determined that this service or a portion of THIBODAUX REGIONAL these services is not payable by your health HEALTH SYSTEM plan, you will be responsible. Responsible Party: Buggage, Nadine 126 Jacobs St Napoleonville, LA 70390-2429 Name: Jason Zimmerman Guarantor Number: GN01864236 Account Number: V00018642361 Service Dates: 12-07-2021-06/22/22 Bill Date: 07/06/22 Insurance Coverage Insurance Policy Number Blue Cross Louisiana IHQ862841864236 For additional information, please contact us at 440-267-2487.

What is Ordered Date?

{"text": [], "answer_start": []}

id_1711473366.060342

Christopher Griffith

athena 10/30/2023 1:33:13 pm EDT Page: 48/86 Christopher Griffith (id #16946692, DATE OF BIRTH: 01/05/26) Encounter Summary for Christopher Griffith Encounter Details Date Type Department Care Team Description 19/12/17 Emergency Discharge Disposition: 01 3:51 AM Baptist Clay Emergency DISCHARGED TO HOME EDT - OR SELF CARE 19/12/17 1771 Baptist Clay Drive 3:44 PM EDT FLEMING ISLAND, FL 32693-8691 Demographics Sex: Female Ethnicity: Not Hispanic or Latino DATE OF BIRTH: 01/05/26 Race: White Preferred Information not available Marital status: Married

what is the DOS or D.O.S?

{"text": [], "answer_start": []}