{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VALERIE ERWIN","gend":1,"add":"390 SPRINGWOOD CTS","city":"SUFFOLK","state":"VA","zip":23435,"dob":"1972-09-02","age":"","mstatus":"","insh":"20027035*01","cliId":"","pno":"757\/401-3093","cno":"757\/401-3093","email":"","ename":"","eno":"","pphy":"STOCKMAN, LYNNE W DO","ppno":"757\/606-1656","pcpadd":"SUITE 15 3235 BRIDGE ROAD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":157406,"pcpname":"North Suffolk Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/419-6081","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/606-1657","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K75.4","K58.0","K21.9","Z87.19","G40.909","F33.2","Z20.822","Z11.59","R06.02","R68.83","R53.83","G40.009","G43.009","I10.","M32.9","E55.9","N39.0","F32.9","M54.5","R63.4","R11.0","L93.0","Z28.21","Z71.9","Z20.828","R15.9","R74.8","R43.9","Z12.11","J30.1","H10.022","R43.2","R07.0","R19.7","R06.00","R11.2","Z11.3","R19.09","N32.81","N30.01","Z23.","R94.5","D50.9","F17.200","M62.838","M62.81","M79.7","R60.9","R29.898","R29.6","Z01.419","Z12.39","Z11.51","L98.9","L29.9","L93.2","J31.0","J02.9","R09.89","K86.1","M35.00","F17.299","J40.","Z72.0","I47.1","I11.9","M32.14","Z87.448","R30.0","M54.17","G47.00","J06.9","F52.9","R40.4","R78.81","F19.10","V58.89","F10.920","R40.2210","T48.901A","R40.0","M41.9","M51.37","G89.29","F51.01","Z87.39","G47.33","D72.819","J45.909","R41.82","R06.2"],"date":["2020-04-09","2021-08-26","2021-08-26","2020-01-09","2020-09-22","2021-08-17","2021-05-12","2020-05-11","2020-05-11","2020-05-11","2020-05-11","2021-04-12","2021-04-12","2021-08-09","2021-08-09","2021-06-07","2020-06-02","2021-08-09","2021-07-28","2020-06-18","2020-06-18","2020-06-30","2020-06-30","2021-05-12","2021-02-17","2021-06-24","2021-08-26","2021-03-23","2021-03-23","2021-06-09","2021-06-09","2020-05-11","2020-05-11","2020-05-11","2020-05-11","2020-05-11","2021-05-07","2020-07-09","2020-07-09","2021-02-17","2021-05-25","2021-05-07","2021-06-07","2021-06-07","2021-06-07","2020-09-21","2020-09-22","2020-06-16","2020-06-24","2020-06-24","2021-05-07","2021-05-07","2021-05-07","2021-05-12","2021-05-12","2021-05-26","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2020-09-25","2020-10-28","2021-09-08","2021-09-08","2021-07-28","2020-03-09","2021-03-14","2021-04-12","2021-07-15","2020-03-24","2021-06-27","2021-08-24","2021-08-10","2021-08-09","2021-08-09","2021-08-09","2021-08-06","2021-08-06","2021-08-09","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2020-09-25","2021-08-09","2021-08-09","2021-08-26","2020-09-22"],"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":[["","27241009903","DULOXETINE ","60MG","30","Select","Select",""],["","59762045001","COLESTIPOL ","1GM","120","Select","Select",""],["","50111043302","TRAZODONE ","50MG","60","Select","Select",""],["","51248015101","VESICARE ","10MG","30","Select","Select",""],["","00378001805","METOPROL ","25MG","60","Select","Select",""],["","00093506105","HYDROXYZ ","25MG","30","Select","Select",""],["","70710122600","AMITRIPTYLIN ","25MG","30","Select","Select",""],["","68180011302","LEVETIRACETA ","500MG","60","Select","Select",""],["","00093100301","BUSPIRONE ","15MG","60","Select","Select",""],["","33342008845","RIZATRIPTAN ","10MG","9","Select","Select",""],["","68462034690","LEVOCETIRIZI ","5MG","90","Select","Select",""],["","65862049460","QUETIAPINE ","300MG","60","Select","Select",""],["","11917011540","VITAMIN ","5000UNIT","90","Select","Select",""],["","00527133001","BACLOFEN ","10MG","30","Select","Select",""],["","60505470303","SOLIFENACIN ","10MG","30","Select","Select",""],["","00591079501","DICYCLOMINE ","20MG","120","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","34","Select","Select",""],["","55111036430","OMEPRA\/BICAR ","40-1100","60","Select","Select",""],["","00069046956","CHANTIX ","1MG","60","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","60","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","14","Select","Select",""],["","42192080201","PHENAZOPYRID ","200MG","9","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","00603533932","PREDNISONE ","20MG","21","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","51672125903","CLOBETASOL ","0.05%","60","Select","Select",""],["","67877057305","BENZONATATE ","100MG","15","Select","Select",""],["","00054429931","FUROSEMIDE ","40MG","60","Select","Select",""],["","16729013716","CLONAZEPAM ","1MG","30","Select","Select",""],["","00363089653","NICOTINE ","21MG\/24H","7","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2","Select","Select",""],["","00536114730","IBUPROFEN ","200MG","60","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","6","Select","Select",""],["","43547028910","BUPROPION ","150MG SR","60","Select","Select",""],["","00378623301","CITALOPRAM ","40MG","60","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","11523723403","MIRALAX ","3350 NF","238","Select","Select",""],["","42571016242","AMOX\/K ","875-125","20","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","65862007701","CIPROFLOXACN ","500MG","10","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","60","Select","Select",""],["","00116200116","CHLORHEX ","0.12%","473","Select","Select",""],["","00406055201","OXYCODONE ","5MG","10","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","45802086801","POLYETH ","3350 NF","238","Select","Select",""],["","00904674860","BISACODYL ","5MG EC","4","Select","Select",""],["","00363032756","GENTLE ","5MG EC","4","Select","Select",""],["","11917010657","MAG ","GRAPE","296","Select","Select",""],["","60505083305","AZELASTINE ","0.10%","30","Select","Select",""],["","61314062810","POLYMYXIN ","TRIMETHP","10","Select","Select",""],["","50111033402","METRONIDAZOL ","500MG","10","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","21","Select","Select",""],["","08333950605","TEGADERM ","FRAME ST","30","Select","Select",""],["","59267100002","PFIZER ","COVID-19","0","Select","Select",""],["","65862049460","QUETIAPINE","300MG","60","Select","Select",""],["","59762045001","COLESTIPOL","1GM","120","Select","Select",""],["","00527133001","BACLOFEN","10MG","30","Select","Select",""],["","27241009903","DULOXETINE","60MG","30","Select","Select",""],["","68462034690","LEVOCETIRIZI","5MG","30","Select","Select",""],["","50111043302","TRAZODONE","50MG","60","Select","Select",""],["","00093506105","HYDROXYZ","25MG","30","Select","Select",""],["","51248015101","VESICARE","10MG","30","Select","Select",""],["","00378001805","METOPROL","25MG","60","Select","Select",""],["","00093100301","BUSPIRONE","15MG","60","Select","Select",""],["","68180011302","LEVETIRACETA","500MG","60","Select","Select",""],["","70710122600","AMITRIPTYLIN","25MG","30","Select","Select",""],["","00069046956","CHANTIX","1MG","60","Select","Select",""],["","65162010250","GABAPENTIN","300MG","60","Select","Select",""],["","33342008845","RIZATRIPTAN","10MG","9","Select","Select",""],["","74312019377","VITAMIN","5000UNIT","30","Select","Select",""],["","00591079501","DICYCLOMINE","20MG","120","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","34","Select","Select",""],["","55111036430","OMEPRA\/BICAR","40-1100","90","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","00603533932","PREDNISONE","20MG","21","Select","Select",""],["","42192080201","PHENAZOPYRID","200MG","9","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","60505470303","SOLIFENACIN","10MG","30","Select","Select",""],["","51672125903","CLOBETASOL","0.05%","60","Select","Select",""],["","67877057305","BENZONATATE","100MG","15","Select","Select",""],["","13811071910","NITROFURANTN","100MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","00378623301","CITALOPRAM","40MG","60","Select","Select",""],["","66993001968","ALBUTEROL","HFA","18","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","42571016242","AMOX\/K","875-125","20","Select","Select",""],["","65862007701","CIPROFLOXACN","500MG","10","Select","Select",""],["","16729013616","CLONAZEPAM","0.5MG","30","Select","Select",""],["","00054429931","FUROSEMIDE","40MG","60","Select","Select",""],["","00363032756","GENTLE","5MG EC","4","Select","Select",""],["","11523723403","MIRALAX","3350 NF","238","Select","Select",""],["","11917010657","MAG","GRAPE","296","Select","Select",""],["","00904674860","BISACODYL","5MG EC","4","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","43547028910","BUPROPION","150MG SR","30","Select","Select",""],["","43598044674","NICOTINE","7MG\/24HR","28","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","50111033402","METRONIDAZOL","500MG","10","Select","Select",""],["","45802086801","POLYETH","3350 NF","238","Select","Select",""],["","70010075401","METHOCARBAM","500MG","60","Select","Select",""],["","08333950605","TEGADERM","FRAME ST","30","Select","Select",""],["","69230014680","IBUPROFEN","200MG","60","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","6","Select","Select",""],["","60505083305","AZELASTINE","0.10%","30","Select","Select",""],["","57237002801","AMOXICILLIN","500MG","21","Select","Select",""],["","00406055201","OXYCODONE","5MG","10","Select","Select",""],["","59267100002","PFIZER","COVID-19","0","Select","Select",""],["","68382061928","COLESEVELAM","625MG","30","Select","Select",""],["","61314062810","POLYMYXIN","TRIMETHP","10","Select","Select",""],["","00065048111","SYSTANE","0.60%","10","Select","Select",""],["","00116200116","CHLORHEX","0.12%","473","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","",""],["No","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":""}]}]}