{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GENNELL   A WHITE","gend":1,"add":"12420 DUNCAN ROAD","city":"PETERSBURG","state":"VA","zip":"23805-9998","dob":"1978-09-06","age":"","mstatus":"","insh":"1372630*01","cliId":"","pno":"804\/243-3617","cno":"804\/243-3617","email":"","ename":"","eno":"","pphy":"LEWIS, JOHN DO","ppno":"","pcpadd":"436 CLAIRMONT COURT SUITE 100","pcpcity":"COLONIAL HEIGHTS","pcpstate":"VA","pcpzip":23834,"pcpcounty":"","pcpid":208807,"pcpname":"SOUTHSIDE PHYSICIANS NETWORK - FAMILY MEDICINE","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G35.","H53.8","L02.11","R00.2","I10.","R60.9","R06.02","E66.01","I49.1","I49.3","J32.4","R43.9","M25.522","M25.512","M75.42","M77.12","R22.1","J31.0","K21.9","R10.13","K29.30","F41.9","R30.0","H18.603","H52.213","H40.013","M54.5","A59.9","R06.83","Z72.821","G47.10","G47.00","R20.8","G47.19","Z71.9","R87.810","Z32.02","R63.4","Z80.0","K21.0","Z79.899","Z68.43","N30.81","H18.623","M47.812","D50.9","R53.83","E55.9","E66.8","Z68.45","J01.00","G47.9","S90.851A","S90.31XA","M79.609","R26.2","L08.9","H53.001","N39.0","N39.46","N32.81","Z68.42","M51.37","M46.96","M54.6","A64.","K29.70","R14.0","R11.0","E86.0"],"date":["2021-06-16","2020-01-09","2020-03-30","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2021-08-09","2020-05-12","2020-05-12","2020-06-04","2020-05-27","2021-04-26","2021-04-26","2021-04-26","2021-04-26","2020-03-30","2020-07-23","2021-05-04","2020-06-17","2020-07-02","2021-05-04","2021-05-04","2021-03-31","2020-06-15","2020-06-15","2020-04-20","2020-04-20","2021-06-16","2021-06-16","2021-06-16","2021-06-16","2020-05-14","2020-09-16","2020-09-02","2021-04-06","2021-04-06","2020-05-28","2020-05-28","2020-07-02","2021-04-01","2021-06-08","2021-06-04","2020-06-15","2020-07-02","2020-09-01","2021-03-18","2021-03-18","2021-03-18","2021-03-18","2020-05-13","2020-07-23","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2020-01-10","2021-06-08","2021-06-08","2021-06-08","2021-02-23","2020-02-27","2020-02-27","2020-06-03","2020-06-03","2020-06-17","2021-07-13","2021-07-13","2021-06-08"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","67877032105","IBUPROFEN ","800MG","60","Select","Select",""],["","00472178310","DICLOFENAC ","3%","100","Select","Select",""],["","00228212750","CLONIDINE ","0.1MG","30","Select","Select",""],["","00078060715","GILENYA ","0.5MG","30","Select","Select",""],["","31604001485","VITAMIN ","500MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE ","20MG","60","Select","Select",""],["","00904759080","FEROSUL ","325MG","30","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","6","Select","Select",""],["","68180051703","LISINOPRIL ","40MG","30","Select","Select",""],["","00054001829","PREDNISONE ","20MG","18","Select","Select",""],["","27241009706","DULOXETINE ","20MG","60","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","15","Select","Select",""],["","16729018201","HYDROCHLOROT ","12.5MG","30","Select","Select",""],["","50111033401","METRONIDAZOL ","500MG","14","Select","Select",""],["","68180065208","DOXYCYC ","100MG","14","Select","Select",""],["","69097094312","GABAPENTIN ","300MG","90","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","69097083412","SERTRALINE ","50MG","30","Select","Select",""],["","50428042799","ALLRGY ","10-240MG","30","Select","Select",""],["","58914017014","CARAFATE ","1GM\/10ML","750","Select","Select",""],["","00093310905","AMOXICILLIN ","500MG","4","Select","Select",""],["","00536100901","FERROUS ","325MG","90","Select","Select",""],["","62175061743","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","65162036111","FOLIC ","1MG","90","Select","Select",""],["","47335093890","AZELASTINE ","0.05%","6","Select","Select",""],["","66689000802","NYSTATIN ","100000","200","Select","Select",""],["","50428014677","CVS ","2000UNIT","90","Select","Select",""],["","53746010901","HYDROCO\/APAP ","5-325MG","5","Select","Select",""],["","00378005301","CIMETIDINE ","200MG","5","Select","Select",""],["","65862086001","FAMOTIDINE ","40MG","14","Select","Select",""],["","60505056000","OFLOXACIN ","0.3% OP","5","Select","Select",""],["","00093220401","METOCLOPRAM ","5MG","45","Select","Select",""],["","45802091987","CETIRIZINE ","10MG","30","Select","Select",""],["","70710113803","FLUCONAZOLE ","100MG","16","Select","Select",""],["","68382025601","OXYBUTYNIN ","10MG ER","90","Select","Select",""],["","65162019050","NAPROXEN ","500MG","20","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","2","Select","Select",""],["","00536116361","MUCUS ","600MG ER","20","Select","Select",""],["","00832105410","BACLOFEN ","10MG","30","Select","Select",""],["","50383077504","LIDOCAINE ","2% VISC","200","Select","Select",""],["","61314063710","PREDNISOLONE ","1% OP","10","Select","Select",""],["","70677000812","","","30","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","14","Select","Select",""],["","24208039915","IPRATROPIUM ","0.06%","15","Select","Select",""],["","67877025130","TRIAMCINOLON ","0.10%","30","Select","Select",""],["","45802001402","HYDROCORT ","2.50%","20","Select","Select",""],["","47781030801","NITROFUR ","100MG","10","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","15","Select","Select",""],["","42037010363","TAGAMET ","200MG","30","Select","Select",""],["","00093321992","KETOCONAZOLE ","2%","60","Select","Select",""],["","13668013601","ESCITALOPRAM ","10MG","30","Select","Select",""],["","00904530660","BANOPHEN ","25MG","30","Select","Select",""],["","69230030401","ALLERGY ","10MG","60","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","14","Select","Select",""],["","00093031401","KETOROLAC ","10MG","20","Select","Select",""],["","00378235193","ESOMEPRA ","40MG DR","30","Select","Select",""],["","16729018201","HYDROCHLOROT","12.5MG","30","Select","Select",""],["","64380080707","IBUPROFEN","800MG","50","Select","Select",""],["","00472178310","DICLOFENAC","3%","100","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","6","Select","Select",""],["","00078060715","GILENYA","0.5MG","30","Select","Select",""],["","68180051703","LISINOPRIL","40MG","30","Select","Select",""],["","55111015810","OMEPRAZOLE","20MG","60","Select","Select",""],["","51991074690","DULOXETINE","20MG","60","Select","Select",""],["","29300013510","CLONIDINE","0.1MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","500MG","4","Select","Select",""],["","00054001829","PREDNISONE","20MG","18","Select","Select",""],["","00378235193","ESOMEPRA","40MG DR","30","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","15","Select","Select",""],["","68180065208","DOXYCYC","100MG","14","Select","Select",""],["","00536100901","FERROUS","325MG","83","Select","Select",""],["","66689000802","NYSTATIN","100000","200","Select","Select",""],["","00904759082","FEROSUL","325MG","90","Select","Select",""],["","65162036111","FOLIC","1MG","90","Select","Select",""],["","50428014677","CVS","2000UNIT","90","Select","Select",""],["","69097094312","GABAPENTIN","300MG","90","Select","Select",""],["","65862050320","AMOX\/K","875-125","20","Select","Select",""],["","62175061743","PANTOPRAZOLE","40MG","30","Select","Select",""],["","50428042799","ALLRGY","10-240MG","30","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","45802091987","CETIRIZINE","10MG","30","Select","Select",""],["","69097083412","SERTRALINE","50MG","30","Select","Select",""],["","70710113803","FLUCONAZOLE","100MG","16","Select","Select",""],["","00093220401","METOCLOPRAM","5MG","45","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","60","Select","Select",""],["","00536116361","MUCUS","600MG ER","20","Select","Select",""],["","00172392670","DIAZEPAM","5MG","2","Select","Select",""],["","50383077504","LIDOCAINE","2% VISC","200","Select","Select",""],["","00093310905","AMOXICILLIN","500MG","4","Select","Select",""],["","58914017014","CARAFATE","1GM\/10ML","750","Select","Select",""],["","60505056000","OFLOXACIN","0.3% OP","5","Select","Select",""],["","61314063710","PREDNISOLONE","1% OP","10","Select","Select",""],["","00832105410","BACLOFEN","10MG","30","Select","Select",""],["","51525029403","AZELASTINE","0.10%","30","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","14","Select","Select",""],["","24208039915","IPRATROPIUM","0.06%","15","Select","Select",""],["","00378005301","CIMETIDINE","200MG","5","Select","Select",""],["","47781030801","NITROFUR","100MG","10","Select","Select",""],["","00904530660","BANOPHEN","25MG","30","Select","Select",""],["","42037010363","TAGAMET","200MG","30","Select","Select",""],["","00093321992","KETOCONAZOLE","2%","60","Select","Select",""],["","45802005505","TRIAMCINOLON","0.10%","454","Select","Select",""],["","69230030401","ALLERGY","10MG","60","Select","Select",""],["","68382025601","OXYBUTYNIN","10MG ER","90","Select","Select",""],["","65162019050","NAPROXEN","500MG","20","Select","Select",""],["","13668013601","ESCITALOPRAM","10MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","14","Select","Select",""],["","47781030301","NITROFURANTN","100MG","10","Select","Select",""],["","00093031401","KETOROLAC","10MG","20","Select","Select",""],["","16571066101","MECLIZINE","25MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","5-325MG","5","Select","Select",""],["","45802001402","HYDROCORT","2.50%","20","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","15","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}