{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AINOTYADEROOM L ","gend":1,"add":"CSES 81EVIRD O","city":"HAMPTON","state":"VA","zip":"23664-1608","dob":"1977-12-28","age":"","mstatus":"","insh":"60014597","cliId":"","pno":"0475751589","cno":7578745626,"email":"","ename":"","eno":"","pphy":"BALKA, STEPHEN DALE","ppno":7578501311,"pcpadd":"191 FOX HILL RD STE D,","pcpcity":"Hampton","pcpstate":"VA","pcpzip":"23669-2360","pcpcounty":"","pcpid":"","pcpname":"RIVERSIDE PHYSICIAN SERVICES INC","plan":"VPHP","program":"MEDICAID","lob":"MLTSS","region":"TIDEWATER","aligned":"","ano":"","add2":"18 SESCO DRIVE","add3":"","madd1":"18 SESCO DRIVE","madd2":"APARTMENT 18","madd3":"","mcity":"HAMPTON","mstate":"VA","mzip":"23664-1608","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J20.9","R05","R68.89","E11.9","I10","D57.3","J45.909","Z85.528","Z85.42","Z90.5","Z86.73","Z87.891","Z79.899","Z88.0","Z91.010","Z91.018","G35","M47.816","G37.9","R53.1","R51.9","M19.90","J44.9","D50.9","R74.8","M51.36","R93.7","M54.40","J42","F31.61","F60.3","R55","F17.210","R53.83","R90.89","R73.01","T78.40XA","F31.9","F31.2","R45.851","R45.850","Z91.14","F14.20","F12.20","F43.10","E78.00","G89.4","I25.2","Z68.41","Z87.448","N39.46","R39.9","M43.6","R68.84","R03.0","S16.1XXA","M54.2","W01.0XXA","S93.402A","E78.2","E11.22","I12.9","N18.9","E66.01","K76.0","M81.0","R04.2","R06.2","K92.1","R10.12","K59.09","K64.8","R25.3","R53.82","G43.709","M17.0","F33.2","E66.9","Z68.33","R25.1","R41.82","R74.02","R31.9","R11.0","F12.90","L84","J30.89","R41.3","D50.0","N64.4","M54.9","Z79.82","H40.053","H40.013","H52.13","H52.4","T82.898A","X58.XXXA","L29.9","F44.7","K21.9","G96.9","F90.9","F41.9","Z68.32","R13.10","N18.2","G43.909","M17.12","M79.605","R06.00","R05.9","R09.3","E78.5","E11.21","Z53.29","M25.461","M17.11","R07.89","M25.562","M79.662","R20.2","M79.671","M79.672","M50.21","M47.812","M99.71","H11.31","H57.11","Y93.01","W19.XXXA","S05.11XA","S39.012A","G43.109","R20.0","E53.8","D64.9","E55.9","G70.9","M79.7","M46.96","R56.9","G56.32","S29.012A","L50.9","M25.532","M25.462","R07.81","M79.604","N39.0","E28.2","D53.9","G25.0","L27.0","R21","R30.0","T36.95XA","Z88.8","G56.12","Z01.419","Z11.3","Z12.31","Z12.4","Z68.35","R31.29","F90.8","Y92.531","T50.8X5A","G81.91","R29.818","M79.601","M79.89","R29.810","Z91.041","E11.65","R60.1","R71.8","M79.10","Z68.39","M50.20","I49.8","I45.81","R07.82","M25.511","R35.0","R07.9","Z59.41","Z59.6","M54.12","M70.51","N30.01","I48.92","R94.31","M25.561","M79.661","R22.0","I78.1","T14.90XA","Z79.4","G93.0","R25.2","J06.9","J98.8","R09.81","R11.2","B97.89","Z88.2","R40.0","N18.30","R10.33","R22.1","Z98.890","Z79.85","M62.838","Z87.19","Z87.2","R10.84","N92.0","R10.32","N20.0","R10.9","R10.2","L73.9","R68.81","N30.91","R60.0","J45.21","N60.02","N60.42","M79.621","L53.9","R79.89","Z87.898","R14.0","K59.03","Z32.02","R31.1","C64.1","R82.89","H93.A1","R42","F40.240","E27.8","G89.29","R10.11","R22.42","D72.829","Z79.84","Z86.2"],"date":["2021-01-12","2021-03-22","2021-01-12","2023-03-25","2023-03-28","2022-01-26","2023-01-13","2023-03-28","2023-01-09","2023-03-25","2023-03-25","2023-01-13","2023-02-16","2023-01-13","2022-11-27","2023-01-09","2022-02-08","2021-01-19","2023-02-16","2021-10-21","2021-06-15","2022-01-26","2023-03-25","2023-01-24","2021-01-21","2023-03-25","2021-01-21","2021-01-21","2022-07-01","2022-12-20","2021-06-25","2023-01-25","2021-01-21","2022-03-07","2022-08-11","2021-03-08","2022-08-05","2023-03-25","2022-06-03","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2023-03-25","2021-03-11","2021-10-21","2021-03-11","2023-03-28","2021-03-17","2021-03-17","2023-05-22","2021-03-20","2021-03-20","2021-03-20","2021-03-20","2022-09-22","2021-03-20","2021-03-20","2023-03-28","2022-12-31","2022-12-31","2022-12-31","2023-03-28","2023-03-25","2021-10-21","2021-03-22","2021-11-09","2021-05-06","2023-01-24","2021-04-21","2021-05-06","2021-07-21","2023-03-28","2021-06-25","2023-03-27","2021-06-08","2022-12-30","2021-06-10","2021-06-15","2021-06-15","2021-06-15","2023-02-10","2023-01-09","2021-06-15","2021-06-25","2022-03-07","2021-06-25","2023-03-27","2023-01-09","2022-04-01","2022-08-05","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-08-04","2021-08-04","2023-01-13","2021-08-04","2022-09-22","2021-10-21","2023-03-25","2023-03-25","2021-10-21","2022-10-05","2021-10-21","2022-04-01","2021-11-09","2021-11-09","2021-11-09","2022-11-27","2021-11-09","2021-11-09","2021-11-09","2021-11-09","2022-10-15","2022-10-15","2022-04-01","2023-03-25","2022-01-26","2022-01-26","2022-01-26","2022-01-26","2022-02-07","2022-02-07","2022-02-07","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2022-02-08","2023-02-16","2022-08-21","2022-03-07","2023-03-27","2022-08-29","2022-03-07","2022-03-07","2022-03-07","2022-03-07","2022-04-01","2022-11-21","2022-04-01","2022-04-01","2022-04-01","2022-04-01","2022-08-21","2022-05-26","2023-03-25","2022-04-01","2022-04-18","2022-05-07","2022-07-01","2022-05-07","2022-05-07","2023-01-09","2022-05-16","2022-05-17","2023-02-02","2022-05-17","2022-05-17","2022-05-26","2023-03-27","2022-08-05","2022-08-05","2022-08-05","2022-08-11","2022-08-11","2022-08-21","2023-01-13","2022-08-21","2022-08-21","2023-03-28","2022-09-14","2022-08-29","2023-03-28","2022-12-31","2022-09-22","2022-12-09","2022-11-30","2022-09-25","2022-09-25","2022-12-08","2023-03-25","2022-09-25","2022-09-25","2022-10-05","2022-10-05","2023-01-19","2022-10-12","2022-10-12","2022-10-15","2022-10-15","2022-10-15","2022-10-15","2022-10-15","2022-11-18","2022-11-18","2022-11-21","2022-12-08","2022-11-27","2022-11-27","2022-11-27","2022-11-27","2023-01-13","2022-12-08","2023-01-11","2023-01-24","2023-01-24","2023-01-24","2023-03-28","2022-12-20","2023-01-24","2023-01-09","2023-01-13","2023-03-27","2022-12-30","2023-03-22","2023-03-28","2023-02-02","2022-12-30","2022-12-30","2022-12-31","2023-01-04","2023-01-04","2023-01-09","2023-01-09","2023-01-13","2023-01-13","2023-01-13","2023-01-18","2023-01-19","2023-01-19","2023-02-02","2023-03-22","2023-02-10","2023-02-10","2023-02-16","2023-02-16","2023-02-16","2023-04-11","2023-03-28","2023-03-28","2023-03-25","2023-05-22","2023-03-28","2023-05-22"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","31722094901","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","29300041519","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","57664037708","TRAMADOL HCL","TAB 50MG","12","Select","Select",""],["","55111053301","DIVALPROEX","TAB 250MG ER","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","00093505798","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","68382056610","METOPROL SUC","TAB 100MG ER","30","Select","Select",""],["","57599000101","FREESTYLE","KIT SENSOR","2","Select","Select",""],["","68645055754","LISINOP\/HCTZ","TAB 20-12.5","30","Select","Select",""],["","70700015010","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","27808008603","HYD POL\/CPM","SUS 10-8\/5ML","70","Select","Select",""],["","14539067401","HYDROXYZ PAM","CAP 25MG","30","Select","Select",""],["","00472024260","PERMETHRIN","CRE 0.05","60","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","53885039310","ONETOUCH US","MIS LANCETS","100","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","65162068210","PHENAZOPYRID","TAB 200MG","10","Select","Select",""],["","68645059459","FAMOTIDINE","TAB 20MG","20","Select","Select",""],["","70010016305","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","65862017260","TOPIRAMATE","TAB 50MG","60","Select","Select",""],["","50228046501","NABUMETONE","TAB 500MG","60","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","00193731221","CONTOUR","TES NEXT","100","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","42806054701","VITAMIN D","CAP 1.25MG","4","Select","Select",""],["","59746017509","PREDNISONE","TAB 20MG","10","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","2","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}