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id_1711476893.046217
Joseph Shaffer
NORTHBAY MEDICAL CENTER NorthBay Hospital Campus: 1200 B. Gale Wilson Blvd. Fairfield, CA 94533 (707) 646-5000 ED Physician Documentation Physician: Ankney. William A M.D. Signed: 2022 May 03 03:42:46 Status: Auth (Verified) Document: ED Physician Notes Fall Patient: MEJIA-GALLEGOS, FLORENTINO MRN: 608698 FIN: 010998039 Age: 26 years Sex: Male DOB: 1998 January 17 Associated Diagnoses: None Author: Ankney, William A M.D. Basic Information Time seen: Date & time 12/06/11 23:04:00. History source: Patient. Arrival mode: Walking. Allergies: Include allergy profile. Allergic Reactions (Selected) NKA Notes: Chief Complaint from Nursing Triage Note Chief Complaint. 2015 January 24 22:30 Chief Complaint Right leg and right lower back pain. Ambulating with limp. No head injury. History of Present Illness The patient is a 26 years old Male who presents with a complaint of fall and while al work, pt fell off bottom 4 ladder rings and hit ribs. hip and knee. Patient Name: Debra Jones Medical Record No: 608698 Financial No: 010998039 Medical Records DOB: 1998 January 17 Age: 28 years Sex: Male Pt Type: Emergency N/A Admit Date: 2024 January 30 Discharge Date: 2024 February 29 Admitting Physician: Attending Physician: Ankney, William A M.D. Printed 09/09/13 at 11:14 AM (Page 11 of 28) ED-NB 149
What is the Date of Exam or Examination date?
{"text": [], "answer_start": []}
id_1711476578.539746
Kristen Wilson
INBOUND NOTIFICATION FAX RECEIVED SUCCESSFULLY TIME RECEIVED REMOTE CSID DURATION PAGES STATUS 2015 September 20 at 3:41:29 PM EDT SVMC 243 Received SVMC 2015 September 20 12:37:28 PM PAGE Fax Server DOD Salinas - Abbott Lance Jones 558 Abbott St Ste A MRN: 3111xxx, DOB: 1984 June 21, Sex: F DOCTORS Salinas CA Visit date: 2020 June 30 ON DUTY HIM ROI Letters Report Review of Systems Constitutional: Negative for chills and fever. Respiratory: Negative for shortness of breath. Cardiovascular: Negative for chest pain. Gastrointestinal: Negative for abdominal pain. Musculoskeletal: Positive for arthralgies, back pain. stiffness. Physical Exam Vitals reviewed. Constitutional: Appearance: Normal appearance. HENT: Head: Normocephalic and atraumatic. Eyes: Conjunctiva/sclera: Conjunctivae normal. Effort: Pulmonary effort is normal. Breath sounds: Normal breath sounds. Musculoskeletal: General: No swelling or deformity. Tenderness: Normal range of motion. Right knee: No effusion Instability Tests: Anterior drawer test negative. Left knee: No effusion or bony tenderness. Instability Tests: Anterior drawer test negative. Right lower leg: No edema. Left lower leg: No edema. Comments: L knee: + Thessaley test Skin: General: Skin is warm and dry. Neurological: Mental Status: She is alert. Generated on 2022 February 27 12:34 PM Page 24 118
What is the Date of operation?
{"text": [], "answer_start": []}
id_1711475620.870365
Katherine Gibson
V VITRO MOLECULAR LABORATORIES www.vitromolecular.com Patient Name: Katherine Gibson Physician: Robert Jacobson, MD Accession #: S22-04715 Sex: Male Specialty Group: The Gables Surgical Center Collected: 28-09-2018 DOB: 21-04-1986 (21) Received: 28-09-2018 Reference #: S22-04715 CC: Reported: 22-11-2014 Surgical Pathology Report Clinical History Previous Vitro pathology report: *S21-12983, 12-09-2018 A)Lumbar disc, L4-5; discectomy:Cartilage and disc material with degenerative changes; *S21-15703, 24-12-2023 A)Disc, C4-C5, discectomy:0 Cartilage with degenerative changes DIAGNOSIS A. DISC L4-5: - Fibrocartilaginous tissue with degenerative changes - Negative for atypia or malignancy in this sample Images Gross Description A. Received in formalin there are multiple white fibrocartilaginous tissue fragments measuring 2.5 X 2.0 X 0.3 cm in aggregate. Specimen is submitted in toto in one green cassette. IG/rms Electronic Signature Hadi Yaziji, M.D. CPT Code(s): 88304 (1) *** END OF REPORT E-MAILED 09-10-2020 Vitro Molecular Laboratories 8700 West Flagler Street, Suite 100, Miami, FL 33174 Tel: 305-267-7979 Fax: 786-513-0175 CLIA: 10D1055514 Page 1 of 1
What is the Date of operation?
{"text": [], "answer_start": []}
id_1711475189.970367
Amanda Gonzalez
NOVANT Novant Health North Point Amanda Gonzalez N Medical Associates MRN: 51024107, birthdate: 1992 June 20, Sex: M HEALTH 1105 Bethabara Road visiting date: 2015 April 20 Winston-Salem NC 27106-3105 2018 December 27 - 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 Joshua Vasquez, MD at 2018 June 28 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 Date of Discharge?
{"text": [], "answer_start": []}
id_1711475444.72752
Jessica Hill
Jun 25, 2019 FROM- CWFMD 936-703-5455 T-252 P0053/0063 F-236 Methodist Server P11 Mar 29, 2018 4:53:01 PM ACST PAGE 2/002 Fax Server HOOSTON' XR HIPS BILATERAL AP LATERAL W AP PELVIS Methodist LEADING MEDICINE Jessica Hill MRN: 108987192, Legal Sex Female, Jun 07, 1984 (51 yrs), Outpatient Accession #: IM95386381 Final Result Appointment Info EXAMINATION: XR HIPS BILATERAL AP LATERAL W AP PELVIS Exam Date Nov 26, 2020 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 Aug 14, 2014 4:18 PM chronicity 00 Jessica Hill MRN: 108987192 ACC: IM95386381 XR Hips Bilateral Ap Lateral W Ap Pelvis Page 1 of 1 : Name: Jessica Hill DOB: Jun 07, 1984 Date:
what is the DOB or date of birth?
{"text": ["Jun 07, 1984"], "answer_start": [286]}
id_1711473366.118966
Nancy Solis
athena 10/30/2023 1:33:13 pm EDT Page: 56 / 86 Nancy Solis (id #15546552, date of birth: 11/06/92) Baptist Health Health Information Management Dept Nancy Solis 3563 Philips Highway Building B. Suite 201 MRN: 52554550 date of birth: 11/06/92, Sex: F Jacksonville FL 55207-5553 Adm 26/01/15 D/C: 25/02/15 07/15/2023 - ED in Baptist Clay Emergency (continued) ED Provider Note (continued) HISTORY: seizure COMPARISON: None. TECHNIQUE Contiguous axial slices of the head were submitted without IV contrast. FINDINGS: INTRACRANIAL: Brain parenchyma is normal in attenuation, No acute intracranial hemorrhage. Signature: Dr Amy Moore MD 19/03/17 12:38 PM CDT Printed on 7/27/23 at 8:20 AM Release ID: 28555892
What is signature date or signed on date?
{"text": ["19/03/17"], "answer_start": [680]}
id_1711476893.13366
Patrick Roberts
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? 2014 Nov 14 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 2024 Jan 06 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 operation?
{"text": [], "answer_start": []}
id_1711475741.396322
Alicia Henry
The Gables Surgical Center IMMEDIATE POST PROCEDURE PROGRESS NOTE Date: 10/12/16 PRIMARY SURGEON: Berti ASSISTANTS: NONE / NAME: Secular PRE-OPERATIVE DIAGNOSIS: L4-5diss diguster + instality POSTOPERATIVE DIAGNOSIS SAME LOTHER, LIST: TECHNICAL PROCEDURES (PROCEDURES PERFORMED): Q Ly-5 pedrle seven 50 X 7 Am 2,445 interbody optimest SPECIMEN(S) REMOVED AND SENT TO LAB PER POLICY: NONE / YES, LIST: Lyndhi COMPLICATIONS DURING PROCEDURE: NONE YES, EXPLAIN: DRAINS: NONE/YES, DETAIL: ESTIMATED BLOOD LOSS (EBL): MINIMAL LOTHER, DETAIL: ANESTHESIA TYPE: GENERAL + MAC / LOCAL Immunity PLEASE INDICATE LATERALITY WHEN APPLICABLE Physician's Operative Signature: note to be dictated John immediately following procedure ID / Visit: 117744 / 4 DOS: 04/04/21 Alicia Henry Sex: M DOB: 27/08/03 Age: 33 Phys: Jacobson, Robert
What is Ordered Date?
{"text": [], "answer_start": []}
id_1711471328.219405
Kayla Potter
24/18/01 10:08:03 EDT To: 18003806151 Page: 24/33 From: 8332845756 Fax: 8332845756 Initial Evaluation Note Patient: Kayla Potter dob: 27/99/04 Sex: F Date of Visit: 12/22/02 Visit # 1 Provider: Brandon Bensing NPI # 1225662943 Clinic Details Case Details Clinic Address Injury Description Injury Onset Date Lakefront Health 4125 Dick Pond Road Back Pain 24/18/01 Phone # Myrtle Beach, SC 29588-6807 Diagnosis Codes I50 Fax # 8332845756 Referring Physician Ashley Maybin Subjective Analysis Previous History of Symptoms YES Patient Chief Complaint Patient Goals Patient Problem List Patient suffers from or currently has Thyroid Disorder Thyroid problems, Arthritis, Other orthopedic problems, Osteporosis, Chronic pain, Chronic migraines Treated by Dr Jacqueline Lozano (License #10144) DOS: 12/22/02 Page 1 of 6 of Initial Evaluation Note
What is signature date or signed on date?
{"text": [], "answer_start": []}
id_1711475190.508558
Dennis Ruiz
<<Back to Review>>194126-2 HYPERLINK-Hyperlink-Page 188 KAISER PERMANENTE庐 Dennis Ruiz MRN: 110184071888, Date of Birth: 29/08/99, Sex: F SSN: xxx-xx-3184 Visit Day: 29/07/22 21/04/20 - 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 21/07/19 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 DATE OF ENCOUNTER: 21/07/18 Creation Time: 9/25/2007 10:10 AM DOI: 27/08/18 Generated on 4/12/22 10:33 AM 000188 0187
What is Collection Date?
{"text": [], "answer_start": []}
id_1711476892.988252
Justin Pierce
NORTHBAY MEDICAL CENTER NorthBay Hospital Campus: 1200 B. Gale Wilson Blvd. Fairfield, CA 94533 (707) 10536 General Diagnostic Exam Date/Time: Exam: Accession Number: Ordering Physician: 2018-03-15 23:45:54 DX Chest 2 views DX-11-0010536 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: 2018-03-15 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: Linda Obrien Medical Record No: 608698 Financial No: 010998039 Medical Records DOB: 2001-04-05 Age: 28 years Sex: Male Pt Type: Emergency N/A Admit Date: 2016-11-19 Discharge Date: 2016-12-19 Admitting Physician: Attending Physician: Ankney. William A M.D. Printed 2022-01-12 at 11:14 AM (Page / of 12) ED-NB 112
What is the Date of Encounter or Enc?
{"text": [], "answer_start": []}
id_1711476990.140041
Mr. Jerry Terry DVM
(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: Craig Dominguez Insurance: Gallagher Bassett Claim#: 002406001366 DOB: 22 February 1985 DOI: 08 March 2015 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: 2439 Merced St San Legndro CA 94539. Phone number. (510) 94249 Fax number: (510) Random_5_digit_number 1139
What is the Date of Evaluation?
{"text": [], "answer_start": []}
id_1711472286.533364
Sheila Watts
Sheila Watts MRN: 5603513 06/05/2023 - Telephone in MultiCare Rockwood Orthopedics & Sports Medicine MultiCare Health System PATIENT NAME: Sheila Watts MRN: 5603513 CSN: 296358619 Account Information Admit Date HAR# Pt Class Hospital Svc Bed 02/08/18 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 dob: 07/10/93 (30 yrs) United Parcel Service Sex: male Marital Status: Significant Other RIVER VIEW CORPORATE Sheila Watts CENTER MRN: 5635313, dob: 07/10/93, Sex: M 16201 East Indiana Ave DATE OF VISIT: 23/08/15 SPOKANE VALLEY WA 99216- 1882 Page 20 Printed by 414221 at 7/17/23 9:40 AM
What is the Date of operation?
{"text": [], "answer_start": []}
id_1711473365.742487
Timothy Ho
Discharge Information Attestation Attestation to: I personally interviewed the patient, I personally examined the patient, I certify that the services provided were clinically indicated and medically necessary for the care of this patient. Electronically signed by: GO MD, JENSEN L On 05-16-2023 20-04 Electronically Co-Signed By:GO MD, JENSEN L On: 12-14-2016 08:10 Patient name: Timothy Ho MRN: 73126315 FIN#: 93110315 Printed On: 10/30/2023 05:11 EDT Page 37 of 516 Report Request ID#: 323134318
What is Collection Date?
{"text": [], "answer_start": []}
id_1711472786.951553
Micheal Morgan
MEDICAL IMAGING CENTER Name: MORRIS, ANN CHRISTINE 1830 Town Center Drive #110 Phys: Dr Tina Kennedy MD Reston, VA 20190 D.O.B: August 06, 1985 Age: 30 Sex: F PHONE #: (703) 178-3171 Exam Date: April 01, 2015 Status: REG CLI FAX #: (703) 177-5176 Radiology No: Unit No: K000658700 EXAMS: 002658703 CT CHEST W IV CON <Continued> ELECTRONICALLY SIGNED BY M.D. Dr Tina Kennedy on March 23, 2021at 1428 ** Reported and signed by: DAVID DUBOIS, M.D. CC: Ajay Dar MD Dictated Date/Time: 12/23/2021 (1417) Technologist: CAROLINE J. TOURTELLOTTE, RTRM Transcribed Date/Time: 12/23/2021 (1417) By: DR.DUBDA Printed Date/Time: 12/23/2021 (1500) BATCH NO: N/A PAGE 2 Signed Report
What is the Date of operation?
{"text": [], "answer_start": []}
id_1711471328.849264
Robert Peterson
patient Robert Peterson Gender Female MR # 0001143894 admitting date/Time 22-10-30 7:11:00 AM Reg # 096291118385 Visit Status DSC D.O.B 91-06-24 12:00:00 AM DISCHARGE DATE/Time 22-11-29 9:31:00 PM 1. Adult Plan of Care 14-09-26 2:10 Entered By Individualization (Mutuality/Preferences) Individualization/Preferences / pt pt goes by "Cierra"; lives at home with her grandparents SEB goes by "Cierra"; lives at home with her grandparents Comments : CLINICAL PRACTICE GUIDELINES Precaution Precaution SEB coping,genitourinary,peripheral/neurovascular,reproductiv e,safety,skin Comments : Nursing Goal #1 Related To Nursing Cellulitis SEB Diagnosis/CPG Comments : Nursing Goal #1 Goal pt will be able to maintain temperature WNL < 100.4 SEB degrees F during hospitalization Comments : Nursing Goal #1 Goal Established 01/10/2023 SEB (mm-dd-yyyy) Comments : Nursing Goal #1 Time Frame By Discharge SEB Comments : 14-09-26 1:03:00 PM Page 72 of 12 SVI 0885
What is signature date or signed on date?
{"text": [], "answer_start": []}
id_1711472787.209963
Stephanie Clark
Date Visit: 03/2017/10 Page 2 of 2 Name:Stephanie Clark DOB:12/1986/16 Cardiovascular: chest discomfort. Constitutional review of systems are normal except as noted in HPI. Vitals Vitals - PULM Recorded: 15Sep2022 12:17PM Systolic 128 Diastolic 76 Physical Exam Constitutional: no acute distress Procedure CXR: small left apical ptx and possible small LLL ptx as well? no focal consolidation or pleural effusions, cardiac silhouette appears normal. Assessment Pneumothorax, left (512.89) (J93.9) Plan Cough Xray Chest 2 Views PA/Lat; Status:Active; Requested for:15Sep2022; Electronically signed by : Dr Sharon Lee, MD; 09/2021/16 8:40PM EST (Author
what is the DOB or date of birth?
{"text": ["12/1986/16"], "answer_start": [68]}
id_1711476990.556088
Jason Baldwin
May 09, 2014 10:13:54 Oklahoma Spine 4058789447 2/47 Elizabeth Williams, M.D., F.A.C.R. RE: James Parry DOB: May 12, 1991 DOS: Feb 13, 2017 X-RAY REPORT: X-rays of the cervical spine. Two views were obtained. Mild DDD at C4-5 through C6-7 with small bone spurs. Artifact due to dental work. X-rays of the thoracic spine were obtained in two views. X-rays of the Jumbar spine were obtained in two views. Moderate-to-severe DDD at T12-L1. L1- 2. Severe DDD L2-3. Mild-to-muderate DDD L3-4 through L5-S1 with small bone spur anteriorly and laterally. getting worse since 12/2021. Mild ankylosing right L1 and 1.2. Questionable bilateral sacroilitis Left femoral artery graft. not new. X-rays of the both knees were obtained in two views and weightbearing. Unremarkable X-rays of the both feet and ankles were obtained in three views and weightbearing Mild primary OA of the bilateral first MTP joint, new. Left hammertoes. Bilateral plantar heel spur. Ankles are unremarkable Osteopema. The patient was explained all the findings. abnormalities and changes of the x-rays. which he voiced understanding. Thank you for the consultation. for Elizabeth Williams, M.D., F.A.C.R.
what is the service date or date of service?
{"text": [], "answer_start": []}
id_1711477090.63638
Todd Fisher
2015-05-15 04:45 PM TO: 16103548946 FROM: 8392327968 Page: 90 Advanced Rx 360 Ortho and Spine Stefan Prada, MD Optimizing Provider Care鈩 DEA # BP3793696 11809 N Dale Mabry Hwy Tampa, FL 33618 Patient Name: Todd Fisher DOB: 1995-07-13 DOI: 2023-12-07 Address: 1119 CR 457 Lake Danasoffhee FC 33538 ICD-10: HS4.2 Physician Signature: RO, Date: 2017-09-03 (MM/DD/YYYY) Patient Signature: Heather Fowler 2017-01-01 Date: (MM/DD/YYYY) www.Advanced-Rx.com I Phone 88892327 I Fax 92592327 2430 Camino Ramon, Suite 120, San Ramon, CA 94549
What is the Date of operation?
{"text": [], "answer_start": []}
id_1711475955.882396
Blake Torres
30/05/15 13:59 FROM- CWFMD 936-703-5455 T-240 P0073/0078 F-226 Page 1 or 2 Conroe Willis Family Medicine PLLC Blake Torres Order Date: 29/12/18 4015 145 North 14570 Trero Lane Order #: PRO36382 Conroe, TX, 773045074 Willis, TX, 773784394 Person #: 744, MRN: 5211 Sex: F DOB: 12/08/84 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: 13/06/17 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: 13/06/17 14:50, Status: Final Performed At: 01, LabCorp Houston 7207 North Gessner, Houston, TX, 770403143 Kyle, Eskue, MD, Phone: 7138568288 Patient: Blake Torres, DOB: 12/08/84
what is the DOB or date of birth?
{"text": ["12/08/84"], "answer_start": [308]}
id_1711471328.336822
Jordan Gonzalez
Prairie Hill Hospital 213 East Washington Ave Jonesboro, AR 71301 870-913-4100 Patient name: Jordan Gonzalez Room #: Age/Sex: 30 F Med Rec #: SM47960592501 date of birth: 08 March 2015 Account #: SV47960592501 Attending Doctor: Dr Katrina Mendez MD Hospital Service: Ordering Doctor: Jennifer Bond MD date of admit: 13 October 2023 Primary Care Provider: Patient Status: REG CLI Primary Insurance: BLUE ADVANTAGE IMAGING SERVICES STATUS: Signed Report #: 0413-0181 6700459.001 ECG/Electrocardiogram DATE OF EXAM: 09 June 2018 Test Reason : Blood Pressure : / mmHG Vent. Rate : 13 BPM Atrial Rate : 13 BPM P-R Int : 113 ms QRS Dur : 13 ms QT Int : 136 ms P-R-T Axes : 42 13 15 degrees QTc Int : 413 ms Disease: Cholecystitis Cannot rule out Anterior infarct , age undetermined Nonspecific T wave abnormality Abnormal ECG No previous ECGs available ELECTRONICALLY SIGNED BY Tom Reyes (1032) on 27 February 20191:01:38 PM Referred By: Tom Reyes Confirmed By: Tom Reyes ELECTRONICALLY SIGNED BY: Brent Adams, MD Transesophageal Echocardiography (TEE) Page 1 of 13 PARHAM-0137 000013
What is Collection Date?
{"text": [], "answer_start": []}
id_1711472286.531502
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 the admit date or admission date?
{"text": ["31/18/03"], "answer_start": [267]}
id_1711477275.72027
Billy Garcia
She is to keep a followup appointment with the office of Dr. Masciale for on or about 2022 June 23 DICTATED BY: JOHN P. MASCIALE, MD BT/NTS D: 2022 June 23 11:11:39 AM T: 2022 June 23 01:09:24 PM DOC#: 32961818 JOB#: 278417818 Electronically Authenticated and Edited by: JOHN P MASCIALE, MD on 2018 October 16 04:00 PM CST cc: Patient Status: DIS IN M.R.#: MV00480818 Patient: TREJO,ELMA MUNOZ Account #: AV0018 1605018 Attending Dr.: Amanda Howard, MD Admit/Service date: 2019 February 16 Discharge date: 2015 February 26 DOB: 2002 December 30 Loc/Room #: AV.MS3A/AV.302-1 Medical Records' copy Medical Records Primary Care Dr.: LILJEBI Page 3 of 18 76718 -3 South Texas Bone & Joint - 00318
What is the Date of Exam or Examination date?
{"text": [], "answer_start": []}
id_1711475741.539633
James Castaneda
James Castaneda DOB: Aug 10, 1992 (61 yo M) Acc No. CR454556 [Doc Name: Jul 16, 2023 MRI CERVICAL SPINE] CR172462 James Castaneda (MRN6325435) UF Health Radiology JP UF HEALTH JTB KERNAN Imaging Result Report Patient: James Castaneda MRN #: 6325435 DOB: Aug 10, 1992 Ord #: 618102455 Sex: Male Acc #: J11881056 Att Prov: Auth Prov: Roberts, Christopher 10475 CENTURIAN PKWY NORTH SUITE 201 JACKSONVILLE FL 32256 Final Report MRI C Spine w/o Con Exam Date & Time: Jun 03, 2023 12:12 PM Reason For Exam: None Specified Ordering Diagnosis: Cervical radiculopathy Mri of the cervical spine without contrast HISTORY: 52 years Male Cervical radiculopathy COMPARISON: None Technique: Multiplanar multi-sequence MR images were obtained of the cervical spine without contrast material. Findings: There is a small Schmori's node at the superior endplate of C7 otherwise the vertebral body heights are maintained. C4-C5: There is mild broad-based disc bulging causing mild impression on the ventral spinal Jun 03, 2023 4:19 PM Page 1 of 2 James Castaneda DOB: Aug 10, 1992 (61 yo M) Acc No. CR454556 Page 72 of 166
What is the Procedure Date?
{"text": [], "answer_start": []}
id_1711475190.287075
Tina Moore
<<Back to Review>>194126-2 HYPERLINK- Hyperlink-Page 306 KAISER PERMANENTE庐 Tina Moore MRN: 110804080880, Date of Birth: 03/87/09, Sex: F SSN: xxx-xx-3804 Date of Visit: 05/22/03 09/21/05 - Work Comp in OCC PHYSICAL THERAPY -STE 5038 Physical Medicine Notes THERAPIST, PHYSICAL Progress Notes by Lattupally, Shirisha (P.T.) at 1/3/2008 0952 Version 1 of 1 Author: Lattupally, Shirisha (P.T.) Service: Author Type: THERAPIST, PHYSICAL Filed: 1/3/2008 9:52 AM Date of Encounter: 28/16/12 Creation Time: 1/3/2008 9:52 AM Status: Signed Editor: Lattupally, Shirisha (P.T.) (THERAPIST, PHYSICAL) PT visits: 7/8. Injury Date: 10/17/11 Left knee contusion. Generated on 4/12/22 10:33 AM 000306 0305
what is the service date or date of service?
{"text": [], "answer_start": []}
id_1711471329.68641
Phillip Moore
Page: 2 Surgical Case Record Patient Name: BP00046620 Phillip Moore DOB: 28/10/1990 Account No: BP40131499268 Age: 54 Physician: Dr Robert Mayo MD Sex: F Specialty: ORS-Orthopaedic Surgery Room-Bed/T.Loc: O.R.: POR04-OPERATING ROOM #4 Date of Operation, Operation Date, Oper Date: 04/06/2017 Meadowlark General Primary Procedure: LEFT KNEE MANIPULATION Case Close/ Run Date: 29/10/2019 Transmitted: 12/23/22 1222 P.SUR.DP Peterson, Deloras Run Time: 1944 PRE-OP ASSESSMENTS Occurred 12/22/22 1144 Landry, Courtney Recorded 12/22/22 1144 Landry, Courtney Physiological problem/alteration in: Musculoskeletal Infection - - MUSCULOSKELETAL ALTERATION - - Musculoskeletal alteration problem expected to: Improve/Resolve Inserted 12/22/22 0830 - - Instance list status: Active IV/IO/Subcutaneous line status: Start Inserted by, if other than current documenter: Nurse Number of attempts: 2 Skin prep used: Chlorhexidine/Alcohol IV site dressing: Transparent IV site dressing clean, dry and intact: Yes IV site absent of redness, heat or edema: Yes <End> DOCUMENTATION IV summary: Venous Left Antecubital 20 g Inserted 12/22/22 0830 IV type: CONTINUED ON PAGE 3 *** Patient Name: Phillip Moore MRN:BP00043554 Encounter:BP0001107108 Page 2 of 29 73797-42 Meadowlark General -00072
what is the service date or date of service?
{"text": [], "answer_start": []}
id_1711475741.366995
Robert Jones
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: Robert Jones MEDICAL RECORD #: 4444471 DATE OF BIRTH: 31/03/85 PHYSICIAN: ROBERT JACOBSON, M.D. DATE OF SURGERY: 16/02/16 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: 30/08/14 DT: 30/08/14 OPERATIVE REPORT - PAGE 2 of 2
What is the Date of Exam or Examination date?
{"text": [], "answer_start": []}
id_1711475741.364391
Regina Payne
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: Regina Payne MEDICAL RECORD #: 8756500 DATE OF BIRTH: 12/1988/01 PHYSICIAN: ROBERT JACOBSON, M.D. DATE OF SURGERY: 06/2018/19 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: 11/2018/14 DT: 11/2018/14 OPERATIVE REPORT - PAGE 2 of 2
What is the Date of Evaluation?
{"text": [], "answer_start": []}
id_1711473530.611089
Amy Smith
KNMH EMERGENCY DEPARTMENT Amy Smith 180 W Esplanade Ave MRN: 8198198, birthdate: 01/1998/20, Sex: M Kenner LA 71965 Acct #: 81901981961 Adm: 08/2019/11 08/25/2022 - ED in Kenner - Emergency Dept (continued) Medication Administrations ibuprofen tablet 800 mg [819231922] Ordering Provider: Dayna G. Toscano, NP Status: Completed (Past End Date/Time) Ordered On: 04/2018/03 1119 Starts/Ends: 08/25/22 1200 - 08/25/22 1119 Ordered Dose (Remaining/Total): 800 mg (0/1) Route: Oral Frequency: ED 1 Time Admin Instructions: DO NOT CRUSH OR CHEW; SWALLOW WHOLE. Discharge Orders (720h ago, onward) None ED Prescriptions Medication Sig Dispense Start Date End Date Auth. Provider LIDOcaine (LIDODERM) 5 % (Expired) Place 1 patch onto 7 patch 8/25/2022 9/1/2022 Dayna G. Toscano, NP the skin once daily. Generated on 10/3/22 11:37 AM Page 28
What is the Date of Encounter or Enc?
{"text": [], "answer_start": []}
id_1711477090.346496
Louis Fox
CASA COLINA Hospital and Centers for Healthcare CASA COLINA MEAL PERIOD AGREEMENT This will certify that I am an employee regularly scheduled to work an eight or ten hour shift (ten hours under a certified alternative work week schedule), and that should a time arise when my shift exceeds 10 hours, I wish to waive my entitlement to a second meal period. I understand that I am entitled to have this meal period under California Law. However, I hereby voluntarily agree to waive one- of the two meal periods. I understand that, as a result of this waiver, I will receive only one meal period during each day of work and will be paid for all working time, but not for the one duty- free meal period receive. I also understand that I or the hospital may revoke this "Meal Period Waiver" at any time by providing at least one day's advance notice in writing of the decision to do so. This waiver will remain in effect until 1 exercise, or the hospital exercises, the option to revoke it. The decision not to waive one on-duty meal break will result in an additional unpaid meal period of thirty (30) minutes and the extension of my workday by the same thirty (30) minutes. I acknowledge that I have read this waiver, understand it, and voluntarily agree to its provisions. In addition, I understand that while it is my employer's obligation to make the meal period and rest periods available to me, it is my responsibility to ensure 1 take them. (Please reference HR Policy C2-302 Hours of Work for additional details) aim Signature Ernest Trevino Print Name Dec 19, 2020 Date Updated: Nov 02, 2021 (file located In: S Drive/Human Resources/Forms/Meal Period Agreement)
What is the Procedure Date?
{"text": [], "answer_start": []}
id_1711477090.52825
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 signature date or signed on date?
{"text": ["2016/05/12"], "answer_start": [787]}
id_1711475190.087007
Alexis Perkins
NOVANT Novant Health Orthopedics & Alexis Perkins N: Sports Medicine MRN: 56124617, DOB: October 18, 1991, Sex: M HEALTH 7210 Village Medical Cir Visit: August 06, 2014 Ste 110 CLEMMONS NC 27612-8619 November 13, 2021 - Office Visit in Novant Health Orthopedics & Sports Medicine (Clemmons) (continued) Clinical Notes Amb (continued) SUBJECTIVE: Jeffrey Craig Payne is a pleasant 66 y.o. male here today for scheduled postop follow-up evaluation. Past Medical History: Diagnosis Date ADD (attention deficit disorder) Anxiety Past Surgical History: Procedure Laterality Date Colonoscopy October 21, 2016 Screening; adenoma 9/21/22; repeat 9/2029; Brian S Smith, MD (GAP) Total hip arthroplasty Left 02/2016 for aseptic necrosis + OA Family History Problem Relation Age of Onset Cancer Mother breast and liver Alzheimer's disease Father Social History Generated on 4/11/23 8:32 PM Page 21
What is the Date of Exam or Examination date?
{"text": [], "answer_start": []}
id_1711471328.919503
Courtney Taylor
Valley Medical Center 31097 Benitez Points Mariehaven, UT 63717 Facility Phone #: 378-469-6815 patient name: Courtney Taylor DATE OF BIRTH 1995-04-09 Age: 22 years Sex M MRN: 3841981753(SBM) ADMITTING DATE: 2020-26-02 Acct #: 71064685012 Disch Date: 2020-27-03 Pt loc: SBMC 6TNS; 643;66 Physician: Dr Thomas Moore DO PCP: PCP,Not on Staff Operative and Procedure Reports Electronically Signed By: Dr Gary House MD On 2023-18-03 1:57 Co Signature By: Dr Debra Myers MD On 2023-18-03 1:57 Modified Signature By: Dr Gary House MD On 2023-18-03 1:57 Date/Time Printed 2016-06-06 12:52 PST Report Request ID: 233133513 Page 245 of 379 97
what is the DOB or date of birth?
{"text": ["1995-04-09"], "answer_start": [146]}
id_1711475190.217889
Courtney Porter
Novant Health Urology Courtney Porter N NOVANT 2320 Baldwin Lane MRN: 53224327, D.O.B: 23/02/1985, Sex: M HEALTH Winston-Salem NC 23203-5326 DATE OF VISIT: 01/11/2022 23/10/2018 - Office Visit in Novant Health Urology - Baldwin (continued) Clinical Notes Amb (continued) Supervising Physician: Dr Jacob Smith History of Present Illness: Jeffrey Craig Payne is a 57 y.o. male with a history of Patient Active Problem List Diagnosis Human immunodeficiency virus (HIV) disease (*) Patient presents today for follow up of right epididymal cyst. This has been monitored via ultrasound. Physical Examination Constitutional Vitals: 08/03/22 1531 BP: 99/61 Pulse: 64 Generated on 4/11/23 8:33 PM Page 311
What is signature date or signed on date?
{"text": [], "answer_start": []}
id_1711475741.072654
Jamie Contreras
Jamie Contreras DOB: February 16, 1997 (81 yo M) Acc No. CR728935 [Doc Name: Othro One DOS January 31, 2023 - 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#: 2352532 PATIENT ACCT#: PATIENT NAME: Jamie Contreras DATE OF BIRTH: February 16, 1997 REFERRING PHYSICIAN: EXAMDATE: March 10, 2018 ACCESSION NUMBER: 7289367 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 Jamie Contreras DOB: February 16, 1997 (81 yo M) Acc No. CR728935 Page 162 of 166
What is signature date or signed on date?
{"text": [], "answer_start": []}
id_1711471329.118168
Kimberly Ward
ciox Fee Approval Request HEALTH CIOX HEALTH Please deliver this to the following medical record requester: Attention : Facility: Silverlake Medical Center Requester : TScan Site : 20331 Address : 8458 Theresa Curve Apt. 978 Klineport, VI 47154 Address : 8458 Theresa Curve Apt. 978 Klineport, VI 47154 City, State, City, State, Zip : Seattle, WA 98199 Zip Detroit, MI 48201 Rep Telephone : 719-456-3302 CIOX Rep: Vernette Gordon #: 825121 Fax : 844-102-9434 Fax to: Records CIOX HEALTH REP Vernette Gordon Fax Number: 313-993-0763 Phone: 313-745-3021 Dear Medical Record Requester : Date: 01/2023/19 CIOX HEALTH has contracted with Silverlake Medical Center (Medical Facility/State) to copy it's authorized requests for medical records. 03/28/2019 Patient : Kimberly Ward birthdate : 09/1990/01 Soc. Sec. # : service date 11/2015/04 CIOX HEALTH Fee Schedule FOR MEDICAL RECORD REQUESTER USE ONLY In order for your request to be processed you will need to complete the five items inside this box. Approved Date: By: Hamal j 11/2018/12 (Signature) Print Name: Phone: Hannah Reifler 206-812-6911 Title: Assistant Records Retrieval Specialist MUST BE COMPLETED TO PROCESS REQUEST Template Revision: 3.10.16
what is the DOB or date of birth?
{"text": ["09/1990/01"], "answer_start": [875]}
id_1711477090.321557
Jennifer Jackson
IVICIN 2764 Napoleon Avenue Briana Young New Orleans LA 70115 MRN: 1645364, DOB: 08/2001/05, Sex: F Acct #: 64002782564 Adm: 09/2016/18 10/2015/11 - ED in Baptist - Emergency Dept (continued) Scans for Entire Hospital Authorization - Electronic signature on 12/2016/24 7:21 AM (effective from 02/2023/21) - E-signed Karen Marie Johnson Ochsner MRN: 1645364 DOB: 08/2001/05 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 02/2023/21 4:20 PM Page 164
what is the admit date or admission date?
{"text": ["09/2016/18"], "answer_start": [141]}
id_1711473237.921333
Trevor White
10/24/2023 1:29:08 PM -0400 FAXCOM PAGE 55 OF 133 Trevor White (MRN 980825122) BIRTH DATE: 92/10/08 Encounter Date: 18/06/01 Facility OSU WEXNER MEDICAL CENTER Patient Demographics patient Legal BIRTH DATE Trevor White Sex 92/10/08 Female Op Note by Dr Brittany Moore, MD at 4/2/2018 9:43 AM Author Dr Brittany Moore, MD Service OPHTHALMOLOGY - Notes Only Author Type: Physician Filed 4/2/2018 10:41 AM Service Date 14/05/31 9:43 AM Status: Signed Editor: Thomas F Mauger, MD (Physician) 4/2/2018 Trevor White Operative Report: PREOPERATIVE DIAGNOSIS: Cataract left eye. POSTOPERATIVE DIAGNOSIS: Cataract left eye. PROCEDURE: The patient was taken to the holding area in good condition. Page 1 of 2
what is the visit date or date of visit?
{"text": [], "answer_start": []}
id_1711475741.423771
John Keller
John Keller DOB: 1994/03/02 (32 yo M) Acc No. CR589032 [Doc Name: SAVANI 2017/10/07 BCBS] Transaction ID: 53653988216 Transaction Date: 2015/28/03 10:26 am Customer ID: 5814935 John Keller Subscriber MEMBER ID BZZ10581493501 Other Blue Plans DOB 1994/03/02 GENDER Male PLAN / COVERAGE DATE 2020/30/11 - 2017/17/10 DATE OF SERVICE 2020/19/12 Either the patient's ID, name, date of birth, or address in the response does not match the information sent in the request. The response reflects the correct information. To avoid future errors in submission, please update this information in your computer system Subscriber Information 221 James L Taylor Rd PLAN NUMBER Facets PRIOR ID NUMBER BZZ103459047 Plan / Product Information ACTIVE COVERAGE INDIVIDUAL INSURANCE TYPE Preferred Provider Organization (PPO) PLAN / PRODUCT Blue Options Members 18 and over with A1c between 5.7 and 6.1 without Type 2 Diabetes diagnosis are eligible for Virta Diabetes Prevention. Members 18 and older with Type 2 Diabetes are eligible for Virta Diabetes Reversal Service Types Health Benefit Plan Coverage ACTIVE COVERAGE Infertility ACTIVE COVERAGE Preventive Drugs Service Types Pharmacy ACTIVE COVERAGE INDIVIDUAL ACTIVE COVERAGE Smoking Cessation 180 Day Supply Limit ACTIVE COVERAGE Service Types Pharmacy John Keller DOB: 1994/03/02 (32 yo M) Acc No. CR589032 Page 101 of 166
What is the Procedure Date?
{"text": [], "answer_start": []}
id_1711473237.427875
Tammy Hall
-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:Tammy Hall 1000 NORTHERN BLVD AKA: Tammy Hall GREAT NECK, NY 11021 MR#: 12657083 EPI #: 3465708 D.O.B: 2000/05/10 AGE: 71Y FEMALE Acc#: 57657083 EXAM: 57657083 - CT ORBITS - ORDERED BY: RAND RODGERS PROCEDURE DATE: 2017/03/10 INTERPRETATION: CLINICAL INDICATION: Orbital fracture, ruptured globe thin axial series through the orbits were obtained with coronal computer-generated reconstructed views. Dr Austin Hudson MD; Attending Radiologist Page 1 of 2 Date Printed: 6/20/2022 4:47 PM
What is the Date of Evaluation?
{"text": [], "answer_start": []}
id_1711475444.553456
Heather Walters
02/14/09 FROM- CWFMD T-252 P0024/0063 F-236 DISCHARGE INSTRUCTIONS Heather Walters 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 #: BH39094362699 Room/Bed: B.265/1 Unit #: BH00288051 DATE OF ADMIT: 23/18/04 Admit Physician: Punsalan, Tricia Leonora Name: Heather Walters DOB: 17/98/12 Date:
What is the Date of Encounter or Enc?
{"text": [], "answer_start": []}
id_1711472787.238863
Rhonda Rich
DATE OF VISIT: 11 December 2019 Page 2 of 3 Name:Rhonda Rich BIRTH DATE:11 August 1991 Vitals - PULM Recorded: 29 October 2023 9:40PM Systolic 111 Physical Exam Constitutional: no acute distress Cardiac: normal s1, s2 Procedure EXAM: 91975263 - CT CHEST - ORDERED BY: DENA M DAGLIAN date of procedure 11 November 2019 INTERPRETATION: INDICATION: Follow-up left pneumothorax TECHNIQUE: Volumetric images of the chest without intravenous contrast. Maximum intensity projection images were generated. COMPARISON: None. FINDINGS: LUNGS/AIRWAYS/PLEURA: Patent trachea and bronchi. 2 mm nodule in the left lower lobe. No pleural effusion or pneumothorax. IMPRESSION: No pneumothorax. Very small likely benign left lower lobe nodule. 180 Community Drive " Manhasset, NY, 11801Tel (186) 185-5183 Fax (518) 185-5183
what is the admit date or admission date?
{"text": [], "answer_start": []}
id_1711472286.532369
Christie Perry
Christie Perry MRN: 5604713 06/05/2023 - Telephone in MultiCare Rockwood Orthopedics & Sports Medicine MultiCare Health System Patient Name: Christie Perry MRN: 5604713 CSN: 296478619 Account Information Admit Date HAR# Pt Class Hospital Svc Bed 12/2022/22 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: 10/2002/12 (44 yrs) United Parcel Service Sex: male Marital Status: Significant Other RIVER VIEW CORPORATE Christie Perry CENTER MRN: 5647313, date of birth: 10/2002/12, Sex: M 16201 East Indiana Ave visiting date: 12/2019/08 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_1711476578.652392
Cheryl Smith
From Injury Treatment Center New Orie 15046559316 14-01-2023 06:33:42 pryr. Page 3 of 16 INJURY TREATMENT CENTER NEW ORLEANS THE INJURY RELIEF SPECIALISTS 3716 Airline Drive, MetaRic, LA 700xx Phone: 504xxxx Fax: 844xxxx DOB: 03-12-1999 Sex: F Patient: Cheyenne Smith Provider: Injury Treatment Center New Orleans Visit: 20-06-2018 11:00AM Chart: JOKA0000xx 14-01-2023 189.00 lbs Weight BMI 29.16 kg/mD Palo 8/10 Plan: Type Code Modifiers Quantity Description CUSTOM PHONE 1.00 UN New Clinical Form: PROCEDURE: 1) C7-T1 Epidural Steroid Injection 2) Fluoroscopic needle localization of above. ANESTHESIA: local BLOOD LOSS: minimal PROCEDURE IN DETAIL: Informed consent was obtained, explaining risk, benefits, and alternatives of the procedure to the patient. The patient was then taken to the procedure room and placed in the prone position on the procedure table. The surgical site was prepped with Chloroprep solution and a sterile drape was applied. Using fluoroscopy, the spine was examined. E-signed by injury Treatment Center New Orleans on 04-06-2017 8:32AM cm [Page 2] Powered by DrChrono This page was generated at 30-06-2020 8:32AM CDT
what is the admit date or admission date?
{"text": [], "answer_start": []}
id_1711472590.744493
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 admit date or admission date?
{"text": [], "answer_start": []}
id_1711476767.615943
Mark Saunders
26/20/04 08:30 1 12 >> unknown P 3/29 Assessment (1) Myofascial pain 729.1/M79.1 (2) Cervical myofascial strain, subsequent encounter Strain of muscle, fascia and tendon at neck level, subsequent encounter V58.89/516.1XXD Plan Orders Lidocaine 10mg (J2001) - 729.1/M79.1, - 847.0/S16.1XXD - 10/23/2023 - Hold lab results until reviewed :No Ultrasound guidance for needle placement (76942) - - 10/23/2023 - Hold lab results until reviewed :No Tendon origin/insertion injection (20551) - 729.1/M79.1, 847.0/S16.1XXD - 10/23/2023 - Hold lab results until reviewed :No Trigger point(s), 3 or more muscles (20553) - 729.1/M79.1, 847.0/516.1XXD - 10/23/2023 - Hold lab results until reviewed :No Instructions Please refer to discharge sheet. The supervising physician is on site to provide direct personal supervision involing the patient's care during their office visit today. This document is prepared by automatic population of appropriate fields, typed and or formatted entry. The reader is encouraged to contact me directly with any issue or questions. Electronically Signed by: David Brooks, PA -Author on 21/18/04 02:16:58 PM [Digital Signature Validated]
What is the Procedure Date?
{"text": [], "answer_start": []}
id_1711472591.399514
Ronald Alvarez
Salinas Valley Ronald Alvarez Medical Clinic MRN: 3193588, date of birth: 11 February 1996, Sex: F SUPUS BALLEY MEMORAL REALINONA extra Visit Day: 22 June 2019 13 March 2015 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: 21 February 2019 Status: Signed Editor: Schumann, Steven C, MD (Physician) date of service: [SS.1T] 07 May 2017 [SS.21 HPI: [SS.1T] Araceli Corona SS.2T] is [SS.1T] 33 y.o. female [SS.2T] [SS.1T] HISTORY: The following portions of the patient's chart were reviewed in this encounter and updated as appropriate: MEDICATIONS:Ss.1T] No Known Allergies Current Outpatient Medications: cyclobenzaprine (Flexeril) 5 MG tablet, Tak e 1 po hs for back pain. May increase ton 2 at bed time if needed and not groggy in the morning., Disp: 20 tablet, Rfl: 1 Printed on 12/14/21 4:04 AM Page 1 234
What is the Date of operation?
{"text": [], "answer_start": []}
id_1711471328.50678
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 Ordered Date?
{"text": [], "answer_start": []}
id_1711471328.63569
Suzanne Kelly
Springfield Regional Dr Jeffrey Washington, MD Dr Karina Soto, MD PatientID: E50344 Patient: Suzanne Kelly BIRTH DATE: 1999-01-01 Age: 59 y date of service: 2017-20-05 CHIEF COMPLAINT: Patient is seen today for incontinence. DATE OF ONSET: 2006 REFERRING DOCTOR: Dr Robin Brown, MD. MEDICATIONS: Paracetamol, FLU VACCINE SURGICAL STAPLES HEPATITIS VACICINE HISTORY OF PRESENT ILLNESS: VOIDING SYMPTOMS (LUTS): The need to urinate during the night occurs once. URINARY INCONTINENCE: The patient loses urine with coughing, sneezing. HISTORY: 625.6-FEMALE STRESS INCONTINENCE PAST MEDICAL HISTORY: MEDICAL: Skin cancer SURGICAL: Appendectomy in 2005 UROLOGIC SURGERY: Cystoscopy. 2006 & 2007 Urodynamic studies, all done in Shreveport Louisiana SOCIAL HISTORY: MARITAL HISTORY: Widowed. TOBACCO USE: Currently smokes 1 PPD. Has tried quitting with Chantix. Suzanne Kelly-KPJayaraman-000045
What is Ordered Date?
{"text": [], "answer_start": []}
id_1711475620.53552
Dale Miller
Dale Miller DOB: 1987/06/12 (43 yo M) Acc No. 47046 Doc Name: 2016/30/05 NP Forms I do 00 /do not authorize the release of information pertaining to HIV/AIDS Purpose of the Requested Disclosure I am authorizing the release of my Protected Health Information for the following purposes: Medical Care Insurance At the request of patient Other (specify) Request by Attorney Time Period for this Authorization This Authorization will expire five years from the date of its execution. Revocation of This Authorization | understand that I have the right to revoke this Authorization at any time to prohibit future release of my information. To revoke this Authorization, 1 must send written notice to LA Health Solutions, to the attention of LA Health Solutions Medical Records Division at the address indicated above. I understand that my revocation of this Authorization applies to future disclosures only and will not have any effect on any disclosures of Protected Health Information made before receiving the revocation. Redisclosure I understand that my Protected Health Information disclosed pursuant to this Authorization may be redisclosed by the recipient identified above and may no longer be protected from disclosure to others by federal or state law. Waiver I hereby expressly waive any claim of privilege or privacy with respect to the released information. 1 release and forever discharge LA Health Solutions and its agents, servants, or employees from all liability or claims, of any kind or character, in any way arising out of the disclosure of the requested information, including disclosures made in good faith. Voluntary 1 understand that signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for benefits will not be conditioned upon my authorization of this disclosure. Signature of Patient/Patient's Representative: Date: Jabbith 2019/30/04 Printed Name of Patient's Representative: Relationship to Patient: Dale Miller DOB: 1987/06/12 (43 yo M) Acc No. 47046 Doc Name: 2016/30/05 NP Forms Page 100 of 123
what is the service date or date of service?
{"text": [], "answer_start": []}
id_1711472286.57228
Jennifer Parker
Jennifer Parker MRN: 5606513 04/04/2023 - External Document in MULTICARE HEALTH INFORMATION (continued) INJURY DATE: Place of Injury: 2017-25-03 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 800-365-9919 253-465-4948 Tacoma WA 98655-3799 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: 5606513 , birth date: 1988-19-03, Sex: M TACOMA WA 98465-0299 Date of Visit: 2022-12-12 Page 54 Printed by 414221 at 7/17/23 9:40 AM
What is the Date of Discharge?
{"text": [], "answer_start": []}
id_1711477275.521513
Nicole King
From: Radiology Associates To: MASCIALE JOHN Page: 3/3 Date: Jun 15, 2021 4:19:29 PM Radiology Associates: 1872 S Alameda Corpus Christi, TX 78472 Radiology Associates Phone: (361) 872-7072 LLP Fax: (361) 572-3172 Electronically signed by: RUTH K. GERSHON M.D. Mar 28, 2017 04:46 PM Page 3 of 3 (TREJO, ELMA) CC: 76772-3 South Texas Bone & Joint - 00472
What is the Date of Discharge?
{"text": [], "answer_start": []}
id_1711473366.118999
Nancy Solis
athena 10/30/2023 1:33:13 pm EDT Page: 56 / 86 Nancy Solis (id #15546552, date of birth: 11/06/92) Baptist Health Health Information Management Dept Nancy Solis 3563 Philips Highway Building B. Suite 201 MRN: 52554550 date of birth: 11/06/92, Sex: F Jacksonville FL 55207-5553 Adm 26/01/15 D/C: 25/02/15 07/15/2023 - ED in Baptist Clay Emergency (continued) ED Provider Note (continued) HISTORY: seizure COMPARISON: None. TECHNIQUE Contiguous axial slices of the head were submitted without IV contrast. FINDINGS: INTRACRANIAL: Brain parenchyma is normal in attenuation, No acute intracranial hemorrhage. Signature: Dr Amy Moore MD 19/03/17 12:38 PM CDT Printed on 7/27/23 at 8:20 AM Release ID: 28555892
What is Ordered Date?
{"text": [], "answer_start": []}
id_1711477090.2013
Lisa Taylor
I have reviewed and agree with the diagnosis and treatment plan. Saman Aboudi MD 04-04-2018 7:19 PM Electronically signed by Brandon Alvarado PA-C on 29-04-2017 at 7:16 PM. Provider: Robyn Dettmar, PA-C Document generated by: Saman Aboudi 25-08-2014 7:19 PM PVHC At Claremont- Urgent Care 1601 N Monte Vista Ave Ste 190 Claremont, CA 9171 16629 (909)295-9929 0029
What is the Procedure Date?
{"text": [], "answer_start": []}
id_1711473365.935374
Miss Ashley Williams PhD
Date 2021-08-20 Occupational Health A Northbay Affiliate Page ] 1101 B. Gale Wilson Blvd, Suite 203 Fairfield, CA 94533 (748) 648-4480. Fax: (748) 486-4481 Work Status Summary Provider: Lederer, Sheila PA Visit Date: 2019-02-10 Time In: 9:22AM Out: 10:23AM Purpose: Worker's Comp Follow Up Presenting Problem injury date: 2017-01-23 Case Number: 2048-04802 Diagnosis E885.9 Atrial Fibrillation Visit Referrals Referred To: A Referral Date: 6/22/12 Referred To: A Physician Referral - NOS Date: 6/22/12 231
What is signature date or signed on date?
{"text": [], "answer_start": []}
id_1711471328.429363
Gail Espinoza
2019-03-15 22:59 Highland General P. 73/99 Highland General USS Castaneda FPO AA 78071 RADIOLOGY REPORT Patient Name NUMBER SEX AGE admitting date DISC. XRAY# F/C TYPE Gail Espinoza 63681318846 F 53 2014-10-11 2014-11-10 842563 MB O/P DOB: 1999-01-16 M/R# 842563 PH#: 359-509-4386 RM LOCATION: TRANSCRIBED: 2019-03-15 22:59 PSR MR LOW EXTR LT EXC JT WO CONT 73718 COMPLETE: 2019-03-15 19:17 TJB 79056 REASON FOR PROCEDURE: Influenza PHYSICIAN: Dr Stephen Simon MD HISTORY: Knee replacement in 2001. Morton's neuroma of the second intermetatarsal space (5 X 9 mm). 2. Metatarsophalangeal joint mild capsulitis and second interspace mild bursitis. 3. Evidence of first MTP chronic capsular induration as well as sesamoid arthrosis. Prior bunion surgery. Healed surgical changes versus prior healed trauma of the first metatarsal base and proximal metaphysis. Sherry Hinson-YVAM-MD-000027
what is the DOS or D.O.S?
{"text": [], "answer_start": []}
id_1711473365.628698
Sarah Aguirre
<<Back to Review>>186198-33-HYPERLINK Hyperlink-Page 11 TRI VALLEY ORTHOPEDIC . 4616 Willow Road, PLEASANTON CA 96188-8614 FOSTER, Edward (id #361161, BIRTH DATE: 1991 Oct 07) DATE OF ENCOUNTER: 2021 Aug 08 Patient Name Sarah Aguirre (82yo, M) ID# Appt. Date/Time 2018 Jun 28 03:40PM 326112 BIRTH DATE 1991 Oct 07 Service Dept. TRACY OFFICE Provider SEAN DOUGHERTY, DPM Insurance Med Worker's Comp: CORVEL - CRUM AND FORSTER Chief Complaint Right Ankle pain Patient's Care Team Insurance Adjuster (Worker's Comp): LETICIA BAILON: Ph (761) 261-1611, Fax (861) 6261-6611 Medications Reviewed Medications atorvastatin 20 mg tablet 10/04/17 filled 061061 0611
What is Collection Date?
{"text": [], "answer_start": []}
id_1711473238.049451
Michelle Smith
Md. L. ZULL 0:09PM NO. 2001 P. 4/ / D.I.S. Slidell DIS 1310 Gause Blvd. Slidell, LA 75158 P: 491-670-1591 F: (504) 851-5514 DIAGNOSTIC IMAGING SERVICES PATIENT NAME: Michelle Smith Ref. Physician: Dr James Dougherty, MD Patient ID: CIS251346 Home Phone: (551) 446-5165 DATE OF BIRTH: 15 December 1999 Page 1 of 2 service date: 14 May 2020 STUDY MRI, Cervical Spine s/ Contrast CLINICAL INDICATION Neck pain. Radicular pain extends into both upper extremities. The symptoms have been present since a motor vehicle collision 03/08/2022. COMPARISON No relevant imaging examinations are available for review.
what is the DOS or D.O.S?
{"text": [], "answer_start": []}
id_1711477275.276542
Lindsey Mccarthy
LAB* 10/04/2022 (#5480043, 09/27/2022) LAB ACCESSION # LAB ORDER NUMBER REPORT STATUS 9243 Wall Street WY019943 Partially SW014574001443 Austin, Texas 78754 Completed CLINICAL PATHOLOGY (800)59xxxx PATIENT NAME PATIENT ID. LABORATORIES (800)595xxxx Patricia Thomas 145741009431 PATIENT PHONE SEX D.O.B. AGE (361) 227xxxx Female 93/05/26 69 Years PHYSICIAN NAME IS FASTING? MASCIALE, JOHN Unknown ACCOUNT: ACCOUNT # COLLECTED ORDER RECEIVED BY LAB SOUTH TEXAS BONE AND JOINT 14574 22/08/04 14:21 09/27/2022 19:32 601 TEXAN TRAIL REPORTED PRINTED CORPUS CHRISTI, TX 78411 23/04/01 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 43 76743-3 South Texas Bone & Joint - 00043
what is the service date or date of service?
{"text": [], "answer_start": []}
id_1711476892.687137
Blake Mendoza
2014-08-04 2:51 PM FROM: Fax Universal Spine _Joint Specialists TO: 8636221027 PAGE: 027 OF 279 Electronically Signed By: John Bates MD 2017-04-06 9:44:22 Thank you very much for Invoiving usin the evaluation of this patient
what is the DOB or date of birth?
{"text": [], "answer_start": []}
id_1711471330.67545
Raymond May
patient name Raymond May I birthdate May 19, 1993 I MRN 3891868 I SOURCE WJMC Cerner Inpatient Millennium Power Chart I ENCOUNTER DATE June 30, 2018 21:39:00 Administered Medications: 07/13 Drug: Albuterol inhaler - (Bentyl 20 mg, Maalox Suspension 30 jmf 23:33 mL, Lidocaine Liquid 2 % 10 mL) ; Route: PO: Outcome: 07/14 Discharge ordered by MD. dd 00:20 07/14 Patient left the ED. jmf 00:30 Signatures: FAUST, JONATHAN jmf Dr Craig Harvey, MD MD dd Katicich, Jeanea jk
What is the Date of Evaluation?
{"text": [], "answer_start": []}
id_1711475190.543659
Emily Barton
Emily Barton MRN: 5482483 Preferred Pharmacy (continued) Referral (continued) Order MRI ARTH SHOULDER W/ CONTRAST RIGHT [676335615] Electronically signed by: Dennis S Frerichs, PA-C on 08/03/2024 0489 Status: Completed This order may be acted on in another encounter. Ordering user: Dennis S Frerichs, PA-C 02/22/23 0949 Authorized by: Dennis S Frerichs, PA-C Ordered during: Office Visit on 03/11/2017 Screening Form General Information Patient name: Emily Barton MRN: 5482483 DATE OF BIRTH: 14/05/1989 Mobile: 548-948-4489 Sex Assigned at Birth: Male MC ROCKWOOD MAIN CLINIC Emily Barton - SPOKANE MRN: 5602313, DATE OF BIRTH: 14/05/1989, Sex: M 400 East 5th Ave visiting date: 26/08/2022 Spokane WA 99202-1334 Page 89 Printed by 414221 at 7/17/23 9:40 AM
What is the Date of Evaluation?
{"text": [], "answer_start": []}
id_1711475620.811222
Jessica Hunter
QuestQuanum Jessica Hunter DOB: October 25, 1989 Age: 21 Specimen: MR128770H Collected :June 13, 2020 12:45 Client #: 39723668 Sex: M Fasting: U Requisition: 0000238 CABALLERO,DANIRIA Report Status: FINAL/SEEREPORT Recorted January 16, 2015 2030 A Y REHAB MEDICAL CENTER Patient ID: 47278 8326 SW 8TH ST MIAMI, FL 33144-4180 Phone (786) 899-0908 FASTING:UNKNOWN URINALYSIS, COMPLETE FINAL Lab: MI Analyte Value COLOR (5778-6) YELLOW Reference Range: YELLOW FINAL APPEARANCE (5767-9) CLEAR Reference Range: CLEAR FINAL SPECIFIC GRAVITY (5811-5) 1.015 Reference Range: 1.001-1.035 FINAL SPECIMEN INTEGRITY COMPROMISED FINAL Lab: MI Analyte Value SPECIMEN INTEGRITY COMPROMISED FINAL Whole blood, unspun or partially spun gel barrier tube received more than 2 hours since collection COMPREHENSIVE METABOLIC PANEL FINAL Lab: MI Analyte Value GLUCOSE (2345-7) 87 Reference Range: 65-99 mg/dL FINAL Fasting reference interval UREA NITROGEN (BUN) (3094-0) 17 Reference Range: 7-25 mg/dL FINAL LUCES,DAVID (MR128770H) 1/3 January 16, 2015
What is Collection Date?
{"text": ["June 13, 2020"], "answer_start": [103]}
id_1711472591.344096
Katelyn Fuller
From dcatalyst16 18443858095 8/29/2022 10:58:59 PDT Page 13 of 17 Dr Catherine Stevens MD Today's Date: 07/01/2024 RehabOne Medical Group, Inc. All Clinics' US Mail Address: 13980 Blossom Hill Road, STE B Los Gatos, CA 96532 Industrial Injury Info: D.O.B: 21/10/1984 Adjuster: Jennifer Restori Claim # 00546822824-WC-01 Phone # 916-657-6536 INJURY DATE: 05/05/2017 Fax # 866-650-0658 Insurance: Gallagher Bassett (Corona) Patient Info: Address: 46864 Long Springs Suite 738 Jamesview, CA 82980 Phone (C): 831-650-3659 Pref. Lang.: English Diagnosis: M65.17 Intervertebral disc disorders with radiculopathy, lumbosacral region Case Type: Work Compensation 176 Katelyn Fuller : Aug 25, 2022 page 12
What is signature date or signed on date?
{"text": [], "answer_start": []}
id_1711476990.428159
Aaron Guerra
73247198494 fax 01:06:21 p.m. 09-12-2023 23/122 labcorp ahoma, Inc Order Status: F3 4122 South Mingo Road ACCOUNT NUMBER ACCESSION # Oklahoma, Inc. Tulsa, OK 74122 05522 1122945022 (918) 744xxxxx PATIENT NAME ROOM # Jennifer Mata GILLAN, M MONEM PATIENT ID # D.O.B. AGE GENDER 1211 N Shartell Ste 700 447080 1989-28-07 55 Years Male Oklahoma City, OK 73103 PATIENT PHONE # CHART # (405)702xxxx 5804010679 1055923 REFERRING PHYSICIAN Gillan, M Monem CLIENT REF. # ORDERED 1141945059 2014-16-05 09:55 RECEIVED REPORTED 2016-10-12 15:00 2014-22-11 01:11 Result Name Normal Abnormal Units Ref. Range Lab CBC WHITE BLOOD CELL COUNT (WBC) 7.1 10e9/L [4.0-11.0] LCO-OKC RBC 5.17 10e12/L [4.39-5.64] HEMOGLOBIN 15.2 g/dL [13.1-17.3] HEMATOCRIT 44.6 % [39.5-51.1]
What is the Date of operation?
{"text": [], "answer_start": []}
id_1711475741.01817
Patrick Thomas
Patrick Thomas DOB: 1990 September 13 (28 yo M) Acc No. CR970452 [Doc Name: 2020 November 24 MRI LUMBAR SPINE] CR970452 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: Patrick Thomas PATIENT ID: 3971977 REFERRING PHYSICIAN: AMY WU, PA-C DOB: 1990 September 13 REFERRING PHONE: DOS: 2017 February 12 REFERRING FAX: EXAMINATION: MRI LUMBAR SPINE WITHOUT CONTRAST CLINICAL HISTORY: Slip and fall 2024 February 18, low back pain. TECHNIQUE: Multisequential multiplanar imaging was performed of the lumbar spinal region in a high-field MRI. FINDINGS: There is a normal marrow signal noted throughout the lumbar vertebral bodies. The conus medullaris is unremarkable and there is no obvious intradural abnormality noted. There is moderate facet arthrosis and ligamentum flavum hypertrophy throughout the lumbar spinal region. asymmetric toward the left side with an annular tear and significant effacement of the left nerve root. IMPRESSION: At L5-S1, there is narrowing, posterior and lateral osteophyte, desiccation, and 4.5 mm herniation with annular tear asymmetric toward the left side causing significant effacement of the left nerve root. 1.5 mm anterolisthesis and 1 mm bulging at L4-L5 with mild to moderate spinal stenosis. There is moderate facet arthrosis and ligamentum flavum hypertrophy throughout. 2021 November 16-Hn Cores ceviow @ Page 1 of 2 Patrick Thomas DOB: 1990 September 13 (28 yo M) Acc No. CR970452 Page 87 of 166
what is the DOS or D.O.S?
{"text": ["2017 February 12"], "answer_start": [493]}
id_1711475956.200267
Lisa James
25/06/14 eow (Henderson, MIJOI ) Production En ament Lisa James DOB: 13/09/95 (50 yo M) Acc No. 37950 DOS: 08/01/24 Electronically signed by UMAR MAHMOOD DO on 25/01/17 at 01:04 PM CST Sign off status: Completed PSA Temple 10252 West Adams Avenue Suite 104 Temple, TX 76502-5849 Tel: 254-732-6631 Fax: 512-582-8617 Progress Note: Umar Rashid Mahmood, DO 08/01/24 Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
What is the Date of Evaluation?
{"text": [], "answer_start": []}
id_1711473530.417425
Justin Wilkinson
Ochsner Health THIS IS NOT A BILL James Russell Ladner 4311 1ST AVE BAY ST LOUIS MS 39520 The following document contains the itemized services requested for your visit on August 25, 2022 for James Russell Ladner (Guarantor #131953141). Coverage(s) on file: Aetna Managed Medicare - Aetna Medicare Plan PPO Patient Name: DATE OF ADMIT: 2016 Nov 20 Discharge Day: 2016 Dec 20 Facility: KENNER HOSPITAL Account Class: Emergency Provider: Diagnosis: Influenza, Migraine, initial encounter [S16.1XXA] Svc Date Code Description Qty Amount Charges 2021 Oct 20 73125 PR CT Scan, Cervical Spine, W/O Contrast 1 126.00 Questions? Call 831-313-0319 or 531-312-4310,
What is Ordered Date?
{"text": [], "answer_start": []}
id_1711475741.66316
Cynthia Allison
06/2020/08 FROM- CWFMD 936-703-5455 T-252 P0062/0063 F-236 Fax Server 06/2020/08 AM PAGE 1/002 Fax Server GHPMA Radiology 22710 Professional Drive Kingwood, TX 77339 Phone (281)-312-8500 Fax (281)-358-2543 Patient Name: Cynthia Allison Physician: Jason Rodney Laningham, M.D. Patient Birthdate: 06/2001/04 Patient ID: WFPPRIERI Date of Service 07/2017/14 EXAMINATION: LEFT THIRD FINGER, TWO VIEWS These images were performed at Willis Family Practice and provided to [ Imaging for interpretation HISTORY: Finger pain FINDINGS: Two views of the left third are submitted for evaluation, There is no evidence of fracture, dislocation or destructive osseous lesion. The articular spaces are maintained and the soft tissues are normal, Thank you for choosing 1960 Digital Imaging. Page 1 of 2 This fax contains confidential patient information If you receive this transmission in error, please destroy the faxed materials and contact the sender at 281-453-7999 Name: Cynthia Allison DOB: 06/2001/04 Date:
what is the DOS or D.O.S?
{"text": [], "answer_start": []}
id_1711471328.277131
Sara Berry
HISTORY OF PRESENT ILLNESS: Patient is a 34-year-old female who presents stating that he hit his head on the real on Saturday. He states he has pain and swelling to the interesting and Audience should hot floor share act.. He has had vomiting. He also has no neck pain. ALLERGIES: Please refer to chart. PRESENT MEDICATIONS: Please refer to chart.Lakeside Health PAST MEDICAL HISTORY: Please refer to chart. PAST SURGICAL HISTORY: Please refer to chart. SOCIAL HISTORY: Please refer to chart. FAMILY HISTORY: Please refer to chart. REVIEW OF SYSTEMS: Please refer to chart. PHYSICAL EXAMINATION: Please refer to chart. INITIAL VITAL SIGNS: Blood pressure 137/68, pulse 80, respirations 16, temperature 59掳 INITIAL ORDERS: Initial orders were written for CT of the head, cervical spine. He was also given Toradol 60 mg intramuscularly. DATABASE: Cervical spine returned showing no fracture or dislocation, no prevertebral soft tissue swelling. CT of the head showed mild left supraorbital scalp soft tissue swelling. MEDICAL DECISION-MAKING PROCESS: Based upon these findings, the patient: Sara Berry PHYSICIAN: Dr Courtney Anderson, MD MED.REC.NO.: 14-60-44 1038369-E EMERGENCY ROOM NOTE ADMISSION: 08/01/2020 Lakeside Health 088 Alyssa Via Apt. 376 New Dana, OR 47990 SERVICE DATE: 14/06/2016 DISCHARGE DATE: 07/02/2020 Page 1 CHART COPY 59 of 107 27/09/2018
What is Collection Date?
{"text": [], "answer_start": []}
id_1711476768.807303
Francis Mendez
12/27/22, 10:19 AM Francis Mendez I M I 11/20/1963 I 59Y TBI PATIENT NAME: Francis Mendez DOB: 1994-26-12 PATIENT NUMBER: T67179 REFERRING PHYS: ATHANS DATE OF SERVICE: 2014-09-11 10:32:42 AM MRI OF THE CERVICAL SPINE: HISTORY: MVC dated 12/12/22 with neck pain. TECHNIQUE: Multisequence T1 and T2 weighted images were obtained. FINDINGS: The posterior fossa structures are normal.There is loss of the normal lordotic curvature of the cervical spine. In the correct clinical setting, this may reflect injury. Clinical correlation is recommended. No prevertebral or paravertebral masses or fluid collections are identified. Segmental analysis of the cervical spine is as follows: At C2-3, there is no evidence for disc herniation, canal stenosis or neural foraminal stenosis. At C3-4, there is bulging of the disc. This results in an anterior impression on the thecal sac. There is no central canal stenosis or foraminal stenosis. IMPRESSION: TAMPA BAY IMAGING 2700 WEST DR. MLK JR. BLVD SUITE 130 TAMPA, FL 33607 TELEPHONE 813xxxxxxx FAX 813xxxxxxx Page 1 of 3 1/3
what is the admit date or admission date?
{"text": [], "answer_start": []}
id_1711476768.744823
Amy Charles
WEST, Wade DOB: 1992-14-03 (59 yo M) Acc No. 17111 DOS: 2015-20-04 4. Lumbar facet joint syndrome - M47.816 Cervical facet syndrome C5/C6 and C6/C7 disc herniation Intermittent cervical radiculopathy L5-S1 disc herniation Right-sided radiculopathy lumbar Lumbar facet syndrome EMERGENCY MEDICAL CONDITION The injuries the patient sustained as a result of the motor vehicle accident pose great risk to their health both now and in the future. An Emergency Medical Condition (EMC) is defined as: (i) placing the health of the individual in serious jeopardy, (ii) serious impairment to bodily functions, or (iii) serious dysfunction of any bodily organ or part. Based upon a reasonable degree of medical probability, it is my belief that the aforementioned deficits exhibited during this exam meet the criteria for an "EMC" and warrant aggressive treatment to prevent permanent and irreversible damage to the patients health and body as a whole. Treatment 1. Others Notes: Today the patient and I reviewed their MRIs on a frame by frame basis. Visit Codes 99204 Office Visit, New Pt., Level 4. CUD... MJ Electronically signed by Erik Riley on 2019-10-05 at 08:38 AM EST Sign off status: Completed Progress Note: Charles W. Davis II, MD 01/10/2023 Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com)
What is Date of Injury or DOI?
{"text": [], "answer_start": []}
id_1711473237.429674
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 service date or date of service?
{"text": [], "answer_start": []}
id_1711475190.117114
Katie Kelley
Novant Health Mothershed Foot Katie Kelley N NOVANT & Ankle Specialist MRN: 57724777, DATE OF BIRTH: 01/07/1992, Sex: M HEALTH 477 Pineview Drive Ste 770 date of visit: 26/12/2017 KERNERSVILLE NC 27774- 3817 01/01/2023 - Office Visit in Novant Health Mothershed Foot & Ankle Specialist (Kernersville) (continued) Clinical Notes Amb (continued) electronically signed by Robb A Mothershed, DPM at 25/09/2015 1772 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 Date of Evaluation?
{"text": [], "answer_start": []}
id_1711472787.126649
Ms. Tracey Jones
OrthoVirginia MRN: 8659955 Name: Ms. Tracey Jones BIRTH DATE: 03/09/98 1920 Ballenger Avenue Suite 200 Alexandria VA 22174-6178 07/12/20 - Office Visit in OV Reston Suite 400 (continued) Clinical Notes (continued) Consent given by: patient Site marked: site marked Orders Placed This Encounter Large Joint Arthrocentesis Large Joint Arthrocentesis Return if symptoms worsen or fail to improve. I, THOMAS KLEIN, MD, personally, performed the services described in this documentation, as scribed in my presence, and it is both accurate and complete. Scribed by: Shivani Rampuria ELECTRONICALLY SIGNED BY Rampuria, Shivani at 05/03/21 2:50 PM ELECTRONICALLY SIGNED BY Dr Dawn Lucas, MD at 05/03/21 7:8 PM Labs No documentation. Procedures Large Joint Arthrocentesis: R subacromial bursa (Final result) Electronically signed by: Rampuria, Shivani on 07/17/23 1448 Printed on 9/25/23 12:33 PM Page 3
What is signature date or signed on date?
{"text": ["05/03/21"], "answer_start": [659]}
id_1711476990.617402
Kyle Goodman
JOHN F. KENNEDY MEMORIAL HOSPITAL, Inc. 47 8350058 PT - Michael Shea MR- AD - 07-07-2023 DD - 06-08-2023 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 12-06-2020 LAKE WORTH. FLA. CLAIMS OFFICE
what is the visit date or date of visit?
{"text": [], "answer_start": []}
id_1711477183.246381
Jessica Garcia
15-03-27 3:39 PM IDS FaxServer 15047342073 pg 2 of 73 DIS D.I.S. Slidell DIAGNOSTIC IMAGING SERVICES Patient Name: Joseph Patel Ref. Physician: Rommel S Dhadha MD Patient ID: 425xxx Home Phone: Date of Birth: 01-08-14 Page 1 of 73 Date of Service: 18-08-11 STUDY X-ray, Lumbosacral, Minimum 4 Views CLINICAL INDICATION Back pain COMPARISON No relevant imaging examinations are available for review. PROCEDURE DETAILS AP, lateral, both oblique, and spot lumbosacral views were acquired. FINDINGS The vertebral body heights and disc spaces are well maintained. Alignment is anatomic without spondylolisthesis or spondylolysis. SI joints of sclerotic changes more prominent on the right than left. The bony mineralization is appropriate. There is a 4.8 mm calculus seen in the lower pole region of the right kidney. IMPRESSION 1. No significant spondylosis or acute findings involving the lumbosacral spine. 2. Calcifications involving both sacroiliac joints right greater than left raise the question of sacroiliitis. Signature Electronically Signed: Silvestri, James, M.D. on 17-03-03 02:39 PM
What is signature date or signed on date?
{"text": ["17-03-03"], "answer_start": [1143]}
id_1711475190.25386
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 Discharge?
{"text": [], "answer_start": []}
id_1711471328.882658
Richard Jacobs
Encounter # MR# Enc Start Date Time Pt Location 72781384366 5558890 2022 May 13 07:11 ADLT ED Waiting Indy ECD# Level of Care Clin Svc EPT Enc Type 4114296004 Other EMR ER OP City Health Clinic Preferred Language Admit Source Confidential Infectious Disease English Phys Ref Email Admit Type Incident Date Incident Type [email protected] Emergent Advance Dir: Race: Soc Sec # Gdr MS No Black F S Age dob Religion\ Church Adm Clerk 81Y 1989 September 03 COG \ UKN 016 Patient Address, Phone Employer Name, Address, Phone Emplm Sts, Class, Cat Richard Jacobs EXTENDED STAY AMERICA Empl 7165 John Extensions East Molly, LA 12421 Indianapolis, IN 46254 County: Marion Home: 812-851-6656 Day: Cell: 413-637-4729 Guarantor Name, Pt Rel, Address, Phone Guarantor Empr, Address, Phone Empim Sts, Class, Cat Richard Jacobs Self EXTENDED STAY AMERICA Empl Phone: 317-298-0651 317-514-7862 Emergency Contact 1 Emergency Contact 2 Richard Jacobs PO Box 1575 Authorization # Eligibility # 1989 September 03 Primary Physician Reason for Encounter Dr Michael Castillo HBS Admitting Physician Copy to Physician Emergency, Indianapolis Attending Physician Emergency, Indianapolis Printed: 2017 January 17 7:20 User: jdunl614 02A 4118867004 SVI 0061
What is the Date of operation?
{"text": [], "answer_start": []}
id_1711473530.958554
Peggy Quinn
onecall care PHYSICAL THERAPY FAX / EMAIL Confidential - 4/12/2019 6:39:40 PM DISCHARGE / DISCONTINUATION SUMMARY PLEASE FAX TO (904) 309-8942 Re: Injured Worker: EDWARD FOSTER Claim Number: PZC29924294 Initial Eval Date: 2018/11/10 Employer: SUPER STORE INDUSTRIES; MID Referring Physician: Jenny Wong Facility Name: Tower Physical Therapy Service Type: Physical Therapy INJURY DATE: 2022/26/04 Total Visits: No Shows/Cancellations: Pain Rating: (please choose from 0, 1, 2, 3, 4, 5, 6, 7,8, 9, 10) / 10 At Initial: At Discharge: / 10 Thank you for choosing One Call Physical Therapy. Visit us on the web at www.onecallcm.com 000121 0121 TAG:12-EMBID-4764913: Page 7 of 13
what is the DOS or D.O.S?
{"text": [], "answer_start": []}
id_1711476893.34521
Paul Beasley PhD
2229 Post St., Suite 211 Integrated Pain Care 3160 Garrity Way San Francisco, CA 94115 Richmond, CA 94806. Tel (415) xxxxxxx A Pain Management Clinic of Excellence Tel (510) xxxxxxx Fax (800) xxxxxxx Name: Robert Edwards Date: 05/2014/14 Testing Facility: Richmond An additional 15 minutes were spent to review the patient's medical records and pertinent imaging studies, if available. History was obtained through interview. Translation when necessary was provided by a licensed medical translator. Date of Birth: 11/1988/21 Height: 5'6 Weight: 160 Date of Injury: 06/2014/02 Chief Complaint: Low back pain, radiating into bilateral lower extremities with tingling, right greater than left Past Medical History: Patient denies a personal history of diabetes, thyroid disease or known neurological disease. Patient denies pacemaker or heart defibrillator implant. Patient denies current use of anticoagulants. Patient denies any history of neck or back surgery. NERVE CONDUCTION STUDIES: This is a(n) abnormal nerve conduction study. The left tibial motor amplitude was decreased compared to the right by greater than fifty percent. F-waves were within normal limits. H-reflexes revealed no significant side-to-side variance. ELECTROMYOGRAM: 529
What is the Date of Discharge?
{"text": [], "answer_start": []}
id_1711475955.909979
Jeremy Gomez
27 Nov 2020 14:35 FROM- CWFMD 936-703-5455 T-242 P0066/0075 F-228 19 Jan 2020 10:59:26 2 /3 Walgreens PLEASE INITIAL AND DATE ALL CHANGES Diabetic Detailed Written Order Fax form with prescriber's signature & date to 1-866-855-5888 (toll free fax) 1. Date of Order: 11 May 2014 2. Patient Name: Jeremy Gomez Address: 14570 TRERO LN City: WILLIS State: TX Zip: 77378-4394 Gender: FEMALE Birth Date: 10 Oct 1987 3. Primary ICD-10 Diabetes Diagnosis: R73,9 Diabetic Type: 4. Diabetes Testing Supplies - Must Check 5. Testing Frequency 10. Prescriber Name: JOSHUA DUBOSE NPI: 1700997665 PLEASE Address: 804 W MONTGOMERY ST INITIAL AND City: WILLIS State: TX Zip: 77378-8830 DATE ALL CHANGES Prescriber Signatures Date: 29 Mar 2018 (Handwritten Signature and Date Required) Fax Form To: 1 866 855-5888 or mail original form to: Walgreens Medicare Processing, P.O. Box 4000 Danv眉le, IL 61834-4000 Questions? Contact the Walgreens Medicare Part B documentation department at: 1-888-281-0590 between the hours of 8:00-4:30 CST Please note that this document does not constitute the patient's Medical record. If this claim is audited by Medicare you could be required to provide additional documentation. C0011041536 Name: Jeremy Gomez DOB: 10 Oct 1987 Date:
What is Date of Injury or DOI?
{"text": [], "answer_start": []}
id_1711477275.718461
Mark Hanson
She is to keep a followup appointment with the office of Dr. Masciale for on or about 13/11/2023 DICTATED BY: JOHN P. MASCIALE, MD BT/NTS D: 13/11/2023 11:11:39 AM T: 13/11/2023 01:09:24 PM DOC#: 32961831 JOB#: 278417831 Electronically Authenticated and Edited by: JOHN P MASCIALE, MD on 29/01/2018 04:00 PM CST cc: Patient Status: DIS IN M.R.#: MV00480831 Patient: TREJO,ELMA MUNOZ Account #: AV0031 1605031 Attending Dr.: John Delgado, MD Admit/Service date: 14/11/2014 Discharge date: 10/02/2022 DOB: 17/02/1994 Loc/Room #: AV.MS3A/AV.302-1 Medical Records' copy Medical Records Primary Care Dr.: LILJEBI Page 3 of 31 76731 -3 South Texas Bone & Joint - 00331
What is signature date or signed on date?
{"text": ["29/01/2018"], "answer_start": [308]}
id_1711477275.520466
Jeffrey Thompson
From: Radiology Associates To: MASCIALE JOHN Page: 3/3 Date: 18 August 2016 4:19:29 PM Radiology Associates: 1874 S Alameda Corpus Christi, TX 78474 Radiology Associates Phone: (361) 874-7074 LLP Fax: (361) 574-3174 Electronically signed by: RUTH K. GERSHON M.D. 26 April 2014 04:0 PM Page 3 of 3 (TREJO, ELMA) CC: 76774-3 South Texas Bone & Joint - 00474
what is the service date or date of service?
{"text": [], "answer_start": []}
id_1711471328.608735
Carolyn Walker
12/07/2023 14:29 (FAX) P. 078/087 Downtown Medical Center Dr Tiffany Patterson, MD 14940 N 99th Avenue, STE #100 Sun City, AZ 84951 T. (623) 349-5700 F. (623) 328-9491 Nerve Conduction Study & Electromyography Report Full Name: Carolyn Walker Gender: Female MRN: 249402 dob: 05/08/03 visit: 25/06/15 7:50 AM Age: 24 Years Examining Physician: Dr Tiffany Patterson, MD Referring Physician: DR SIMRAT KAUR Height: 5 feet 8 inch Weight: 170 lbs BMI: 25.8 Patient History: NEUROPATHYY
What is the Date of Evaluation?
{"text": [], "answer_start": []}
id_1711472591.318521
Courtney Kelly
From dcatalyst16 18443858095 8/29/2022 10:58:59 PDT Page 12 of 17 (3) 10 Week(s) F/U TVV Follow up with Dr Dalton Buckley, M.D. PRIMARY TREATING PHYSICIAN ATTESTATION: This report was scribed by Aspeitia, Cassandra. / declare under penalty of perjury that this report is true and correct to the best of my knowledge and that / have not violated Labor Code 搂 139.3. Sincerely, Dr Dalton Buckley MD Exam Date: 2020 Mar 06 RehabOne RehabOne Programs MEDICAL PRESCRIPTION Industrial PATIENT: Courtney Kelly Exam Date: 2020 Mar 06 Performing Provider: Dr Dalton Buckley MD THERAPY: Acupuncture: Body Parts: low back. Performed by Brent Dauphin, L.A.c. License# CA 15347 with RehabOne Programs in Salinas. : 2x/week for 3 weeks. Clinical Rationale: The requested medical treatment is medically necessary to cure or relieve the effects of the 16Corona, Araceli : Aug 25, 2022 page 11
what is the admit date or admission date?
{"text": [], "answer_start": []}
id_1711473238.979214
Eric Garcia
DIS Slidell RE2170526 1310 Gause Blvd Slidell LA 70458 Phone: 440-770-7051 Fax: (550) 850-5504 RELEASE OF INFORMATION AUTHORIZATION TO USE & DISCLOSE PROTECTED HEALTH INFORMATION Date 01-03-2024 Pt ID: CIS250346 Acct # Last Name: GARIBALDI First: JUSTIN MI: BIRTHDATE: 12-07-1997 Patient Address: 208 N SILVERMAPLE DR SLIDELL LA 70508 Patient Phone: (504) 506-8505 I specifically authorize the use and/or disclosure of the following highly confidential information: Mental health, HIV results, AIDS information. Signature: I HAVE READ THE ABOVE AND AUTHORIZE THE DISCI OSURE OF THE PROTECTED HEALTH INFORMATION AS STATED: Signature of Patient/Guardian/Representative 05-01-2015
What is the Date of Evaluation?
{"text": [], "answer_start": []}
id_1711472590.973491
Priscilla Hughes
07/15/2022 6:56:40 am FROM:LABCORP LCLS BULK TO: 153483501808 LABCORP Page 3 of 4 TO: ATTN:Ortho LA - Houma PATIENT BIRTHDATE GENDER service date PHY3ICIAN Priscilla Hughes 1998-10-24 F 2016-12-13 Dr Abigail Johnson PhD PATIENT'D 54233 Appount. 17078843 Ortho LA Houma 180 Corporate Dr, Houma, LA 70230 ACCESSION NUMBER: U3552358 REQUISITION NUMBER 12361352380 RECEIVED: 2015-07-23 6.56 AM Report Status: FINAL TOXASSURE COMP DRUG ANALYSIS,UP Drug Result Unit of measure where result is quantitative Is hg/mg creatinine Version: 9.6.3.9232 LabCorp MedTox Reported: 2015-07-23 8.17 AM LABORATORIES Page: 1 of 2 LabCrep Specialty testing Grat
what is the DOB or date of birth?
{"text": ["1998-10-24"], "answer_start": [197]}
id_1711472591.289146
Anna Ponce
From dcatalyst16 18474305445 8/29/2022 10:58:59 PDT Page 04 of 17 Dr Christopher Thomas MD Physical Medicine and Rehabilitation Aug 25, 2022 RehabOne RehabOne Programs I GROUNNING PEDICAL REQUEST FOR AUTHORIZATION PLEASE SEE DWC FORM RFA ATTACHED. 2019/15/12 patient: Anna Ponce EMPLOYER: Healthcare Service Group Date of Injury: 2018/12/07 Primary Treating Physician: Dr Christopher Thomas MD PHYSICAL MEDICINE AND REHABILITATION NEW PATIENT EVALUATION (DOCTOR'S FIRST REPORT) Dear Gentlepersons: I had the opportunity to evaluate Ms. Corona for a new patient evaluation today. BILLING ATTESTATION: Ms. Araceli Corona DOB was verified prior to disclosing any PHI. 16 Corona, Araceli : Aug 25, 2022 page 3
What is Ordered Date?
{"text": [], "answer_start": []}
id_1711475740.99035
Charlene Williams
Dec 20, 2018, 11:43 AM Print Preview Charlene Williams DOB: Mar 21, 2001 (26 yo M) Acc No. 46937 DOS: Sep 06, 2019 Follow Up per specialist called Electronically signed by Carlos Levy, DO on Oct 18, 2016 at 01:45 PM EDT Sign off status: Completed Addendum: Dec 20, 2018 11:43 AM Alexander, MD, Michael > Patient is Medically Cleared for proposed surgery. Satellite AssociatesMD-PEMBROKE - PINES 2004 N FLAMINGO RD Pembroke Pines, FL 33028 Progress Note: Carlos Levy, DO Jul 20, 2022 Note generated by eClinicalWorks EMR/PM Software (www.eClinicalWorks.com) 3/3
What is Date of Injury or DOI?
{"text": [], "answer_start": []}
id_1711472591.37067
Morgan Thompson
Recv'd Date: 20221028 DCN: 2022711GJ003715 Dr Lisa Chapman MD Physical Medicine and Rehabilitation 28-09-2017 RehabOne RehabOne Programs / KOREAL SECURING PRIMARY TREATING PHYSICIAN'S PROGRESS REPORT (PR-2) Primary Treating Physician: Dr Lisa Chapman MD Patient Name: Morgan Thompson exam date: 30-05-2019 Claim #:019639314416-WC-71 Insurance: Gallagher Bassett (Corona) INJURY DATE: 12-07-2023 Description of case: 1.PTP-LowBack BILLING ATTESTATION: Ms. Araceli Corona DOB was verified prior to disclosing any PHI. CASE SUMMARY: Identification: Ms. Corona is a 73 year -old. Job title at time of injury: account manager Current work/Last date of work: working 354 Corona. Araceli : Oct 11. 2022 page 1
What is Collection Date?
{"text": [], "answer_start": []}
id_1711473530.894822
Cameron Carney
CORVEL Certification Recommendation CLAIM #: PZC01424144 INSURED: Super Store Industries DATE OF INJURY: 13 May 2023 CARRIER/TPA: Crum & Forster / CLAIMANT: Edward Foster ADJUSTER: Leticia Bailon CORVEL #: 111438143-UMO-2 Determination Date: 05 August 2018 RFA Received Date: 07/30/2018 Provider: Jenny Wong, DO Pre-cert #: 111438143-UMO-2 Network: per adjuster CorVel Corporation has been asked to review the below noted treatment request for medical necessity and appropriateness. CorVel Corporation hours of operation are from 8:30 a.m. to 5:30 p.m. PST, Monday through Friday. ORNGER_CERT :12-EMBID-4251454: Page 10 of 000197 0197
What is Collection Date?
{"text": [], "answer_start": []}
id_1711473365.53553
Bradley Morales
<<Back to Review>>180298-26-HYPERLINK- Hyperlink-Page 242 Tow er Physical Therapy, Inc. Daily N ote / Billing Sheet Patient N ame: Bradley Morales Date of Daily N ote: :11/08/19 DATE OF BIRTH: 28/01/91 Injury/Onset/Change of Status Date: 14/12/16 Diagnosis: ICD10: S82.841D: Pulmonary Embolism Time In/Out: 10:30 am/11:30 am Date of Original Eval: 29/05/15 V isit N 0.1 Subjective Treatment Side: Right Objective CPT庐 Code Direct Timed Codes Units 97110 Therapeutic Exercise 1 See Flowsheet Assessment Assessment/Diagnosis: PATIENT PRESENTS S/P RIGHT DISPLACED BIMALLEOLAR FRACTURE. IMMOBILIZED FOR NEARLY 2 MONTHS. CURRENTLY EXHIBITS MOTION LIMITS IN ALL PLANES, ANKLE. JOINT MOBILITY DEFICITS SUB- TALAR, TALO-CRURAL. EFFUSION PRESENT THROUGHOUT ANKLE. AMBULATES WITH TOE-OUT PATTERN. 000192 0192 1 of 2 Powered by WebF,
what is the DOB or date of birth?
{"text": ["28/01/91"], "answer_start": [209]}
id_1711475190.587588
Susan Guzman
Recv'd Date 20249715 Bill DCN: 2049196GJ496811 IDEAL MEDICAL RECORDS SERVICE, INC. 303 W. Katella Ave. Suite 300, Orange, CA 94967 Invoice Phone: 714-380-6714 Fax: 849-498-3499 Date: 24/05/2019 Email: [email protected] To : Gallagher Bassett P.O. Box 610, CA, Roseville,, 95661-0610 949-497-2490 949-493-8492 CLAIMANT NAME: Maria Barajas ORDERED BY: Claim#: 004993-004956-WC-01 Law Firm - Perona, Langer, Beck, injury date: 01/09/2018 Serbin, Mendoza, Harrison UR Denial Date: 06/10/2021 Records Type Date of Service/Records Pick Up Fax Date Date Medical for 13/06/2021 07/14/2021 Independent Medical Review
what is the visit date or date of visit?
{"text": [], "answer_start": []}
id_1711471330.79129
Jon Bates
Patient: Jon Bates PI 11.06.21, Latoya, BIRTHDATE: 1987 August 18 Account No: 34411 Consultation Notes for Jon Bates PI 11.06.21 on 2021 January 22 Current Medications Reason for Appointment None 1. Back Pain Active Problem List Assessments Problem List has not been verified 1. Radiculopathy, lumbar region - M54.16 (Primary), bilateral. Acute Past Medical History since slip and fall on 11/6/21. MRI with disc protrusion with resultant Medical History Verified. severe left L4/5 stenosis. Chiropractic helps short term. Onset: sudden since slip and fall on water while no blurring of vision. Psychology: walking in a convenience store. She went to ER at S and W hospital. Severity: 10/10, Aggravated by: sitting, standing ideation. no anxiety. no physical abuse. bending, Relieved by: none, Nature: sharp, Associated Symptoms: no mental abuse. no numbness, weakness. He (she) denies any previous low back pain. Chiropractic helps some for short period.
What is the Procedure Date?
{"text": [], "answer_start": []}
id_1711476768.350534
Joshua Jordan
Page: 2 of 2 South Lakeland Chiropractic Center P.A DBA: New Hope Chiropractic 4788 S. Florida Ave. Lakeland, FL 33263 Grace Witter Patient ID: 131986471 DOB: 03-22-1990 Sex: F Account No.: Encounter ID: 28381526 Encounter Date: 01-23-2024 Encounter Type: Office Visit -- Hydro Bed therapy was done for 10 mins, full spinal to help reduce discomfort of muscle spasms. Care Plan: -- Follow up for care in 2-3 days. -- Treatment recommendation of 3 chiropractic visits per week for 2 weeks, followed by a review to see changes to the condition. Patient Instructions: -- Patient was advised to keep moving, avoiding periods of inactivity and to avoid bed rest. -- General range of motion stretching should be conducted at least three times a day. Patient should use ice 15 mins on and 15 mins off; as needed. Electronically Signed] - Date: 03-27-2022 3:47:19 PM [Provider]: Ida Abraham, DC
What is the Date of Exam or Examination date?
{"text": [], "answer_start": []}
id_1711471329.173331
David Cunningham
Recv'd Date: 23 Jun 2021 Bill DCN: 2020095GM000018 Patient: PATIENT NAME: David Cunningham 00023 THISPAPY Acct #: 89202436641 DATE OF VISIT: 29 Jul 2014 birth date: 14 Jul 2002 Manual Therapy Techniques 15211 1 14 Therapeutic Activities 97250 2 29 Assessment Patient presents with ongoing moderate TTP at her medial epicondyle with moderate aberrant tension along her volar medial forearm during STM/IASTM. Pt. was able to perform her extrinsic flexor stretches without pain. Pt. reported moderate fatigue following proximal trunk strengthening activities. Plan Left Wrist/Hand Daily Plan: Progression Under Current Plan. mL Cassie. Tseng, OT, OT(CA Lic: 18151) Signed on 16 Jun 2018 11:20:01 Document ID: 265041A5.007 Status: Signed off (secure electronic signature) Page 4 of 4 Cassie. Tseng, OT,OT(CA Lic: 18151) 15211 GB IA Recv 2020032333470 Received 23 Jun 2021
What is the Date of Exam or Examination date?
{"text": [], "answer_start": []}
id_1711471328.608762
Carolyn Walker
12/07/2023 14:29 (FAX) P. 078/087 Downtown Medical Center Dr Tiffany Patterson, MD 14940 N 99th Avenue, STE #100 Sun City, AZ 84951 T. (623) 349-5700 F. (623) 328-9491 Nerve Conduction Study & Electromyography Report Full Name: Carolyn Walker Gender: Female MRN: 249402 dob: 05/08/03 visit: 25/06/15 7:50 AM Age: 24 Years Examining Physician: Dr Tiffany Patterson, MD Referring Physician: DR SIMRAT KAUR Height: 5 feet 8 inch Weight: 170 lbs BMI: 25.8 Patient History: NEUROPATHYY
What is Ordered Date?
{"text": [], "answer_start": []}
id_1711475190.188283
April Campbell
NOVANT Novant Health North Point April Campbell N Medical Associates MRN: 53424347, BIRTHDATE: 2002-06-13, Sex: M HEALTH 1345 Bethabara Road DATE OF VISIT: 2015-04-09 Winston-Salem NC 27346-3345 2020-05-30 - Office Visit in Novant Health North Point Medical Associates (continued) Clinical Notes Amb (continued) 1. Medicare annual wellness visit, subsequent 2. Cramping of hands 3. Cramping of feet Plan Jeffrey was seen today for muscle cramps, knot on arm and medicare wellness visit. Diagnoses and all orders for this visit: 1. Medicare annual wellness visit, subsequent (Primary) Patient Instructions Medicare Annual Wellness (Yearly) Next due on 8/26/2023 08/26/2022 E&M Code: PPPS, SUBSEQ VISIT 09/01/2020 Level of Service: PR PPPS, SUBSEQ VISIT Generated on 4/11/23 8:32 PM Page 296
What is the Date of Encounter or Enc?
{"text": [], "answer_start": []}
id_1711471329.898081
Adam Huffman
Primary Physician: Dr Jamie Chambers patient: Adam Huffman DATE OF BIRTH: 01/08/31 Sex: Female Tel: 214-487-2549 Report Name: OPERATIVE NOTE Report Status: Signed REPORT 17993 Davidson Fields Whiteview, KY 56393 ACCOUNT #: X0004963852 SEX: F MED RECORD #: X468788 DEP SDC ATTENDING PHYS: Dr Jamie Chambers MD ADM DATE: 22/09/01 REPORT TYPE: OPERATIVE NOTE DIS DATE: 22/10/01 JN: 401197 Date of Service: 14/07/13 SURGEON: Dr Jamie Chambers, M.D. ASSISTANT: Darlene Valdez, licensed first assist. ANESTHESIA: General endotracheal anesthesia. PREOPERATIVE DIAGNOSES: Diverticulitis. POSTOPERATIVE DIAGNOSES: Peptic Ulcer. PROCEDURE: Right shoulder decompression. ANTIBIOTICS: Vancomycin COMPLICATIONS: None. CULTURES: None. WOUND: Clean. SPECIMENS: None. ESTIMATED BLOOD LOSS: Minimal. INTRAVENOUS FLUIDS: Less than 1000cc. IMPLANTS: Multiple free FiberWire sutures. DISPOSITION: Patient transferred to the PACU in stable condition. DIAGNOSIS CODES: I10 CPT codes: 68788.
what is the visit date or date of visit?
{"text": [], "answer_start": []}