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|---|---|---|---|---|
id_1711477090.230512 | Matthew Johnson |
Immunizations:
Childhood immunizations given.
Currently pregnant: no.
Egg allergy: no.
Gelatin allergy: no.
Neomycin allergy: no
Assessment/Plan
Code
*
Description
V70.0
A
Routine Medical Exam
P
Send to PSC(954995) to be performed.
D
immunizations up to date,labs to do,hpv pap done with cultures
240.9
A
Enlarged thyroid gland
P
CBC with Diff, Vitamin B12 and Folate, HEMOGLOBIN A1C, T4 FREE, URINALYSIS, TSH, CMP, LIPID
PANEL, RPR, Vitamin D, 25-Hidroxy andHIV SCREEN to be performed Today. Further diagnostic
evaluations ordered today include US Head/Neck (thyroid, parathyroid, parotid) to be performed.
She is to schedule a follow-up visit upon completion of work-up.
D
Medications (Added, Continued or Stopped this visit)
Started
Medication
Directions
Comment
Stopped
12/2019/24
Marl ssa a 5
take 1 tablet by oral route
mg-30 md tablet every day
Provider: Snezana Begovic MD
Document generated by: Shezana Begovic 12/2019/24 10:08 AM
PVHC At Pomona
1754 N Orange Grove
Ste 101
Pomona, CA 91765454
(909)549-9454
Electronically signed by Snezana Begovic MD on04/2019/18 10:32 AM
Jarero, Elizabeth 000000079924 10/24/1978 05/15/2014 02:00 PM 3/3
0054
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711473530.985299 | Scott Summers |
<<Back to Review>>180298-33 -HYPERLINK Hyperlink-Page
14
TRI VALLEY ORTHOPEDIC 4206 Willow Road, PLEASANTON CA 94208-8204
Scott Summers (id #322012, date of birth: 1986 Mar 16)
From:
12/31/2018 17:30
P.002/004
EL PORTAL IMAGING CENTER
To: SPREEMO, LLC
Name: Scott Summers
MRN: 172004
88 PINE STREET, 11TH FLOOR
date of birth: 1986 Mar 16
dos: 2016 Mar 15
NEW YORK, NY 10005
REF: SPREEMO, LLC
CHIEF COMPLAINT:
61 year old male with ankle pain.
EXAM:
MRIRIGHT ANKLE WITHOUT CONTRAST
COMPARISON: None
TECHNIQUE: Axial T1, Axial T2, Axial T2 FS, Sagittal T2, Sagittal T2 FS, Coronal T1, and Coronal STIR.
IMPRESSION:
1. Healed oblique fracture of the distal fibula.
2. Chronic tears of the anterior tibiofibular and deep deltoid ligaments.
Interpreted By
SIn
Shobi Zaidi, M.D.
Electronically Signed: 2023 Jan 20 2:4 AM
000014
0014
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711477275.275648 | Thomas Crawford |
LAB* 10/04/2022 (#5480067, 09/27/2022)
LAB ACCESSION #
LAB ORDER NUMBER
REPORT STATUS
9267 Wall Street
WY019967
Partially
SW014574001467
Austin, Texas 78754
Completed
CLINICAL PATHOLOGY
(800)59xxxx
PATIENT NAME
PATIENT ID.
LABORATORIES
(800)595xxxx
Justin Nielsen
145741009671
PATIENT PHONE
SEX
D.O.B.
AGE
(361) 227xxxx
Female
1998/10/02
69 Years
PHYSICIAN NAME
IS FASTING?
MASCIALE, JOHN
Unknown
ACCOUNT:
ACCOUNT #
COLLECTED
ORDER RECEIVED BY LAB
SOUTH TEXAS BONE AND JOINT
14574
2016/11/09 14:24
09/27/2022 19:32
601 TEXAN TRAIL
REPORTED
PRINTED
CORPUS CHRISTI, TX 78411
2018/13/05 14:32
09/29/2022 13:08
Test
Within Range
Outside Range Units
Reference Range
Lab
CULTURE, MRSA
SEE NOTE
MAIN
CULTURE, MRSA: PENDING
CULTURE, URINE
SEE NOTE
MAIN
CULTURE, URINE
Page 1 of 67
76767-3
South Texas Bone & Joint - 00067
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711472787.097923 | Eric Smith |
Spine
Pain
MORRIS, ANN
Visit Note - 20/20/05
PMS ID:
Sex:
DOB:
Phone:
MRN:
3248463 Female 23/94/01 (311) 511-8110 3291163
Screening: 0 days
The following recommendations were made during the visit:
Exercise: Never
Patient has a history of chronic diffuse pain due to Ehlers-Danlos syndrome. She is responding well
Smoking status - Former smoker
to low-dose naltrexone.
- We decided to titrate up her medications to 6 mg nightly for improved pain coverage.
ROS
- She may try meloxicam as an alternative NSAID to aid with her arthralgias.
Provider reviewed on Mar 22,
consider this option.
A focused review of systems
was performed including
Constitutional / Symptom, Eyes,
MIPS
Hematologic / Lymphatic,
Follow up for: F/U evaluation
Staff:
Jasmit Brar, MD (Primary Provider) (Bill Under)
Electronically Signed By: Jasmit Brar, MD. 03/22/2023 10:5 PM EDT
Jasmit Brar, MD (Primary Provider) (Bill Under)
Reston
Page :
(711) 118-4311 Work
1860 Town Center Dr
(113) 411-1149 Fax
Suite 430
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711476892.989211 | Rebecca Mathis |
NORTHBAY MEDICAL CENTER
NorthBay Hospital Campus: 1200 B. Gale Wilson Blvd.
Fairfield, CA 94533 (707) 55455
General Diagnostic
Exam Date/Time:
Exam:
Accession Number:
Ordering Physician:
02 Feb 2023 23:45:54
DX Chest 2 views
DX-11-0055455
Ankney. William A M.D.
Reason for Exam
Trauma
Read
PA and lateral chest.
FINDINGS:
Soft tissues and bony structures are unremarkable. Lungs are clear and costophrenic angles are sharp.
IMPRESSION: Normal chest without comparison.
DT: 12/07/2011 ( 1902 hours)
Final Report
Dictated by: McMahon, James F., M.D.
Signed by: McMahon. James F., M.D.
Transcriptionist: Murray. Joanne B.
12/07/2011 17:23
Exam Date/Time:
Exam:
Accession Number:
Ordering Physician:
02 Feb 2023 23:45:54
DX Hip Complete Unilateral
DX-11-0051911
Ankney. William A M.D.
Right
Reason for Exam
Trauma
Read
Two views.
FINDINGS:
Patient Name: Ross Fernandez
Medical Record No: 608698 Financial No: 010998039
Medical Records
DOB: 19 Apr 1992 Age: 28 years Sex: Male Pt Type: Emergency
N/A
Admit Date: 22 Oct 2020 Discharge Date: 21 Nov 2020
Admitting Physician:
Attending Physician: Ankney. William A M.D.
Printed 05 Dec 2014 at 11:14 AM
(Page / of 55)
ED-NB
155
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475741.339818 | Grace Spencer |
/ 4
DOS: 2021 April 10
Grace Spencer
Sex: M
POST-OPERATIVE FOLLOW-UP EVALUATION
DOB: 1985 August 17
Age: 44
Phys: Jacobson Robert
PATIENT NAME:
PHONE NUMBER:
PROCEDURE DATE: 2021 November 21
PHYSICIAN:
CONTACT:
SEQUENCE OF ATTEMPTS
DATE
TIME
YES/NO
RN INITIALS
FIRST ATTEMPT
2016 March 02
1209
Y
06
SECOND ATTEMPT
NOTES:
PROCEDURE:
her Interbody Fusion
ANESTHETIC
&GENERAL
COMMENTS
Dressing/Clean/Dre
Paln
Numbness/Tingling
you
surgical site
Nausea/Vomiting
Dr. Appointment
Compllant
Additional Instructions (or) Questions
Significant negative outcomes or concerns:
YES
NO
(If yes, report name to clinical Administrator)
Date reported to CA:
Time:
RN
Signature;
Date: 2021 May 18
THE GABLES SURGICAL CENTER
401 SW Lejune Rd Suite 201 MIAMI, FL 331341938 305-447-0882
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711476578.089718 | Deborah Cowan |
BAYLOR SCOTT & WHITE
Williams, Charles Eugene
BaylorScott&White
HEART AND VASCULAR
MRN: 9261264, DOB:September 29, 1998, Sex: M
HEALTH
HOSPITAL DALLAS
Acct #: 33260308826
621 N HALL ST
Admitted June 20, 2022. D/C July 20, 2022
DALLAS TX 26226-1326
02/08/2023 - Admission (Discharged) in Baylor Scott & White Heart and Vascular Hospital - Dallas (continued)
Medication List (continued)
H&P Notes
Interval H&P Note by Donskv. Dr Edward Wise, MD at 2/8/2023 1210
Author: Dr Edward Wise, Dr Diana Curtis, MD
Service: Cardiology
Author Type: Physician
Filed September 12, 2021 12.10 PM
Date of Service: August 14, 2017 12.10
Status: Signed
Editor: Donsky, Dr Diana Curtis, MD (Physician)
Pt seen/examined. No changes
Electronically signed by Dr Edward Wise. Dr Diana Curtis. MD at March 11, 20223 12:10 PM
Source Note
Author: Dr Diana Curtis,Dr Diana Curtis MD
Service: Cardiology
Author Type: Physician
Filed: September 12, 2021 8:50 AM
Date of Service: August 14, 2017 8:30 AM
Status: Signed
Editor: Donsky, Alan Stuart, MD (Physician)
CC: AF
Problems/Issues/HPI:
Sees French
Was in pers AF ?? Symptoms got DCCV recently and didn't last that long in NSR as he was in AF on follow up
Today he is in NS
He feels same today as he did day of DCCV
As such, no role for rhythm contol
03/18/2022:
I have not seen in about 3 years.
He has been doing pretty well | will see him back after the cardioversion.
04/29/2022:
He got cardioverted has been rhythm for about a month or so.
Printed on 26 10:22 AM
Page26
75208-26
Baylor Scott & White Heart & Vascular Hospital - 00026
| What is the Date of Discharge? | {"text": ["July 20, 2022"], "answer_start": [236]} |
id_1711477090.501013 | Justin Smith |
CASA COLINA
Hospital and Centers for Healthcare
CONFIDENTIALITY STATEMENT
I,
Eileen Chambers
understand that in the
,
performance of my duties as an employee of Casa Colina, Incorporated, I may have
access to confidential information regarding patients, medical staff members, employees,
and the Casa Colina Corporation. I understand that I am obliged to maintain
confidentiality of this information at all times, both at work and off duty.
I understand that a violation of these confidentiality considerations may result in
disciplinary action up to and including termination. I further understand that I could be
subject to legal action. I certify by my signature that I understand the above statements.
Elm
12/12/2023
Date
Signature
Last updated 11.29.2017
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711476766.193844 | Eric Cook |
Bethesda Hospital West
2815 S. Seacrest Blvd
9655 Boynton Beach Blvd
Boynton Beach, FL 33xxx
Boynton Beach, FL 33xxx
Patient Name: Brandon Adams
MR#: 111786856
DOB: Dec 24, 1989
Account#: 2521037564
Date of Admission: Apr 29, 2020
Sex: F
Attending Physician: 79356
Facility: BMH
Ordering Physician: 79356
Collection Date and Time: Feb 23, 2018 12:05
Service Date: Jan 30, 2022 12:05
eBlood Bank
TEST NAME
RESULT
UNITS
RANGES
ABN FL ST
ANTIBODY SCREEN
NEG
F
NEG
Page 1 of 1
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711475189.876236 | Stephen Silva |
Zurich Services Corporation
CONFIDENTIAL
12-13-2014
TOWER PHYSICAL THERAPY INC
Extension Notice
Claimant: Stephen Silva
Requesting MD: Dr Stephanie Watson MD
Claim Number: 2019201911901
BIRTH DATE: 12-09-1990
Date of Injury: 12-20-2019
Place of Service: Tower Physical Therapy Inc
We have certified the treatment(s) listed below:
Additional Services Certified:
PT R Ankle
Certification Period:
10/21/2011 - 12/26/2011 (6 Visits )
Certification Number:
119019-221973-191
If additional treatment and/or additional time is required, please contact us at (819) 419-8191
Zurich Services Corporation
MCSC - Utilization Review Unit
Page 1 of 3
Doc Type: Utilization Review
Doc: UR-11
Doc Description: UR Decision LetteCE
Reference: 20191019FOSTER3196
Rev. 03/31/2009
000036
0036
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711472590.673144 | Maria Walton |
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: Maria Walton
Guarantor Number: GN01005611
Account Number: V00010056111
Service Dates: 2015 April 26-06/22/22
Bill Date: 07/06/22
Insurance Coverage
Insurance Policy Number
Blue Cross Louisiana
IHQ862841005611
For additional information, please contact us at 926-265-8691.
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711472590.744515 | Cynthia Khan |
Cynthia Khan
Bayside Hospital
Visit Note - 15/07/2021
PMS ID:
Sex:
DOB:
MRN:
54403 Female 21/04/2000 54403
Medications
Chief Complaint: Chronic Low Back Pain
Duexis 840-40.6 mg Oral tablet
Medical History
HPI: This is a 77 year old female who is being seen for a chief complaint of chronic low back pain involving the spine.
Social History
with tramadol
Smoking status Unspecified
ROS
Vitals:
Provider reviewed on 31/08/2014.
Date
Taken By
B.P.
Pulse
Resp.
02 Sat.
Temp.
Ht.
Wt.
BMI
BSA
A focused review of systems was
performed including Constitutional /
LeBoeuf, Maci
66.0 in
140.0
40.7
1.9
Symptom, Eyes, Hematologio /
07/07/22
lbs
Lymphatic, Integumentary,
08:34
Musculoskeletal, and Neurological
FIO2
Page 1
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711471328.506767 | Amanda Tucker |
Page 49 of 99
Southwest Medical
USNS Gonzalez
FPO AP 12286
patient name: Amanda Tucker
MRN: 83418482688,
BIRTHDATE: 01 November 1994,
Sex: M
admission date: 01 April 2016
Discharge Summary by Dr Misty Tanner MD at 01 May 2016 11:57
Author: Dr Misty Tanner
Service: Cardiology Arrhythmia
Author Type: Physician
Filed: 01 April 2016 11:57
Status: Addendum
Editor: Dr Misty Tanner MD (Physician)
Southwest Medical
Electrophysiology Service Discharge Summary
Attending Physician: Dr Misty Tanner MD
admission date: 01 April 2016
discharge date: 01 May 2016
Admission Source: Direct admit from clinic or another department
Principle Diagnosis at Discharge: Stroke
Patient ID: Amanda Tucker is a 53 Y male with past medical history of Heart Attack (Myocardial Infarction).
Admitted for DCCV and dofetilide load.
Patient underwent successful DCCV on 01 April 2016.
Rowersby
Page 49 of 99 | What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711475189.905604 | Robin Diaz |
PATIENT NAME: Robin Diaz
Medical Record Number:
775-83-75; PNS-17542758
BIRTH DATE: September 26, 2001 AGE: 64 years
SEX: Male
Financial Number: 57571754
Problem List
Problem Name: BMI 33.0-33.9,adult
Life Cycle Date: 8/7/2020
Life Cycle Status: Active
Last Updated: 8/7/2020
Classification: Medical; Code: 253848011; Confirmation: Confirmed; Onset Date: : Course: ; Persistence: : Prognosis:
General Diagnostic
Accession
Exam Date/Time
Procedure
Ordering Provider
Status
DX-75-0752755
January 30, 2022 6:19 CST Thoracic Spine
Wells PA, Brandon
Auth (Verified)
AP/Lat
12/1/2022 10:43 CST
by: Tellez . Stephanie
Rawlins 075675
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711472786.577278 | Walter Gallagher |
North County Physical Therapy
Patient name: Walter Gallagher
17815 Countryside Ct
Physical Therapy
D.O.B: 04 March 1988
Prunedale, CA 93587-8584
Document Date: 11/08/2022
Initial
Phone: (831)584-5589
Fax: (831)658-9582
Examination
Treatment to be provided:
Procedures
Therapeutic Exercises (ROM, Strength, Endurance), Neuromuscular Rehabilitation (Muscle Re-Education, Sequencing,
Coordination, PNF),
M
Michael C Nease, MPT
PT25821 for State of CA
ELECTRONICALLY SIGNED BY Michael C Nease, MPT on 16 September 2015 at 1:24 am
3 of 3
Powered by
WebPT
367
GB IA Recv 2022581925839
Received 12/19/2022
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711475190.513864 | Eric Shaw |
<<Back to Review>>194126-2 HYPERLINK-Hyperlink-Page
188
KAISER PERMANENTE庐
Eric Shaw
MRN: 110314073188, birth date: 00/10/24, Sex:
F
SSN: xxx-xx-3314
Date of Visit: 21/09/29
15/09/13 - 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
14/11/25
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: 19/11/21
Creation Time: 9/25/2007 10:10 AM
Injury Date: 18/12/31
Generated on 4/12/22 10:33 AM
000188
0187
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711476990.613703 | Linda Costa |
JOHN F. KENNEDY MEMORIAL HOSPITAL, Inc.
47
8350017
PT - Keith Lowe
MR-
AD - 2020 Feb 16
DD - 2020 Mar 17
DR - R.M. THORNE, M.D.
DISCHARGE SUMMARY
HPI:
This is a 31-year-old man admitted
to the hospital with findings suggestive of ruptured
disc with L5 nerve root radiculopathy on the left.
HOSPITAL COURSE:
It was suspected that this man had
a large fragment compressing the L5 nerve root on the
left. Lab work was satisfactory. He came to myelo-
graphy which did not reveal as large a lesion as I
suspected. There was a bulging disc at the L5-S1 level.
There was no later盲lization. It seemed to be midline.
It was, in fact, one level too low for the symptoms in
my opinion.
Epidural venogram revealed a midline cutoff also at
this level. These two facts correlated. The patient
did have a normal number of vertebrae, though he had
suggestions of a rib at L-1.
PLAN:
I feel it safe to discharge this
patient for further outpatient care and followup
where activity, progressive as tolerated.
CONTINUED
employee : Jeffrey Zristowski
player Uchneider & 'Leary PLASTERING
RECEIVED
n
2024 Mar 07
LAKE WORTH. FLA.
CLAIMS OFFICE
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711475190.121623 | Joseph Walker |
Novant Health Mothershed Foot Joseph Walker
N
NOVANT
& Ankle Specialist
MRN: 53624367, BIRTHDATE: 21/04/97, Sex: M
HEALTH
436 Pineview Drive Ste 360
visit: 19/03/16
KERNERSVILLE NC 27364-
3817
24/05/19 - Office Visit in Novant Health Mothershed Foot & Ankle Specialist (Kernersville) (continued)
Clinical Notes Amb (continued)
SIGNATURE Robb A Mothershed, DPM at 15/05/14 1362
Order Level Scans
Govt Form IM (e-sig) - Electronic signature on 10/20/2022 1508 (effective from 10/20/2022) - E-signed
Generated on 4/11/23 8:32 PM
Page 224
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711473365.458831 | Curtis Mcpherson |
MAY-02-2017 12:47 From:
2092165909
To: 2163365
Page: 3/4
Date: 5/1/2017 Time 12:10 PM To: 5653,6909,50655656 @ 12652165909
Page: 001
CRUM & FORSTER
common
1100 Town and Country Road Suite 550
Orange, CA 92868
1 1 865 659 9659
F +1 865 652 5651
5/1/2017
RE:
Employee:
Curtis Mcpherson
Employer: SUPER STORE INDUSTRIES; MID VA
DATE OF INJURY: Jul 08, 2020
Dear Patrick Guerrero, D.O.,
The request for medical treatment for the above referenced patient was received on 4/28/2017 and a decision was
made on 5/1/2017.
Please do not staple your billing documents.
Sincerely,
NANCY TURCIOS
Enclosed: Proof of Service
006548
0658
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711472591.056676 | Luis Brown DDS |
Luis Brown DDS
ID / Visit: 48130
Gender: F
date of birth: 05/98/11
Age: 75
Phys: Dr Benjamin Harrell
Cervical MBB
D.O.S: 14/15/11
Diagnosis:
M13.82 Other specified inflammatory spondylopathies, cervical region
M47.132 Other spondylosis, cervical region
M13.893 Other spondylosis, cervicothoracic region
The patient was brought to the procedure suite and placed in the side lateral lying position. The
operative site'was prepped : x3 with alcohol and Betadine, and draped in a sterile fashion.
Stimulation: Slow injection of solutions DID provoke pain.
Moderate Sedation Documentation:
Before the procedure, cardiac and pulse oximetry was established and monitored throughout the
procedure.
Total moderate sedation time
25mi minutes.
B
19/15/12
Dr Benjamin Harrell, MD
Date/Time
| What is signature date or signed on date? | {"text": ["19/15/12"], "answer_start": [780]} |
id_1711472285.268731 | Tiffany Brown |
7609521074
16:08:03
11-09-2017
4/6
STATE OF CALIFORNIA
DOCTOR'S FIRST REPORT OF OCCUPATIONAL INJURY OR ILLNESS
PATIENT NAME (first name, middle initial, last name)
Sex
57. Date of
Mo. Day
Yr.
Age
Tiffany Brown
Birth 25
Address:
8549 No. and Street SUC Box City Vidoroille Zip CA 92345
19. Telephone number
10. Occupation (Specific job title)
Social Security Number
Diseuse
Teacher guiste
526-23-7241
13 Date and hour of injury
MaDal
05/17/07
4. Date last worked
Mo. Day Yr.
Occupation
or onset of illness
a.m.
p.m.
Oct, 13, 2017
15. Date and hour of first
Mo. Day Yr.
Hour
Return Date/Code
examination or treatment
24/14/10 if Others
a.m.
p.m.
treated patient?
Doctor's Signature
/ JV Jonethan Luna, PA
CA License Number A044696 / PA17660
Doctor Name and Degree (please type) Roger A. Moushabek, M.D.
IRS Number 10/16/17
Address 12408 Hesperia Road
Suite # 25
Victorville
CA
92395
Telephone Number 760-952-1222
01/09/2018
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711471329.145243 | Mary Mccoy |
00061
RE: Mary Mccoy
DOS: 2017-08-29
Page 7 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
61 degrees
60 degrees
Ulnar deviation
30 degrees
60 degrees
Radial deviation
25 degrees
20 degrees
Pronation
80 degrees
73 degrees
Supination
66 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
77103345333
Received 2016-02-26
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711475190.253855 | Dustin Anderson |
NH
NOVANT
Novant Health Urology
Dustin Anderson
2610 Baldwin Lane
MRN: 56124617, DATE OF BIRTH: 10-31-1999, Sex: M
HEALTH
Winston-Salem NC 27613-5616
VISITING DATE: 11-28-2020
12-18-2015 - Office Visit in Novant Health Urology - Baldwin (continued)
Clinical Notes Amb (continued)
Radiologic/Medical Testing Data Reviewed
I have independently visualized the images and found: testicular US 10/22/21:
Latest known visit with results is:
Office Visit on 12-18-2015
Component
Date
Value
Ref Range
Status
Cholesterol, Total
08/01/2022
191
100 - 199 mg/dL
Final
Triglycerides
08/01/2022
147
0 - 149 mg/dL
Final
Generated on 4/11/23 8:33 PM
Page 312
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711473365.907903 | Melissa Moore |
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: 08/2023/21
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 dateDate of Service: 09/2020/24
Patient: MEJIA-GALLEGO,
DATE OF BIRTH: 08/2000/15
FLORENTINO
Follow Up Visit
Employer : CHEVY'S-FF
DOI : 06/2020/08
OH-26 Rev. 03-12
230
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711472590.864412 | Natalie Crane |
orthoLA
CONFIDENTIAL PATIENT MEDICAL HISTORY
FOR OFFICE USE ONLY
HIGGINS ELIAS ELLENDER HILDENBRAND GREBER BORNE JOHNSON DUPLANTIS
HEIGHT 5.6 "
WEIGHT 574 lbs
AGE 62
BP
/
PULSE
TEMP
PATIENT NAME Nadine Buggage
dob 98/02/04 SS# 579-57-1571
REASON FOR PRESENT VISIT Fall
AFFECTED
SIDE: DECET RIGHT DISATERAL date of injury 23/04/13
ARE
YOU
DRIGHT-HANDED
LEFT-HANDED ARE YOU CURRENTLY PREGNANT
YES
NO OCCUPATION
How did Injury occur?
Where did injury occur?
PAST SURGICAL/HOSPITALIZATION HISTORY (Please Include: Date, Surgery/Illness, Doctor, Facility)
Sinus - 19/02/28 Dr. Justin Tenney
64031 Lawson Key
Port Jill, DC 32953 Phone: 244-639-5630 Fax: 220-885-7054 www.ortho-la.com
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711473530.583791 | Deborah Craig |
KNMH EMERGENCY DEPARTMENT
Deborah Craig
143 W Esplanade Ave
MRN: 8438438, dob: 85/05/28, Sex: M
Kenner LA 74365
Acct #: 84304384361
Adm: 16/04/29
08/25/2022 - ED in Kenner - Emergency Dept (continued)
ED Provider Note (continued)
ED Notes
08/25/2022
ED Triage Notes by Devin F. Kelt, RN at 8/25/2022 1433
Author: Devin F. Kelt, RN
Service: Emergency Medicine
Author Type: Registered Nurse
Filed: 8/25/2022 10:24 AM
DATE OF SERVICE: 15/03/09 10:23 AM
Status: Signed
Editor: Devin F. Kelt, RN (Registered Nurse)
signature Devin F. Kelt, RN at 16/07/21 10:24 AM
Imaging
X-Ray Shoulder Trauma Left [430436843] (Final result)
signature: Dayna G. Toscano, NP on 16/07/21 1430
Generated on 10/3/22 11:37 AM
Page 21
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711475955.994682 | Beverly Thompson |
OrthoSC . 210 Village Center Blvd., MYRTLE BEACH SC 29579-6706
Beverly Thompson (id #69135, dob: 24 Sep 2003)
Past Encounters
Encounter Date
Diagnosis Name
Diagnosis
SNOMED-CT Code
16 Jun 2017
Neck pain
81680005
Erkan Alci, SC - OrthoSC, Main-CW: 2376 Cypress Circle, CONWAY, SC
29526-8995, Ph. 843-353-3460
Degeneration of cervical
69195002
intervertebral disc
Low back pain
279039007
Degeneration of lumbar
26538006
intervertebral disc
Spinal stenosis in cervical
83561009
region
Goals Section
Goal
Description
Status
Start Date
Updated by
Updated on
None Recorded
Health Concerns Section
Related Observation
None Recorded
Concern
Status
Updated by
Updated on
None Recorded
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711477275.638846 | Brandon Gutierrez |
ORTHOPAEDIC ASSOCIATES OF CORPUS CHRISTI
601 Texan Trail, Suite 300, Corpus Christi, Texas 78411
Telephone #: Fax #:
Preop Form
Name:
ELMA TREJO
DOB: 05-12-1991
SSN: 45796xxxx
Address: 601 HUGHES AVE
Room:
8
MRI:
Rad Ass 10-15-2015
ALICE, TX
78332
Phone:
Order: 1st
Clearance: cleared- Dr. Kapasi
361xxxxxxx
Ins: CENTENE-ALLWELL
Table: 4 poster jackson
Assist: Brandon Harris, Cert 1st
Hosp: SPOHN SOUTH
Cell Saver: yes
Home Health:
??
Arrival: 5:30 AM
Brace:
LSO- in hosp
1st postop: 02-17-2023
Date of Surgery: 10-01-2020
Xray:
02-17-2023 2V LUMBAR!!
PCP:
Lies: Francispo Rodriguez RNP-BC-CONVIA
Diagnosis:
Minimal thoracolumbar scoliosis, grade 1 L2 and L3 retrolistheses, grade 1 L4
spondylolisthesis, L4 and L5 degenerative disc disease
Procedure: L3, L4, and L5 laminectomies, radical L4 and L5 discoidectomies, transforaminal
lumbar interbody fusions at L4 and L5, internal fixation with PEEK cages, L3 to
sacrum posterolateral intertransverse fusion with local and iliac autograft.
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711472286.531536 | Sandra Reyes |
Sandra Reyes
MRN: 5606513
06/05/2023 - Telephone in MultiCare Rockwood Orthopedics & Sports Medicine
MultiCare Health System
patient: Sandra Reyes
MRN: 5606513
CSN: 296658619
Account Information
Admit Date
HAR#
Pt Class
Hospital Svc
Bed
31/18/03
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
date of birth:
22/86/10 (50 yrs)
United Parcel Service
Sex:
male
Marital Status:
Significant Other
RIVER VIEW CORPORATE
Sandra Reyes
CENTER
MRN: 5665313, date of birth: 22/86/10, Sex: M
16201 East Indiana Ave
DATE OF VISIT: 07/18/11
SPOKANE VALLEY WA 99216-
1882
Page 20
Printed by 414221 at 7/17/23 9:40 AM
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711477090.318947 | Michele Mckay |
IVICIN
2710 Napoleon Avenue
Morgan Rocha
New Orleans LA 70115
MRN: 1105310, DOB: 1990/31/07, Sex: F
Acct #: 10002782510
Adm: 2023/22/07
2018/10/05 - ED in Baptist - Emergency Dept (continued)
Scans for Entire
Hospital Authorization - Electronic signature on 2014/15/04 7:21 AM (effective from 2017/18/10) - E-signed
Karen Marie Johnson
Ochsner
MRN: 1105310
DOB: 1990/31/07
Health
Age: 59 y.o.
Sex: female
HOSPITAL AUTHORIZATION
A.
Health Consent for Examination and Treatment: I hereby authorize the providers and employees of Ochsner
System ("Ochsner") to provide medical treatment/services which includes, but is not limited
not performing limited and administering tests and diagnostic procedures that are deemed necessary, including, to, but
the to, imaging examinations, blood tests and other laboratory procedures as may be required by
special instructions of my physician(s).
1.
I understand and agree that this consent covers all authorized persons, including but not limited to
residents, nurse practitioners, physicians' assistants, specialists, consultants and independently
procedures and medical or surgical treatment.
contracted physicians who are called upon by the physician in charge to carry out the diagnostic
2. I hereby authorize Ochsner to retain or dispose of any specimens or tissue, should there be such
remaining from any test or procedure.
Generated on 2017/18/10 4:20 PM
Page 110
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711476072.120267 | Brenda Holt |
2022 September 12 12:49 FROM- CWFMD
936-703-5455
T-256 P0098/0111 F-240
Fax completed form to: 1-855-633-7673
SILVER/SCRIPT Submitted
Questions, please call: 1-866-235-5660
24 hours a day 7 days a week
(TTY users call: 1-866-236-1069)
online 5.18.16
Request for Coverage of a Non-Formulary Drug
Patient Information
Prescriber and Pharmacy Information
Name Brenda Holt
Name Joshua Dubose
Member ID
Specialty Family Practice
Medicare ID
DEA
Date of Birth 1988 June 28
Sex: M
NPI
1,700997665
Address 14570 TRERO LANE
Address 804 West Montgomery
City WILLIS
City Willis
State TX
ZIP 77378
State TX
ZIP 77378
Fax (936) 890-9008
Nursing Home Resident?
YES / NO
Pharmacy name Walgreens
Home care patient?
YES / NO
If no available formulary alternatives have been previously tried, please check this box.
I
attest that the information provided 1900 othis fonm nature and accurate as of this
date:
Prescriber's signature:
Date: 2018 June 10
5246-24762a 011912
Y0080_APLS_50096_2013
Name: Brenda Holt
DOB: 1988 June 28
Date:
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711472786.858258 | Donald Anderson |
Virginia Cancer
Specialists
Specializing in Cancer and Blood Disorders
LOCATION: VCS Loudoun
PATIENT NAME: Donald Anderson
MRN: 387680
dob: 1990 Aug 03
ATTENDING PHYSICIAN: Dr Tiffany Walker
DATE OF SERVICE 2023 Jul 07
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_1711476893.101983 | John Cruz |
131 3274625
Reset Form
Print Form is
STATE OF CALIFORNIA
Division of Workers' Compensation
Disability Evaluation Unit
EMPLOYEE'S DISABILITY QUESTIONNAIRE
DEU Use Only
This form will aid the doctor in determining your permanent impairment or disability. Please compl猫te this form and
give it to the physician who will be performing the evaluation. The doctor will include this form with his or her report
and submit it to the Disability Evaluation Unit, with a copy to you and your claims administrator.
Employee
Florentino
First Name
MI
Mejia
Last Name
SSN (Numbers Only)
1624 Travion Court #1, Fairfield, CA 3274625
Street Address 1/PO Box (Please leave blank spaces between numbers, names or words)
International Address (Please leave blank spaces between numbers, names or words)
Fairfield
CA
94533
City
State
Zip Code
Date of Birth
21 August 2003
MM/DD/YYYY
Date of Injury
09 October 2019
MM/DD/YYYY
Chevy's
Employer
Restaurant
Nature of Employers Business
Claim Number 1
0024060013b6wc01
DWC-AD form100 (DEU) Page 1 (REV. 11/20328)
376
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711475621.03763 | Terrance Schultz |
Associates MD
Terrance Schultz, 20 Y,M, 21/02/92
4780 Davie Road, STE 103, Davie, FL 33314
786-253-8738
CUMULATIVE REPORTS
Urine Test, Dip Stick
COLLECTION DATE
07/03/21
Order Date
20/08/21
Result Date
20/10/15
Ordering Physician
Carlos G Levy
Color
YELLOW
Appearance
CLEAR
SG
1.020
pH
6.0
Protein
NEG
Glucose
NEG
Bili
NEG
Ketones
NEG
Blood
2+
Urobili
NEG
Nitrites
NEG
WBC
NEG
Terrance Schultz, 21/02/92
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711475620.318824 | Scott Hansen |
Scott Hansen DOB: 09/1995/08 (56 yo M) Acc No. 42568
03/2017/02
Scott Hansen DOB: 09/1995/08 (56 yo M) Acc No. 42568 DOS: 12/2020/14
97140 MANUAL THERAPY, Modifiers: 59
72040 X-RAY OF CERVICAL SPINE 3 view
72070 X-RAY OF THORACIC SPINE AP/LAT
72100 X-RAY OF LUMBAR SPINE 2 view
Follow Up
2 - - 3 Days
Electronically signed by Dr. Nicholas DiGerolamo Jr, DC on 04/2023/06 at 01:40 PM CDT
Sign off status: Completed
Visit Status: CHK (Check Out)
Provider: Matthew Laudun, D.C.
Date: 12/2023/08
Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
Scott Hansen DOB: 09/1995/08 (56 yo M) Acc No. 42568
Page 30 of 47
| what is the DOS or D.O.S? | {"text": ["12/2020/14"], "answer_start": [132]} |
id_1711473365.938117 | John Moran |
Date 16/08/01
Occupational Health A Northbay Affiliate
Page
]
1101 B. Gale Wilson Blvd, Suite 203
Fairfield, CA 94533
(743) 643-4430. Fax: (743) 436-4431
Work Status Summary
Provider:
Lederer, Sheila PA
Visit Date:
19/05/01 Time In: 9:22AM Out: 10:23AM
Purpose:
Worker's Comp Follow Up
Presenting Problem
DATE OF INJURY:
21/05/24
Case Number: 2043-04302
Diagnosis
E885.9
Ulcerative Colitis
Visit Referrals
Referred To: A Referral
Date: 6/22/12
Referred To: A Physician Referral - NOS
Date: 6/22/12
231
| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711472591.400492 | John Perry |
Salinas Valley
John Perry
Medical Clinic
MRN: 3126218, date of birth: Apr 19, 1995, Sex: F
SUPUS BALLEY MEMORAL REALINONA extra
VISIT: Dec 28, 2019
Jan 02, 2024 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: Mar 10, 2022
Status: Signed
Editor: Schumann, Steven C, MD (Physician)
Service Date:
[SS.1T]
Mar 28, 2022 [SS.21
HPI:
[SS.1T]
Araceli Corona SS.2T] is [SS.1T] 22 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 Procedure Date? | {"text": [], "answer_start": []} |
id_1711475741.071867 | Mark Tate |
Mark Tate DOB: 2000 Apr 29 (73 yo M) Acc No. CR595865
[Doc Name: Othro One DOS 2016 Mar 21 - 5.20.22-]
4933 University Blvd W
Jacksonville, FL32216
ADVANCED
Upright Open MRI & X-Ray
DIAGNOSTIC GROUP
High Field MRI
Tampa
Brandon
Lakeland
Kissimmee
Orlando
Jacksonville
Orange Park
Palm Beach Gardens Jupiter
PATIENT MR#: 8381391
PATIENT ACCT#:
PATIENT NAME: Mark Tate
DATE OF BIRTH: 2000 Apr 29
REFERRING PHYSICIAN:
EXAMDATE: 2017 Aug 09
ACCESSION NUMBER: 5958673
EXAMDESCRIPTION MRI LEFT ANKLE
CLINICAL HISTORY: Slip and fall 01/19/2022, ankle and foot pain.
TECHNIQUE: Multisequential multiplanar imaging was performed of the left ankle
and hindfoot in a high-field MRI.
FINDINGS:
Abnormal marrow signal intensity in the lateral aspect of the calcaneus near the
plantar surface as well as along the dorsal surface of the navicular bone. More
significant abnormal signal intensity throughout the 2nd cuneiform bone, but
especially the dorsal surface with some irregularity of that surface.
IMPRESSION:
1.
Some abnormal marrow signal intensity in the lateral aspect of the calcaneus
and along the dorsal surface of the navicular bone appears to represent marrow
edema related to bone contusion without obvious fracture line. More significant
abnormal signal intensity in the 2nd cuneiform bone, especially along the dorsal
surface with some irregularity of that surface.
2.
Degenerative changes, as noted. No disruption of the major ligamentous or
tendinous structures including the Achilles tendon. No malalignment of the
tarsometatarsal joints.
Page 1 of 2
Mark Tate DOB: 2000 Apr 29 (73 yo M) Acc No. CR595865
Page 162 of 166
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711475741.30781 | Evan Kane |
A
The Gables Surgical Center
11/2.
Patient Name: Evan Kane Date of
Procedure:
2021-11-25
Diagnosis: M53.86, MUS.06, M47.26
ICD 9: M53.86, M48.06CPT: 22558
Procedure:
MU7.26.
Consent To Read: L45 interbody fusion with
bilateral pedical screws
Patient Address: asoo SW 48 St
City: Miami
State: FL
Zip: 33165
D.O.B: 1994-09-17 Age:
47.
Sex: M/F
Requires Transportation: ( ) Yes () No
Insurance Co. Name:
OMNi Atty: Edersy Suarez
Policy No:
Group No:
786-420-2893
Phone No:
Referral - Authorization No:
Worker's Comp ( ) Yes ( ) No Date of injury:
2022-02-16
Claim No:
Adjuster:
leonard - No: Cannula
Instrumentation:
Type of
Anesthesia: General
Local
LOC/Sed
Regional
Choice
PRE - OP ANTIBIOTICS
PHYSICIAN SIGNATURE DR. JACObson & DR. Berti
The Gables Surgical Center
401 SW Lejeune Road, Suit 201
Miami FI 33134
Telephone: 305-447-0882 Fax 305-447-0213
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711472787.182747 | Jamie Bryant |
Northwell
Health
Physician Partners
Name:
Jamie Bryant
VISIT: 05/17/09
Address:
2433 COOPER DRIVE
MRN: 70877973
EAST MEADOW, NY 11434
D.O.B: 02/89/06
Reason For Visit
Jamie Bryant 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 (343.28) (F43.23)
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 (436) 495-4393 Fax (543) 435-5433
| What is Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711475190.455539 | Jennifer Elliott |
NOVANT
NOVANT HEALTH MEDICAL
Jennifer Elliott
N
PARK HOSPITAL
MRN: 55824587, birthdate: 1994/21/09, Sex: M
HEALTH
1580 South Hawthorne Road
Adm: 2021/24/07, D/C: 2021/23/08
Winston-Salem NC 27583-3582
2022/17/11 - Admission (Discharged) in NHMPH Surgical Services (continued)
Results
Imaging:
No results found.
Electronically signed:
Dr Scott Wilson, MD
2017/06/11 / 3:35 PM
Electronically signed by Brandon L Craven, MD at 10/20/22 1536
Op Note
Brandon L Craven, MD at 10/20/2022 1639
Author: Brandon L Craven, MD
Service: Urology
Author Type: Physician
Filed: 10/20/22 1641
service date: 2021/18/04 1639
Status: Signed
Editor: Brandon L Craven, MD (Physician)
NOVANT HEALTH MEDICAL PARK HOSPITAL
Operative Note
Surgery Date: 2014/01/10
Generated on 4/11/23 8:32 PM
Page 254
| what is the DOB or date of birth? | {"text": ["1994/21/09"], "answer_start": [102]} |
id_1711476578.061727 | Joy Gonzalez |
BAYLOR SCOTT & WHITE
Williams, Charles Eugene
+
BaylorScott&White
HEART AND VASCULAR
MRN: 9211614, DOB: 1984-10-16, Sex: M
HEALTH
HOSPITAL - DALLAS
Acct #: 33410308841
641 N HALL ST
Admitted 2015-06-23. D/C 2015-07-23
DALLAS TX 754126-1341
2022-05-05 - Admission (Discharged) in Baylor Scott & White Heart and Vascular Hospital - Dallas (continued)
Treatment Team (continued)
User
Date/Time
Action
Provider
Role
ED
Reeves, Vanessa P
2022-05-05 1315
Add
Donsky, Alan Stuart, MD
Attending
No
Events
Admission at 2015-06-23 0920
Unit: Baylor Scott & White Heart and
Room: DSH BHVH EP LAB POOL ROOM Bed: NONE
Vascular Hospital - Dallas
User: Clark, Belinda
Patient class: Hospital Outpatient Surgery
Surgery at 2021-07-06 1207
Unit: BHVH_EP_LAB
Room: DSH EP ROOM 4
Patient class: Hospital Outpatient Surgery
Discharge at 2015-07-23 1653
Unit: Baylor Scott & White Heart and
Room: DSH BHVH EP LAB POOL ROOM
Bed: NONE
Vascular Hospital - Dallas
User: Entwisle, Samantha Lynn
Patient class: Outpatient in a Bed
Medication List
Printed on 2019-09-08 10:22 AM
Page 41
75241-68
Baylor Scott & White Heart & Vascular Hospital - 00041
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711476767.618702 | Adam Ibarra |
04-01-2014 08:30
1 12
>>
unknown
P 3/59
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: Dennis Krueger, PA -Author on 04-30-2021 02:47:58 PM
[Digital Signature Validated]
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711476893.196824 | Kelly Gonzalez |
.3
I declare under penalty of perjury that this report is true and correct to the best of my knowledge and that I have not
violated Labor Code 139.3.
Primary Treating Physician: Christine Frost, MD
Date of Exam: Apr 11, 2017
CA License #: A24311
Specialty: Urgent Care
Address:
558 ABBOTT ST STE A
Telephone:
Phone: 831-Random_7_digit_number
SALINAS CA 93901-4320
Dept: 831-Random_7_digit_number
Dept Fax: 831-755-7886
Signature: Steven Schumann
Date: May 08, 2014
241
GB IA Recv 2021121980760
Received Mar 03, 2020
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711476578.449863 | Jeremy Lopez |
BRAVE HEALTH INC . 1960 NW 7th Avenue, Suite 300, MIAMI FL 36036-1160
OWENS, Shannon (id #92960, dob: 15/95/05)
Return to Office
Patient will return to the office as needed.
Encounter Sign-Off
Encounter signed-off by Eric Collins, Joel Richardson, 22/20/08
Encounter performed and documented by Eric Collins, Joel Richardson
Encounter reviewed & signed by Eric Collins, Joel Richardson on 22/20/08 at 7:21pm
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711475955.885085 | Lawrence Singleton |
20/05/22 13:59 FROM- CWFMD
936-703-5455
T-240 P0073/0078 F-226
Page 1 or 2
Conroe Willis Family Medicine PLLC
Lawrence Singleton
Order Date: 09/07/21
4015 145 North
14570 Trero Lane
Order #: PRO36382
Conroe, TX, 773045074
Willis, TX, 773784394
Person #: 744, MRN: 5211
Sex: F
DOB: 14/10/01
Ordering: Dubose PA-C, Joshua
Performing #: LabCorp
Location: Willis CWFM 1
Component
Result Units
Flag
Range
Comment
Result 1
No
growth
Urine Culture, Routine
Final
report
Urinalysis, Complete (Collection Date: 10/04/19 14:50. Status: Final)
Performed At: 01, LabCorp Houston
7207 North Gessner, Houston, TX, 770403143
Kyle, Eskue, MD, Phone: 7138568288
Component
Result Units
Flag
Range
Comment
Microscopic Examination
Microscopic Examination (Collection Date: 10/04/19 14:50, Status: Final
Performed At: 01, LabCorp Houston
7207 North Gessner, Houston, TX, 770403143
Kyle, Eskue, MD, Phone: 7138568288
Patient: Lawrence Singleton, DOB: 14/10/01
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711476766.192062 | Paul Lee |
Bethesda Hospital West
2815 S. Seacrest Blvd
9655 Boynton Beach Blvd
Boynton Beach, FL 33xxx
Boynton Beach, FL 33xxx
Patient Name: Anthony Patel
MR#: 111786869
DOB: 1999-06-07
Account#: 2521037694
Date of Admission: 2023-07-25
Sex: F
Attending Physician: 79369
Facility: BMH
Ordering Physician: 79369
Collection Date and Time: 2016-05-15 12:05
Service Date: 2016-12-10 12:05
eBlood Bank
TEST NAME
RESULT
UNITS
RANGES
ABN FL ST
ANTIBODY SCREEN
NEG
F
NEG
Page 1 of 1
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711471330.615189 | Jonathan Williams |
Patient Name: Jonathan Williams
Date of Encounter: 17-09-08 1:01PM MRN: 710-071-787
The patient was guided through neuromuscular reeducation exercises one on one with the physical therapist and/or student physical
therapist. The neuromuscular reeducation included exercises to improve movement, balance, coordination,
kinesthetic sense, posture, and proprioception. The neuromuscular reeducation exercises were instructed
to be performed in a pain free manner. The time of neuromuscular reeducation includes preparation of each
activity, patient education and training of each task, performance of the exercise, and post-assessment of
patient's performance.
Visit Type: Progress Note
Procedure Charges:
Therapeutic Exercises: 1 units 33 minutes
Therapeutic Activities: 1 units 33 minutes
Signatures
SIGNATURE : Jessica Foster, PT; Dec 12
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711475955.481326 | 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 DOS or D.O.S? | {"text": ["2022-11-19"], "answer_start": [703]} |
id_1711477275.611282 | Lauren Lopez |
CHRISTUS Spohn Hosp South
5950 Saratoga Blvd.
Corpus Christi, TX 78414
ADMISSION/SERVICE DATE
TIME
DISCHARGE DATE
TIME
ACCOUNT NUMBER
16/05/16
1554
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: 01/09/15
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 the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711472286.467356 | Jason Taylor |
Sunrise Health
Jason Taylor
MRN: 000049169003, BIRTH DATE: 17 August 1999, Sex: F
10/04/2017 - ALLIED HEALTH/NURSE VISIT - MH/BH in PSYCHIATRY (continued)
Jason Taylor (MR # 000014969003)
Page 1 of 2
After Visit Summary
Jason Taylor
10/4/2017
MRN: 000014969003
Visit and Patient Information
Visit Information
Date & Time
Provider
Department
11 May 2021 5:00 PM
ELIZABETH BOEHNING WHITE LCSW
Psywlcwm Psy
Visit Summary
Vitals
LMP
11/21/2014
Health Problems Reviewed
None.
Medications
Kaiser Permanente, SCPMG: Jason Taylor (000014969003)
Page 1 of 2
Printed on 3/16/23 7:41 AM
Page 72
108/150
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711471330.732701 | Mary Miller |
Mary Miller (MR # 53500146) DATE OF BIRTH: 10/2001/31 Age: 68 yrs
Enc Date: 02/2019/03
Therapy Treatment
No treatment plans exist
Medications at End of Encounter
Paracetamol (Taking) Take by mouth
Medication Documentation Review Audit As Of This Encounter
Reviewed by Dr Walter Rodriguez, MD on 10/09/17 at 1835
Encounter Status
Closed by Dr Walter Rodriguez, MD on 10/9/17 at 6:35 PM
Go to the IP MAR Infusion Coder's Report.
All Charges for This Encounter
Code
Description
DATE OF SERVICE
Service Provider
Modifiers Qty
99214
PR OV EST PT LEV 4
10/2022/27
Dr Walter Rodriguez, MD
1
WC002
PR PR2 TREAT MD PROGRESS REP 10/2022/27
Dr Walter Rodriguez, MD
1
FORM
Mary Miller (MR # 53500146) Printed by [S124212] at 10/11/17 8:52 AM
Page 3 of 3
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711477090.749425 | 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 Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711475620.382844 | Linda Lee |
Linda Lee DOB: 1993-24-11 (17 yo M) Acc No. 39964 Doc Name: Linda Lee P300
This Progress Notes documentation is IN PROGRESS
49
LA Health Solutions
LA Health Solutions, LLC
Baton Rouge LaPlace Kenner Metairie Uptown Westbank New Orleans East Slidell
Mandeville
Neurophysiology Report
Full Name: Linda Lee
Gender:
Male
Patient ID: 0017
Date of Birth: 1993-24-11
Visit Date:
2018-14-11 2:39 PM
Examining Physician: Jonathan Jones, MD
Conclusion:
Jonathan Jones, MD
Linda Lee DOB: 1993-24-11 (17 yo M) Acc No. 39964 Doc Name: Linda Lee P300
Page 9 of 38
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |
id_1711471329.145246 | Mary Mccoy |
00061
RE: Mary Mccoy
DOS: 2017-08-29
Page 7 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
61 degrees
60 degrees
Ulnar deviation
30 degrees
60 degrees
Radial deviation
25 degrees
20 degrees
Pronation
80 degrees
73 degrees
Supination
66 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
77103345333
Received 2016-02-26
| What is Ordered Date? | {"text": [], "answer_start": []} |
id_1711475620.349484 | Kenneth Wallace |
Kenneth Wallace DOB: Jul 23, 2000 (33 yo M) Acc No. 67605
Aug 13, 2015
Kenneth Wallace DOB: Jul 23, 2000 (33 yo M) Acc No. 67605 DOS: Oct 20, 2015
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 Apr 29, 2018 at 01:05 PM CDT
Sign off status: Completed
Visit Status: CHK (Check Out)
Kenneth Wallace DOB: Jul 23, 2000 (33 yo M) Acc No. 67605
Page 23 of 47
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711475741.046402 | Adam Mcdonald |
Adam Mcdonald DOB: 30 Nov 1998 (40 yo M) Acc No. CR165247
[Doc Name: 16 May 2015 MRI LUMBAR SPINE]
4933 University Blvd W
Jacksonville, FL32216
ADVANCED
Upright Open MRI & X-Ray
DIAGNOSTIC GROUP
High Field MRI
Tampa . Brandon . Lakeland . Kissimmee . Orlando . Jacksonville . Orange Park . Palm Beach Gardens - Jupiter
PATIENT NAME: Adam Mcdonald
PATIENT ID: 4167393
REFERRING PHYSICIAN: AMY WU, PA-C
DOB:
30 Nov 1998
REFERRING PHONE:
DOS:
29 Nov 2014
REFERRING FAX:
EXAMINATION: MRI LUMBAR SPINE WITHOUT CONTRAST
GEORGE VEGA, MD
Electronically signed on: 15 Apr 2014 9:10:40 AM
Transcribed by: JN on: 15 Apr 2014 7:12:17 AM
L3-51
Page 2 of 2
Adam Mcdonald DOB: 30 Nov 1998 (40 yo M) Acc No. CR165247
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711472591.396725 | Tammy Horton |
Salinas Valley
Tammy Horton
Medical Clinic
MRN: 3192366, DOB: 1999 December 22, Sex: F
SUPUS BALLEY MEMORAL REALINONA extra
Visit: 2014 December 15
2023 November 21 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
date of encounter: 2018 May 12
Status: Signed
Editor: Schumann, Steven C, MD (Physician)
service date:
[SS.1T]
2017 November 07 [SS.21
HPI:
[SS.1T]
Araceli Corona SS.2T] is [SS.1T] 19 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 Collection Date? | {"text": [], "answer_start": []} |
id_1711476578.062617 | Cynthia Jordan |
BAYLOR SCOTT & WHITE
Williams, Charles Eugene
+
BaylorScott&White
HEART AND VASCULAR
MRN: 9211614, DOB: 91/10/11, Sex: M
HEALTH
HOSPITAL - DALLAS
Acct #: 33510308851
651 N HALL ST
Admitted 14/05/20. D/C 14/06/19
DALLAS TX 755126-1351
23/04/17 - Admission (Discharged) in Baylor Scott & White Heart and Vascular Hospital - Dallas (continued)
Treatment Team (continued)
User
Date/Time
Action
Provider
Role
ED
Reeves, Vanessa P
23/04/17 1315
Add
Donsky, Alan Stuart, MD
Attending
No
Events
Admission at 14/05/20 0920
Unit: Baylor Scott & White Heart and
Room: DSH BHVH EP LAB POOL ROOM Bed: NONE
Vascular Hospital - Dallas
User: Clark, Belinda
Patient class: Hospital Outpatient Surgery
Surgery at 21/12/29 1207
Unit: BHVH_EP_LAB
Room: DSH EP ROOM 4
Patient class: Hospital Outpatient Surgery
Discharge at 14/06/19 1653
Unit: Baylor Scott & White Heart and
Room: DSH BHVH EP LAB POOL ROOM
Bed: NONE
Vascular Hospital - Dallas
User: Entwisle, Samantha Lynn
Patient class: Outpatient in a Bed
Medication List
Printed on 17/01/02 10:22 AM
Page 51
75251-68
Baylor Scott & White Heart & Vascular Hospital - 00051
| What is the Date of Discharge? | {"text": ["14/06/19"], "answer_start": [224]} |
id_1711473365.881484 | Gabriel Hall |
To: 9549226864
From: 8139931818
10-26-23 11:56am p. 3 of 20
Page 2 of 4
Advent Health
Wesley Chapel
Dr Michael Walton, M.D.
Laboratory Report
patient name: Gabriel Hall
COLLECTED ON: 19-11-2017 Collected Time: 09 23
CNP
PROCEDURE
RESULT
UNITS
REF RANGE
Sodium
140
133-143
COLLECTED ON: 19-11-2017 Collected Time: 09:23
Laboratory Results Legend: @=Abnormal *=Comment c=Corrected
Admit: 17-09-2019
Patient: Gabriel Hall
Sex
:
F
birth date:
30-05-2000
PrintDT: Nov 11. 2022 9:43:05 AM
Copies to: None
Page 2 of 4
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711471328.71748 | Amber Norris |
Harbor Community Health
1965 Johnson Parkways Suite 652
Coxport, PA 14018
118-635-3460
PATIENT NAME:
Amber Norris
MRN;
6681544
Admit:
18/03/2018
FIN:
64364921849
Disch:
birth date/Age/Sex: 12/04/1992
81 years
Female
Admilting: Dr Amy Fisher, MD
Location:
OPDC MR
Magnetic Resonance Imaging
Accession
Exam Date/Time
Exam
Ordering Physician
Patient Age at Exam
MR-23-0072913
01/10/2017 15:27 EST
MRI Lower Joint w/o
Dr Amy Fisher, MD 81 years
Contrast Right
Reason for Exam
(MRI Lower Joint w/o Contrast Right) Trochanteric bursitis of right hip; right hip pain
COMPARISON:
None.
FINDINGS:
Bones: There Is no fracture, dislocation, or contusion. The bone
marrow signal Is normal.
Articular Cartilage: Not well evaluated in the absence of intra
contrast.
Tendons: Gluteus minimus tendon is intact.
Report Request ID: 6681544
Page 23 of 99
Print Date/Time: 2/24/2023 15:27 EST | what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711475955.854901 | Melissa Stanley |
11-04-2015 14:00 FROM- CWFMD
936-703-5455
T-240 P0075/0078 F-226
rage 1 01 4
Conroe Willis Family Medicine PLLC
Melissa Stanley
Order Date: 11-29-2014
4015 145 North
14570 Trero Lane
Order #: PRO28809
Conroe, TX, 773045074
Willis, TX, 773784394
Phone #: (936) 441-1122
Person #: 744, MRN: 5211
Sex: F
DOB: 05-21-2002
Ordering: Dubose PA-C, Joshua
Performing #: LabCorp
Location: Willis CWFM 1
Tests Ordered : CBC With Differential/Platelet (005009), Comp. Metabolic Panel (14) (322000), Hemoglobin A1c (00145
3), Lipid Panel (303756), Vitamin D, 25-Hydroxy (081950), Thyroid Panel With TSH (000620)
Vitamin D, 25-Hydroxy (Collection Date: 07-11-2016 14:34, Status: Final)
Performed At: 01, LabCorp Houston
7207 North Gessner, Houston, TX, 770403143
Kyle, Eskue, MD, Phone: 7138568288
Component
Result Units
Flag
Range
Comment
Vitamin D, 25-Hydroxy
52.6 ng/mL
30.0-100.0
Vitamin D
deficiency
intakes for
Patient: Melissa Stanley, DOB: 05-21-2002
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711471330.589336 | Crystal Landry |
Downtown Medical Center
Crystal Landry
MRN: 33773659, date of birth: 08/97/04, Sex: M
7604 Lauren Village
Justinstad, TN 92428
visiting date: 04/18/12
Result Summary (continued)
Documents - Encounter Level on 16/15/03: (continued)
Dr Frank Burns, MD
Phone: 714-503-6269
7604 Lauren Village
Justinstad, TN 92428
Please sign and return this page only by fax or mail.
Plan of Care Approval for Crystal Landry
Thank you for this referral.
Dean Harm is a good candidate for continued physical therapy services. Patient has been compliant to
home exercise program.
Respectfully yours,
Therapist Signature:
David Gonzales, PT, DPT PT60388818
03/15/06 9:13 pm
Plan of Care Approval
Total Visit Count: 5
Approval of the plan of care as documented
Changes to Plan of Care:
Hold therapy service until patient follows up at physician office.
Physician Signature:
Dr Frank Burns, MD
Approval Date:
16/18/01
Progress Evaluation for Crystal Landry
Page 6
date of birth: 08/97/04
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711472786.527391 | Christopher Le |
North County Physical Therapy
17815 Countryside Ct
Physical Therapy
Prunedale, CA 93407-8804
Initial
Phone: (831)404-5409
Fax: (831)663-4022
Examination
patient name: Christopher Le
Date of Initial Examination: 2020/24/01
birthdate: 1998/19/11
Injury/Onset/Change of Status Date: 2019/03/10
Referring Physician(s): Dr Todd Drake MD
Diagnosis: ICD10: S32.2XXA: Appendicitis
Visit No.: 1
Treatment Diagnosis: ICD10: S32.2XXA: Pneumonia,
Subjective
History of Present Condition/Mechanism of Injury: Patient states she did not fracture her coccyx although that is her official
diagnosis on the Worker's Comp. forms.
Pain Location: Left SI
Pain Scale: Worst: 8 Best: 3 Current: 5
Pain Description: Sharp
Medical History: No Known Significant PMH To Affect Treatment
Objective
Inspection
Patient Consent
Patient/Parent/Guardian Consent
Yes
1 of 3
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| what is the admit date or admission date? | {"text": [], "answer_start": []} |
id_1711472285.690868 | 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 the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711475444.556163 | Cameron King |
13/05/2015 FROM- CWFMD
T-252 P0024/0063 F-236
DISCHARGE INSTRUCTIONS
Cameron King
BH9026517790/BH00288051
For Patients Who Smoke
You should quit. It is the most important thing you can do for your health.
Here are other FREE resources you can use.
The American Cancer Society:
1-800-227-2345
The American Lung Association:
1-800-548-8252
Internet site:
http://smokefree.gov
DISCHARGE MEDICATIONS
Please refer to the discharge medication list provided by the nurse at the time of
discharge. Please be sure to take this list with you to your next physician office
visit.
I understand that a copy of my home medication list as well as the medications I received
during this hospital stay will be provided to my next health care provider.
HCA Houston Conroe
Name :
PRICE,ERICA NICOLE
Acct #: BH19298859200
Room/Bed: B.265/1
Unit #: BH00288051
admission date: 29/12/2019
Admit Physician: Punsalan, Tricia Leonora
Name: Cameron King
DOB: 05/06/1988
Date:
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711473238.084179 | Sarah Walton |
NO. 2001 E. 27 /
Patient Name: Sarah Walton
service date: 27 Dec 2015
The C1-2 articulation is unremarkable in appearance.
The cervical spinal cord is normal in size and appearance. No abnormal signal intensity is noted in
the cervical spinal cord.
Normal alignment of the cervical spine is identified.
IMPRESSION
Loss of the normal lordotic curve of the cervical spine is identified, and this is associated with
muscle spasm secondary to soft tissue injury.
Signature
Electronically Signed: Dr Brooke Camacho, M.D. on 22 May 2020, 3:19 PM
2
| what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711475190.352675 | Craig Barnes |
<<Back to Review>>194126-3-HYPERLINK- - Hyperlink-Page
187
Craig Barnes
KAISER PERMANENTE庐
MRN: 110414041841, D.O.B: 04/07/87, Sex:
F
SSN: xxx-xx-3414
Visiting Date: 02/03/22
13/03/16 - 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 21/02/16 10:26 PM
Generated on 4/6/22 11:06 AM
000187
0186
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711472786.577226 | Walter Gallagher |
North County Physical Therapy
Patient name: Walter Gallagher
17815 Countryside Ct
Physical Therapy
D.O.B: 04 March 1988
Prunedale, CA 93587-8584
Document Date: 11/08/2022
Initial
Phone: (831)584-5589
Fax: (831)658-9582
Examination
Treatment to be provided:
Procedures
Therapeutic Exercises (ROM, Strength, Endurance), Neuromuscular Rehabilitation (Muscle Re-Education, Sequencing,
Coordination, PNF),
M
Michael C Nease, MPT
PT25821 for State of CA
ELECTRONICALLY SIGNED BY Michael C Nease, MPT on 16 September 2015 at 1:24 am
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367
GB IA Recv 2022581925839
Received 12/19/2022
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711471330.764695 | Catherine Lindsey |
Oceanside Medical
55381 Robert Dam
Markhaven, CO 45839
State of California
Division of Workers' Compensation
PRIMARY TREATING PHYSICIAN'S PROGRESS REPORT (PR-2)
Reason: Followup
DATE OF SERVICE: 18/22/11
Patient:
Last Name:
First Name:
MI:
date of birth:
Mullins
Catherine Lindsey
R
08/91/09
Address:
958 Sanchez Circles
Joshuafort, CA 79737
Occupation (Specific job title)
SSN:
Date of Injury:
INFORMATION TECH
446-62-8178
16/19/02
Subjective:
The patient reports that her low back pain has gotten better. Still has the pain in her right hip and
right knee.
Objective findings:
LS: There is tenderness over the right lumbosacral paraspinous muscles and over the right gluteal
area by the hip. There is no tenderness over the trochanteric bursa.
Diagnoses: (K64) Rheumatoid Arthritis
792
| What is the Date of Discharge? | {"text": [], "answer_start": []} |
id_1711475741.481406 | Dr. Gregory Sellers |
Dr. Gregory Sellers DOB: 1989-01-11 (60 yo M) Acc No. CR748117
2015-06-01, 9:09 AM
JAX SPINE & PAIN CENTERS
Courtney Delaparte, APRN
5191 FIRST COAST TECH PKWY THIRD FLOOR
Nurse Practitioner
JACKSONVILLE, FL 32224-0609
Tel: 904-223-3321 Fax:
Patient:
Dr. Gregory Sellers
2015-06-01
DOB:
1989-01-11, Sex: Male
Address:
1329 SOARING FLIGHT WAY, JACKSONVILLE, FL 32225-6828
Phone:
904-887-5708
Ordered Date:
2016-03-20
Assessments:
Lab:
OTHER
Fasting:
No
Specimen:
Clinical Info:
Name
Value
Reference Range
Carisoprodol
Cotinine
EtG
Gabapentin
Result:
Received Date:
Notes:
Patient Name: Dr. Gregory Sellers , DOB: 1989-01-11
file:///C:/Users/Emilym/AppData/Local/Temp/eCW.qini20at.emp/8f6cfce6-7098-4914-b013-deb0b635698c.htm
1/1
Dr. Gregory Sellers DOB: 1989-01-11 (60 yo M) Acc No. CR748117
Page 43 of 166
| What is signature date or signed on date? | {"text": [], "answer_start": []} |
id_1711476893.167915 | Autumn Townsend |
State of California
Division of Worker's Compensation
PRIMARY TREATING PHYSICIAN'S PROGRESS REPORT (PR-2)
Check the boxes which indicate why you are submitting a report at this time. If he patient is "Permanent and Stationary"
(I.e., has reached maximum medical improvement), do not use this form. You may use DWC Forms PR-3 or PR-4.
Periodic Report (Required 45 days after last report)
Change in treatment plan
Release from care
Change in work status
Need for referral or consultation
Response to request for informaton
Change in patient's condition
Need for surgery or hospitalization
Request for authorization
Other:
PATIENT:
Last:
Corona
First: Araceli
Middle:
Address: 1450 MADRONER DR
City: Salinas
State:
CA
Zip: 67553
Date of Injury:
Sex:
female
DOB:
1990/09/05
Occupation:
SSN: 617xxxx
Phone: 831xxxx
EMPLOYER NAME: Healthcare Services Group
Subjective Complaints: Worker's Compensation (WC DOI 12/721 BACK)
Diagnoses:
ICD-10-
CM
1. Lumbar strain, subsequent encounter
$39.012
D
Treatment Plan:
TREATMENT PLAN: Light work starting 12/15/2021. Physical therapy. Return 12/23/2021.
Orders Placed This Encounter
Ambulatory referral to Physical Therapy
DATE OF SERVICE:
2015/20/05
CHIEF COMPLAINT:
Chief Complaint
Patient presents with
Worker's Compensation
WC DOI 2021/31/01 BACK
GB IA Recv 2021122107346
Received 2017/01/03
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711472787.00711 | Kelly Dawson |
MedStar Georgetown University Hospital
patient name:
Kelly Dawson
Admit/Discharge: 01/2017/29
02/2017/28
Admitting Doctor: Kessler,MD,Craig Martin
Date of Birth: 11/1992/23 Age: 33 years
Sex: Female
Office/Clinic Notes
DOCUMENT NAME:
Hematology Office/Clinic Note
PERFORM INFORMATION:
Kessler,MD. Craig Martin (6/29/2022 13:36 EDT
RESULT STATUS:
Modified
SERVICE DATE/TIME:
06/2022/19 13:29 EDI
SIGN INFORMATION:
Kessler,MD. Craig Martin (02/2019/01 12:03 EDT): Kessler
MD,Craig Martin (7/16/2022 17:49 EDT)
Visit Date
Medications
Date of Visit: 01/2019/15
aspirin 0 Refill(s)
atorvastatin - mg tab, PO, Daily, 0 Refill(s)
Chief Complaint
fluticasone-vilanterol (Breo Ellipta 100
Easy bruising associated with possible von Willebrand disease
mcg-25 mcg inhalation powder) - 1 puff,
Print Date/Time:
10/2/2023 6:20 EDT
Report Request ID:
529758966
www.medstarhealth.org
Page 99 of 134
| what is the DOB or date of birth? | {"text": ["11/1992/23"], "answer_start": [179]} |
id_1711475444.635275 | Frederick Dalton |
From: DAVID GOLDMAN
Fax:
To:
Fax: (610) 354-8946
Page: 4 of 72
May 19, 2020 4:33 PM
Frederick Dalton
Visit Note - January 06, 2023
PMS ID:
Sex:
DOB:
MRN:
438-5647467272
Female
November 12, 2000
016804
Medications
OPHTHALMIC MEDICATIONS
Chief Complaint: Eye Irritation
NONE
extended release 24 hr
citalopram 40 mg Oral tablet
diphenoxylate-atropine 2.5-0.025 mg
Pt has not been using drops currently.
Oral - tablet
hydrochiorothiazide 25 mg Oral
Pt tried Restasis 2015, did not help (pt has no idea how long she used it for)
tablet
lorazepam 1 mg Oral tablet
No asthma, yes some seasonal allergies.
losartan 100 mg Oral tablet
S/P LASIK OU 2010
mirtazapine 15 mg Oral tablet
Pt has not tried plugs.
sumatriptan succinate 100 mg Oral
Pt states last eye exam 03/2019
tablet
temazepam 15 mg Oral capsule
Aimovig Autoinjector 70 mg/mL
On further history taking, pt has no grittiness, no burning, no irritation but pt's only complaints are a film over the vision
Subcutaneous auto-injector
OU that fluctuates (not like a floater or black spider web) and crusting (seldom) upon awakening
Last dilated exam over 1 year ago
Ocular History
Obtained and Reviewed December
28, 2020.
Allergic conjunctivitis
Tear film insufficiency
Eye Exam
Wears glasses
Vision
Distance Test Type: Snellen Chart
Mark Milner (Primary Provider) (Bill Under)
David A. Goldman MD LLC
Page 1
(561) 630-7120 Work
3502 Kyoto Gardens Dr
(561) 630-7122 Fax
Suite B
Palm Beach Gardens, FL 33410
| What is the Date of Evaluation? | {"text": [], "answer_start": []} |
id_1711471328.808794 | Cheryl Gutierrez | Forest Hill Hospital
Patient Name: Christina Schaefer
Forest Hill Hospital
MRN: 00076593, BIRTHDATE: 1991 June 23, Sex: M
Forest Hill Hospital
2716 Melissa Highway Suite 745
Michaelton, ID 47443
Acct #: 1182240
Patient Info
Patient Name
Account Number
Gender
BIRTHDATE (Age)
Cheryl Gutierrez (00076593)
1182240
Male
1991 June 23 (71 year old)
Patient Demographics
Address
Phone
4163 Anderson Stream
Theresatown, MP 91479
527-577-4803 (Home)
Emergency Contact(s)
Name
Relation
Home
Work
Mobile
Christina Schaefer
Girlfriend
527-577-4803
Epic Admission Information
Arrival Date/Time:
04/17/2018 1005
admission date/Time:
2022 August 01 1005
IP Adm. Date/Time:
Admission Type:
Emergency
Point of Origin:
Emergency Room
Means of Arrival:
Walk In
Primary Service
Emergency
Secondary Service:
Transfer Source:
Home
Service Area:
MEMORIALCARE
Unit:
CHLB EMERGENCY
SERVICE AREA
Admit Provider:
Attending Provider:
Dr Danny Thomas, MD
Referring Provider
Date of Discharge/Time
2022 August 31 1155
5 of 107
06/15/2021 | What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711475741.366167 | Nathaniel Lopez |
THE GABLES SURGICAL CENTER
401 S.W. 42nd Avenue, Suite 201
Miami, Florida 33134
Tel: (305) 447-0882 Fax: (305) 447-0213
OPERATIVE REPORT
PATIENT NAME: Nathaniel Lopez
MEDICAL RECORD #: 1199262
DATE OF BIRTH: 31/07/84
PHYSICIAN: ROBERT JACOBSON, M.D.
DATE OF SURGERY: 18/10/21
and expanded filling the cavity fo disc space across midline and expanding the colipase to the right. that
the position was across the midline. This crossed the disc space. This was removed. Then, an OptiMesh
was placed in the disc space and then 3.5 pipettes of bone was impacted into the disc space.
X
Aldo Berti M.D.
JOB#: 537954 RJ: med: anu/nss/im DD: 06/10/23
DT: 06/10/23
OPERATIVE REPORT - PAGE 2 of 2
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711471329.543379 | David King |
03 July 2014 0:9
98684548647
HEWITT ADMIN DEPT
PAGE 0/19
patient name:
David King
MRN: 25-153139
Encounter:
06 August 2019 11:15AM
Physical Exam
GENERAL: Patient in no acute distress. Tcarful throughout
HEENT: PERRLA, EOMI,conjunctiva normal, TMs normal, oropharynx clear
NECK: supple, no lymphadenopathy, normal thyroid.
LUNGS: Clear to auscultation bilaterally.
HEART: RRR, no murmurs.
ABDOMEN: soft, non-tender, without hepato-splenomegaly.
EXTREMITIES: No edema
NEUROLOGIC: Alert and oriented, grossly intact.
Assessment
Acute stress disorder (308.3)
Plan
As SX are work related, d/w pt eval by wep as well but she states that they have not helped her in the past
Advise 1 mo off work due to high stress at work
SSRI and psychotx d/w pt
She wishes to hold off starting SSRI at this time, but agrees to psychotx
Advise weekly or more tx in the first mo
f/u 1 mo or pm.
Signature
SIGNATURE : Dr Jeffrey Serrano MD; 30 July 2015 12:12 PM PST; Author.
2 of 2
MRN: 25-651409
2-3-2014
2013252242
44201503370194220
SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.
[6615313-01] 145
| What is the Date of Encounter or Enc? | {"text": ["06 August 2019"], "answer_start": [126]} |
id_1711475620.386135 | Brandon Powell |
Brandon Powell DOB: 88-09-28 (62 yo M) Acc No. 99125 Doc Name: Brandon Powell P300
This Progress Notes documentation is IN PROGRESS
49
LA Health Solutions
LA Health Solutions, LLC
Baton Rouge LaPlace Kenner Metairie Uptown Westbank New Orleans East Slidell
Mandeville
Neurophysiology Report
Full Name: Brandon Powell
Gender:
Male
Patient ID: 0062
Date of Birth: 88-09-28
Visit Date:
21-01-23 2:39 PM
Examining Physician: Jonathan Jones, MD
Conclusion:
Jonathan Jones, MD
Brandon Powell DOB: 88-09-28 (62 yo M) Acc No. 99125 Doc Name: Brandon Powell P300
Page 9 of 38
| what is the visit date or date of visit? | {"text": ["21-01-23"], "answer_start": [415]} |
id_1711475620.87303 | Mark Olson |
V
VITRO MOLECULAR
LABORATORIES
www.vitromolecular.com
Patient Name: Mark Olson
Physician: Robert Jacobson, MD
Accession #: S22-04715
Sex: Male
Specialty Group: The Gables Surgical Center
Collected: May 13, 2016
DOB: Apr 29, 1987 (69)
Received: May 13, 2016
Reference #: S22-04715
CC:
Reported: Mar 28, 2016
Surgical Pathology Report
Clinical History
Previous Vitro pathology report:
*S21-12983, Aug 27, 2017 A)Lumbar disc, L4-5; discectomy:Cartilage and disc material with degenerative changes;
*S21-15703, Oct 10, 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
Feb 20, 2017
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 Procedure Date? | {"text": [], "answer_start": []} |
id_1711472591.342397 | Robert Caldwell |
From dcatalyst16
18443858095
8/29/2022 10:58:59 PDT
Page 13 of 17
Dr Michael Johnson MD
Today's Date: 2015 December 12
RehabOne Medical Group, Inc.
All Clinics' US Mail Address: 13980 Blossom Hill Road, STE B Los Gatos, CA 97532
Industrial Injury Info:
BIRTH DATE:
2000 December 22
Adjuster: Jennifer Restori
Claim #
00548963781-WC-01
Phone # 916-757-7536
date of injury:
2017 April 19
Fax #
866-750-0758
Insurance: Gallagher Bassett (Corona)
Patient Info:
Address:
67552 Jennifer Cove
West Joshua, MS 66600
Phone (C): 831-750-3759
Pref. Lang.:
English
Diagnosis:
M75.17
Intervertebral disc disorders with radiculopathy, lumbosacral region
Case Type:
Work Compensation
176 Robert Caldwell : Aug 25, 2022
page 12
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711471329.088187 | Amy Johnson |
Central Regional Medical
USS Davis
FPO AP 41970
Workers' Compensation Medical Status Questionnaire
PATIENT: Amy Johnson
Today's date: 20/11/2017
Patient ID #: 0443351
DATE OF INJURY: 05/12/2022
Employer: FOOD LION
Carrier: RETAIL BUSINESS
SERVICES
Treating physician: Dr Crystal Glass
IC file: 2022224556
1. Diagnosis: Osteoporosis
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: 43LB 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 Christine Rogers, MD
Date: 21/03/2024
| what is the DOB or date of birth? | {"text": [], "answer_start": []} |
id_1711475444.73114 | Amy Rogers |
Feb 03, 2018 FROM- CWFMD
936-703-5455
T-252 P0053/0063 F-236
Methodist Server P11 Aug 01, 2016 4:53:01 PM ACST PAGE
2/002
Fax
Server
HOOSTON'
XR HIPS BILATERAL AP LATERAL W AP PELVIS
Methodist
LEADING MEDICINE
Amy Rogers
MRN: 108987192, Legal Sex Female, Dec 17, 1993 (51 yrs), Outpatient
Accession #: IM89569651
Final Result
Appointment Info
EXAMINATION: XR HIPS BILATERAL AP LATERAL W AP PELVIS
Exam Date
Jul 04, 2015
INDICATION: M25.552 Pain in left hip, M25.511 Pain in
right shoulder, M25,552 M25. 51
Department
COMPARISON: None
111-111-1111
4015 I-45 NORTH SUITE 120
IMPRESSION:
CONROE TX 77304-5076
No visible fracture or dislocation.
Reason for Exam
No significant joint space narrowing of the right or
M25.552 M25.51
left hips.
Bone island of the left femoral neck.
Diagnoses
Left hip pain
1SB1RAD_PS01
Right shoulder pain, unspecified
Signed by Trakhtenbroit, Michael Alan, MD on Jan 22, 2020 4:18 PM
chronicity
00
Amy Rogers MRN: 108987192 ACC: IM89569651 XR Hips Bilateral Ap Lateral W Ap Pelvis
Page 1 of 1
:
Name: Amy Rogers
DOB: Dec 17, 1993
Date:
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711472286.578313 | Michael Davis |
Michael Davis
MRN: 5602413
04/04/2023 - External Document in MULTICARE HEALTH INFORMATION (continued)
Injury Date:
Place of Injury:
2020-21-01 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
800-324-9919
253-424-4948
Tacoma WA 98245-3799
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: 5602413 , birth date: 1988-15-07, Sex: M
TACOMA WA 98424-0299
Date of Visit: 2019-05-01
Page 54
Printed by 414221 at 7/17/23 9:40 AM
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711471328.848455 | Paul Silva | patient
Paul Silva
Gender
Female
MR #
0009611028
Admission Date/Time
11/05/2023 7:11:00 AM
Reg #
045467338596
Visit Status
DSC
D.O.B
03/05/1993 12:00:00 AM
discharge date/Time
10/06/2023 9:31:00 PM
1. Adult Plan of Care
06/06/2023 11:46
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 :
06/06/2023 1:03:00 PM
Page 34 of 12
SVI 0325 | what is the visit date or date of visit? | {"text": [], "answer_start": []} |
id_1711476990.613739 | Linda Costa |
JOHN F. KENNEDY MEMORIAL HOSPITAL, Inc.
47
8350017
PT - Keith Lowe
MR-
AD - 2020 Feb 16
DD - 2020 Mar 17
DR - R.M. THORNE, M.D.
DISCHARGE SUMMARY
HPI:
This is a 31-year-old man admitted
to the hospital with findings suggestive of ruptured
disc with L5 nerve root radiculopathy on the left.
HOSPITAL COURSE:
It was suspected that this man had
a large fragment compressing the L5 nerve root on the
left. Lab work was satisfactory. He came to myelo-
graphy which did not reveal as large a lesion as I
suspected. There was a bulging disc at the L5-S1 level.
There was no later盲lization. It seemed to be midline.
It was, in fact, one level too low for the symptoms in
my opinion.
Epidural venogram revealed a midline cutoff also at
this level. These two facts correlated. The patient
did have a normal number of vertebrae, though he had
suggestions of a rib at L-1.
PLAN:
I feel it safe to discharge this
patient for further outpatient care and followup
where activity, progressive as tolerated.
CONTINUED
employee : Jeffrey Zristowski
player Uchneider & 'Leary PLASTERING
RECEIVED
n
2024 Mar 07
LAKE WORTH. FLA.
CLAIMS OFFICE
| What is the Date of Discharge? | {"text": ["2020 Mar 17"], "answer_start": [106]} |
id_1711473530.925767 | 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 Discharge? | {"text": [], "answer_start": []} |
id_1711477183.618014 | Laura Hernandez |
03 August 2023 17: 19 NSCL
(FAX)3656564456
P.001/056
Patient Communication:
Nursing Services & Consultants of Laredo
Patient: Gary Bullock (BE50256)
114 W. Railroad Ave.
Date of Birth: 29 September 2001
Benavides, TX, 78341
Date of Contact: 06 November 2017
Phone: Fax:
Physician: JOHN MASCIALE (NPI: 1915619156)
601 TEXAN TRAIL #300
CORPUS CHRISTI, TX 78411
VS: B/P: 148/70 PULSE: 92RESPIRATIONS:1 TEMPERATURE: 97.9 SPO2: 95 WEIGHT: BLOOD SUGAR: 294 NON-
FASTING
COMMENTS: HYPERGLYCEMIA
Arrived at patient S home patient is laying in bed with multiple dogs home noted to be cluttered and
dirty with multiple pets living inside. Assessed patient head to toe with no new wounds noted. patient
states she does have pain in her left leg when ambulating.
NURSES FOLLOW UP (MARK ALL THAT APPLY WITH AN X) :
None needed
Orders Received by RN (name) :
Physician's orders received: Refer to telephone order dated > (write date)
:
Physician notified. Orders received to continue with current plan of care including who spoke with:
Medication verified with Physician, Physician's office or written prescription.
Medication profile updated.
Patient/caregiver notified of new orders.
PHYSICIAN NOTIFIED: Masciale John
RN NOTIFIED: Diane Vaughn, RN
LVN REPORTING: Siera Bazan, LVN
PHYSICIAN FOLLOW UP/ORDER:
OTHER:
Signature:
Date:
Digitally signed by: SIERA CELESTA BAZAN LVN
23 June 2014
76756-3
South Texas Bone & Joint - 00356
| What is the Procedure Date? | {"text": [], "answer_start": []} |
id_1711476767.986318 | Joseph Lynn |
Page: 1 of 23
South Lakeland Chiropractic Center P.A
DBA: New Hope Chiropractic
4788 S. Florida Ave.
Lakeland, FL 33823
Grace Witter
Patient ID: 131986423
DOB: 06/99/04
Sex: F
Account No.:
Encounter ID: 282344423
Encounter Date: 30/19/06
Encounter Type: Office Visit
SUBJECTIVE:
Chief Complaint:
Patient reports pain in the left arm, shoulder, neck, lower back and left side of her hip and leg. She reports on
28/19/04 she was at the Deli in Publix while walking away after being served she slipped and threw her left arm
in the air to break her fall and grabbed at the deli counter to catch herself.
Patient reports the pain wakes her up while she is sleeping when she accidentally rolls onto her left side She was referred to Dr. Bloom by Dr. Li; her shoulder pain is managed by Dr. Li.
OBJECTIVE:
Vital Signs:
Height: 62.00 in
Weight: 165.00 lbs
BMI: 30.18
Blood Pressure: 122/82 mmHg
Temperature: 97.30 F
Pulse: 76 beats/min
| What is the Date of Encounter or Enc? | {"text": ["30/19/06"], "answer_start": [253]} |
id_1711475444.762075 | Susan Carney |
08-22-2023 16:47 FROM- CWFMD
936-703-5455
T-252 P0054/0063 F-236
Methodist Server P20 07-01-2014 PM PACE
2/003
Fax Server
HOUSTON
XR CERVICAL SPINE 2 OR 3 VW
Methodist
LEADING MEDICINE
Susan Carney
MRN: 106217198, Legal Sex: Female, 04-05-1997 (Random 2 yrs), Outpatient
Accession #: IM62171984
Final Result
Appointment Info
EXAM: XR CERVICAL SPINE 2 OR 3 VW
Exam Date
02-16-2017
CLINICAL HISTORY: M54.12 Radiculopathy cervical
region, M54.12
Department
COMPARISON: None
111-111-1111
4015 1-45 NORTH SUITE 120
3 views of the cervical spine are obtained.
CONROE TX
FINDINGS:
Reason for Exam
M54.12
Straightening of cervical Iordotic curvature
secondary patient positioning.
spondylolisthesis is seen. Dens is at midline and
intact.
Calcifications are identified within the aortic arch.
Willis TX
Soft tissues are unremarkable.
IMPRESSION
No acute abnormality identified within the cervical
spine.
JMRI
Chronic findings as detailed above.
9.20.22
would
steble
to
IRMIRAD PS17
if
continue
glashing
Susan Carney MRN: 162171982 ACC: IM62171984 XR Cervical Spine 2 or 3 Vw
Page 1 of 2
Name: Susan Carney
DOB: 04-05-1997
Date:
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711475189.974797 | Anthony Clark |
NOVANT
Novant Health North Point
Anthony Clark
N
Medical Associates
MRN: 57024707, dob: 12 December 1985, Sex: M
HEALTH
1705 Bethabara Road
VISITING DATE: 20 December 2015
Winston-Salem NC 27706-3705
26 March 2017 - Office Visit in Novant Health North Point Medical Associates (continued)
Outpatient Medications as of 4/5/2023:
alprazolam (XANAX) 1 MG tablet, Take one tablet (1 mg dose) by mouth 3 (three) times a day as needed.
signature Dr Rebecca Bailey, MD at 15 November 2022 1954
03/28/2023 - GWSM REHAB PT CONTINUOUS APPT in Novant Health Rehabilitation Center Kernersville
Visit Information
Provider Information
Encounter Provider
Referring Provider
Erika Klein, PT
Ana A Frunza, MD
Generated on 4/11/23 8:32 PM
Page 7
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711476990.140988 | Andrew Miller |
(Page 7 of 20)
(Page 3 of 16)
Recv'd Date: 20140909 Bill DCN: 2014252GJ000800
Toufan Razi M.D.
Pacific Pain
Qualified Medical Evaluator
Institute
Pain Management Specialist
PACIFIC PAIN INSTITUTE FUNCTIONAL RESTORATION PROGRAM
PROGRESS REPORT WEEK # 4
Name: Stacy Hancock
Insurance: Gallagher Bassett
Claim#: 002406001366
DOB: 1987-25-09
DOI: 2014-24-05
INTRODUCTION:
As part of his comprehensive treatment plan for patient's Chronic Pain Syndrome, patient has
successfully completed the FOURTH WEEK on the Pacific Pain Institute Functional Restoration
Program.
According to MTUS guidelines, It Is not suggested that a continuous course of treatment be
Interrupted at two weeks solely to document these gains, If there are preliminary Indications
that these gains are being made on a concurrent basis. Patient has currently completed his 80
authorized hours of Functional Restoration Program, plus 48 additional hours.
The following constitutes the Integrative summary report generated by Dr. Toufan Razi and
LPCC Adriana Flores after the patient has completed the fourth week of the program on
8/15/2014.
A. MEDICAL EVALUATION
SYMPTOMS PROGRESSION: The patient is a 29-year-old male. He has lower back pain, lumbar
radiculopathy and chronic pain syndrome. Patient has participated In the Pacific Pain Institute
Functional Restoration Program for the last 4 weeks. The patient has remained very
cooperative despite having low back pain and burning sensation running down his right leg.
The patient has remained compliant and has participated in all the exercises activities that have
been prescribed for him.
Pacific Pain Institute Functional Restoration Program. Address: 2415 Merced St San Legndro CA 94515. Phone
number. (510) 78443 Fax number: (510) Random_5_digit_number
1115
| What is the Date of Consultation? | {"text": [], "answer_start": []} |
id_1711472591.398609 | 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 Date of Injury or DOI? | {"text": [], "answer_start": []} |
id_1711477090.52824 | Mr. Tyler Johnson DDS |
Health survey and History
Please describe your injuries:
Please Mark the area of your pain on the drawings below
Left shoulder Rotator cuff tom
x
What medications do you take?
Acetaminophen 500mg as needed
Diclofenac Sod. 50mg as needed
How often and how much?
as need i tab
Did you return to work? ( ) Yes
No
If yes, how long were you off?
Cowecks.
Please Make the degree of all conditions which you have, or have had. Using the following letters to rate your condition:
Nervous System
Cardio-Vascular
o = Occasional
Eyes, Ear, Nose & Throat
F = Frequent
Dizziness
Chest pain
Eye Strain
C = Constant
Walking problems
Patients[Signature)
Date: 2014/07/10
(If minor, parents or guardian's signature)
Doctors Signature:
Date: 2016/05/12
Dt: Abraham Chiropractic Playsician
Address. 4788 S Florida Ave. Lakeland, FI 33813 Pnone. 863.649.1490 Fax. 863.649.1049
| what is the service date or date of service? | {"text": [], "answer_start": []} |
id_1711472787.269505 | Randy Wright |
Northwell
Health
Authorization for Release of Health Information
6. Date or event on which this Authorization will expire (this field must be completed with a data or event):
EXPIRE 19/09/24
7. PallonVAgenV$urrogate/Guardlan (Signature):
8. Date:
2
Laun
16/02/09
9. Printed name of person signing this form:
10. Authority to sign on behalf of pallent or relationship to patient
(if applicable):
@ Lisa Arvarado
Date/Time
Print: Interpreter's Name and Relationship to Patient
Signature: Interpreter
K. N
16/02/09
Karla Holemann
Print Witness Name
Witness to Signature
Copy 1 - Patient Medical Record
Copy 2 - Patient or Patient's Personal Representative
Page 2 of 2
VD001 (5/11/19)
| what is the DOB or date of birth? | {"text": [], "answer_start": []} |
id_1711473237.373703 | Chad Ford |
39
FAX
MRN: 1934636H
Chad Ford
Nassau Unly. Medical
Gender: Female
Center
Age: 23y (1986 January 11)
Current Location:
Surg-Pediatric Eye Clinic
AMB OPHTH New Patient Ophthalmology Visit [Charted Location: Surg-Pediatric Eye
Clinic [Service Date: 2018 May 26 1:5, Authored: 07-Apr-22 10:53]- for Visit:
7710879X1004010031,
Notice of Status and Rights Involuntary Admission:
Patient's Name: Chad Ford
MRN: 1910710H
Sex: Female
dob: 1986 January 11
Facility Name: Nassau University Medical Center
Date of Admit: 2024 January 22 10:31
Date & Time: 2017 January 03 11:01
Allergies:
Allergy, Intolerance, Adverse Event:
Allergies:
No Known Allergies: Active
HPI:
Ophthalmology HPI:
Chief Complaint
Left ruptured globe
Page 1 of 6
| What is Collection Date? | {"text": [], "answer_start": []} |
id_1711471328.457234 | Brian Harris |
Downtown Medical Center
8075 Williams Highway Suite 402
West Jamesburgh, GA 11434
Patient Name Brian Harris
SS #/SIN 410-99-1101
DOB 93-09-29
Female
Cell Phone 756-205-8263
Patient's Address Unit 0739 Box 9805
DPO AP 15292
Spouse or Patient's Guardian name Jeff Rocha
Phone 756-205-8263
In case of a medical emergency, if the patient is of school age 15+, is ok to treat in my absence.
Jeff Rocha
Do you have any Medical insurance? Yes No if yes,
complete the following:
Name of the insured medicaid
Relationship to patient Self
DOB 93-09-29
SS#/SIN 454-10-1410
signature: 23-03-31
189634-10 Downtown Medical Center - 00041
| what is the DOS or D.O.S? | {"text": [], "answer_start": []} |
id_1711476893.043462 | Russell Powell |
NORTHBAY MEDICAL CENTER
NorthBay Hospital Campus: 1200 B. Gale Wilson Blvd.
Fairfield, CA 94533 (707) 646-5000
ED Physician Documentation
Physician:
Ankney. William A M.D.
Signed:
08-09-2017 03:42:46
Status:
Auth (Verified)
Document:
ED Physician Notes
Fall
Patient: MEJIA-GALLEGOS, FLORENTINO
MRN: 608698
FIN: 010998039
Age: 26 years Sex: Male DOB: 13-03-2000
Associated Diagnoses: None
Author: Ankney, William A M.D.
Basic Information
Time seen: Date & time 12/06/11 23:04:00.
History source: Patient.
Arrival mode: Walking.
Allergies: Include allergy profile.
Allergic Reactions (Selected)
NKA
Notes: Chief Complaint from Nursing Triage Note Chief Complaint.
09-07-2014 22:30
Chief Complaint
Right leg and right lower back pain. Ambulating with limp.
No head injury.
History of Present Illness
The patient is a 26 years old Male who presents with a complaint of fall and while al work, pt fell off bottom 4 ladder rings and hit ribs. hip
and knee.
Patient Name: Devin Parks
Medical Record No: 608698 Financial No: 010998039
Medical Records
DOB: 13-03-2000 Age: 28 years Sex: Male Pt Type: Emergency
N/A
Admit Date: 04-10-2014 Discharge Date: 03-11-2014
Admitting Physician:
Attending Physician: Ankney, William A M.D.
Printed 09/09/13 at 11:14 AM
(Page 11 of 28)
ED-NB
149
| What is signature date or signed on date? | {"text": ["08-09-2017"], "answer_start": [198]} |
id_1711473237.891875 | Joyce Becker |
10/24/2023 1:29:08 PM -0170 FAXCOM
PAGE 80
OF 133
Menniti, Cheryl "Sherry" (MRN 971619628) BIRTH DATE: 1988 November 29
encounter date: 2019 February 01
Orders
Normal Orders This Visit
CASE REQUEST - SURGERY [SUR17017 Custom]
OB History
No obstetric history on file.
Prenatal Physical
No pregnancy episode available.
Routing History
None
Encounter Status
Signed by Dr Patricia Salazar, MD on 2024 February 17 at 17:45
Your Current Medications Are
AMIOdarone 170 MG tablet
amitriptyline 17 MG Tab
Printed by [WHI179] at 10/10/2023 2:57 PM
Page 9 of 10
| What is the Date of operation? | {"text": [], "answer_start": []} |
id_1711476893.130949 | Charles Thompson |
1010700320067
13f377905001
Claim Number 2
Claim Number 3
PLEASE ANSWER THE FOLLOWING QUESTIONS FULLY:
How was your evaluating doctor selected? (check one)
From a list of doctors provided by the State of California, Division of Workers' Compensation.
Other (explain)
What is the of the doctor who will be doing the evaluation? Paulette Cass, ,D.C.
name
When is your examination scheduled?
02/05/2020
What were your job duties at the time of your injury?
COOK,
What is the disability resulting from your injury?
Injury to back, rightarm right shoulder.
How does this injury affect you in your work?
Aggravated with bending, lifting, pushing, pulling standing,
walking, reaching.
Have you ever had a disability as a result of another injury or illness?
no
If so, when?
Please describe the disability?
Date
25/09/2017
Signature Florentino Mejia
Gallegos
MM/DD/YYYY
DWC-AD form100 (DEU) Page 2 (REV. 11/2008)
DWC-AD form 100 (DEU)
375
| What is the Date of Encounter or Enc? | {"text": [], "answer_start": []} |
id_1711473237.429699 | Heather Harris |
-0400
PAGE 2
OF 3
Massapequa Imaging
An Affiliate of Northwell Health
1220 Hicksville Road, Seaford, NY 11783 (516) 266-3456 (516) 266-3490
RAND RODGERS
PATIENT NAME:Heather Harris
1000 NORTHERN BLVD
AKA: Heather Harris
GREAT NECK, NY 11021
MR#: 12509533
EPI #: 3450953
D.O.B: 20/89/11
AGE: 57Y FEMALE
Acc#: 57509533
EXAM: 57509533 - CT ORBITS - ORDERED BY: RAND RODGERS
PROCEDURE DATE: 18/14/10
INTERPRETATION: CLINICAL INDICATION: Orbital fracture, ruptured globe thin axial series through
the orbits were obtained with coronal computer-generated reconstructed views.
Dr Douglas Oneal MD; Attending Radiologist
Page 1 of 2
Date Printed: 6/20/2022 4:47 PM
| What is the Date of Exam or Examination date? | {"text": [], "answer_start": []} |