{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON ROULHAC","gend":1,"add":"1620 ELDER AVE","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1964-08-06","age":"","mstatus":"","insh":"20041611*01","cliId":"","pno":"757\/971-4215","cno":"757\/971-4215","email":"","ename":"","eno":"","pphy":"GRAHAM, MARY O MD","ppno":"757\/460-1207","pcpadd":"1147 INDEPENDENCE BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":670145,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/352-9670","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/460-2136","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R39.81","N32.81","M89.9","L22.","R10.9","G89.4","M47.22","M51.36","G43.809","I10.","G43.011","G43.711","E11.65","G46.7","R51.","J30.1","J30.81","L73.9","B37.3","R14.0","K59.00","K21.9","R10.10","NO DATA","K44.9","K43.2","M17.12","B37.0","Z23.","M25.512","M75.42","J01.00","N60.02","M79.7","E11.9","M79.662","E55.9","E78.2","R53.83","I16.0","E87.6","D64.9","R94.31","B35.1","I73.9","E11.51","Z79.891","M25.562","Z86.010","S23.3XXA","J45.21","F17.210","Z79.899","Z88.8","Z88.5","M79.602","Z72.0","M25.50","Z01.419","Z12.39","Z12.12","R51.9","Z87.891","Z20.828","R10.33","J45.909","E05.90","J20.9","M72.2","M21.41","M21.42","R35.1","L30.9","Z13.820","Z51.81","K52.9","E11.36","G89.29","Z90.710","R11.2","R10.30","Z83.3","Z82.49","Z98.1","Z98.890","Z90.79","Z90.49","R10.819","R10.0","M54.16","M54.2","M54.5","M54.6","F11.20","F41.1","R63.4","F33.2","R10.31","R10.32","E05.00","R79.89","Z92.29"],"date":["2021-08-27","2021-10-27","2021-08-27","2021-08-27","2021-07-22","2021-08-10","2021-06-21","2021-06-21","2021-02-22","2021-10-04","2021-08-10","2020-09-14","2021-08-10","2021-08-10","2020-09-14","2021-08-30","2021-08-30","2020-10-20","2020-10-20","2021-07-22","2021-07-22","2021-07-22","2021-03-30","2021-03-30","2021-03-30","2021-06-22","2021-06-21","2020-02-19","2020-02-19","2021-09-14","2020-03-06","2021-06-10","2020-04-14","2021-09-14","2021-10-04","2021-07-13","2021-08-17","2020-07-13","2020-06-18","2020-10-25","2020-10-25","2020-10-25","2020-10-25","2020-11-11","2020-11-11","2020-11-11","2021-03-22","2021-09-14","2021-07-22","2020-05-14","2020-09-02","2020-09-27","2020-09-27","2021-09-18","2021-09-18","2020-09-27","2020-10-25","2020-07-13","2021-08-17","2021-08-17","2021-08-17","2020-11-09","2021-09-18","2021-06-09","2020-01-07","2021-06-07","2021-07-16","2020-12-18","2020-08-13","2020-08-13","2020-08-13","2021-05-27","2021-06-07","2021-08-17","2021-08-17","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-01","2021-09-18","2021-09-18","2021-09-18","2021-09-18","2021-09-18","2021-09-18","2021-09-18","2021-09-18","2021-09-01","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-14","2021-09-23","2021-09-23","2021-09-23","2021-09-18","2021-09-18","2021-10-04","2021-10-04","2021-10-04"],"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":[["","64380073706","VITAMIN ","50000UNT","4","Select","Select",""],["","64764017530","DEXILANT ","60MG DR","30","Select","Select",""],["","69097084615","CYCLOBENZAPR ","10MG","60","Select","Select",""],["","52817031910","BACLOFEN ","5MG","90","Select","Select",""],["","50111043403","TRAZODONE ","100MG","30","Select","Select",""],["","00591079410","DICYCLOMINE ","10MG","28","Select","Select",""],["","24208039830","IPRATROPIUM ","0.03%","30","Select","Select",""],["","00456141030","BYSTOLIC ","10MG","30","Select","Select",""],["","68382014005","TOPIRAMATE ","100MG","60","Select","Select",""],["","33342009441","RIZATRIPTAN ","10MG ODT","60","Select","Select",""],["","65162052111","PROMETHAZINE ","25MG","60","Select","Select",""],["","00406052301","OXYCOD\/APAP ","10-325MG","100","Select","Select",""],["","00536408610","SENEXON-S ","8.6-50MG","60","Select","Select",""],["","68462026430","ROSUVASTATIN ","40MG","30","Select","Select",""],["","57896048930","POLYETH ","3350 NF","510","Select","Select",""],["","59779030603","CVS ","","510","Select","Select",""],["","66689000816","NYSTATIN ","100000","240","Select","Select",""],["","00115169449","EPINEPHRINE ","0.3MG","2","Select","Select",""],["","67877021560","CEFUROXIME ","250MG","20","Select","Select",""],["","62332042771","BENZONATATE ","200MG","60","Select","Select",""],["","00378064110","PREDNISONE ","10MG","10","Select","Select",""],["","42543009801","BUT\/ASA\/CAF ","","90","Select","Select",""],["","57237000511","FLUCONAZOLE ","150MG","2","Select","Select",""],["","45802006405","TRIAMCINOLON ","0.10%","30","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","10","Select","Select",""],["","65862051601","NAPROXEN ","550MG","40","Select","Select",""],["","00093227534","AMOX\/K ","875-125","20","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","68180051902","LISINOP\/HCTZ ","20-12.5","60","Select","Select",""],["","37205061273","CLEARLAX ","","510","Select","Select",""],["","29300024310","AMLODIPINE ","10MG","30","Select","Select",""],["","00002143611","EMGALITY ","120MG\/ML","1","Select","Select",""],["","65862056099","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","00469260290","MYRBETRIQ ","50MG","30","Select","Select",""],["","00173052400","IMITREX ","5MG\/ACT","6","Select","Select",""],["","76385012350","METHOCARBAM ","500MG","40","Select","Select",""],["","23155010205","METFORMIN ","500MG","30","Select","Select",""],["","00527155201","BUT\/ASA\/CAFF ","","90","Select","Select",""],["","00006011254","JANUVIA ","50MG","30","Select","Select",""],["","57896070310","IRON ","325MG","60","Select","Select",""],["","00536105227","PEG3350 ","","510","Select","Select",""],["","00527169501","BUT\/APAP\/CAF ","","12","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","59651015201","PROGESTERONE ","100MG","30","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","00172392670","DIAZEPAM ","5MG","10","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","00536035510","DSS\/SENNA ","8.6-50MG","60","Select","Select",""],["","65162027250","SMZ\/TMP ","800-160","10","Select","Select",""],["","65862085901","FAMOTIDINE ","20MG","30","Select","Select",""],["","55513084301","AIMOVIG ","140MG\/ML","1","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","45802014167","CICLOPIROX ","8%","7","Select","Select",""],["","43386031214","GAVILAX ","","510","Select","Select",""],["","45963070996","METOPROL ","25MG ER","30","Select","Select",""],["","60505004101","ETODOLAC ","400MG","20","Select","Select",""],["","67877022305","GABAPENTIN ","300MG","90","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","16","Select","Select",""],["","53885024510","ONETOUCH ","ULTRA","50","Select","Select",""],["","51660052605","ALLERGY ","10MG","30","Select","Select",""],["","56151146004","TRUE ","GLUCOSE","50","Select","Select",""],["","23155007001","METHIMAZOLE ","5MG","30","Select","Select",""],["","57896045501","SENNA ","8.6-50MG","60","Select","Select",""],["","42571014405","CELECOXIB ","200MG","30","Select","Select",""],["","67877019905","AMLODIPINE","10MG","30","Select","Select",""],["","64380073706","VITAMIN","50000UNT","4","Select","Select",""],["","68180051902","LISINOP\/HCTZ","20-12.5","60","Select","Select",""],["","00456141030","BYSTOLIC","10MG","30","Select","Select",""],["","68462026430","ROSUVASTATIN","40MG","30","Select","Select",""],["","68382014005","TOPIRAMATE","100MG","60","Select","Select",""],["","64764017530","DEXILANT","60MG DR","30","Select","Select",""],["","69097084615","CYCLOBENZAPR","10MG","60","Select","Select",""],["","52817031910","BACLOFEN","5MG","90","Select","Select",""],["","50111043403","TRAZODONE","100MG","30","Select","Select",""],["","00591079410","DICYCLOMINE","10MG","28","Select","Select",""],["","65162052111","PROMETHAZINE","25MG","60","Select","Select",""],["","00406052301","OXYCOD\/APAP","10-325MG","100","Select","Select",""],["","00536408610","SENEXON-S","8.6-50MG","60","Select","Select",""],["","59779030603","CVS","","510","Select","Select",""],["","33342009441","RIZATRIPTAN","10MG ODT","12","Select","Select",""],["","57896048930","POLYETH","3350 NF","510","Select","Select",""],["","24208039830","IPRATROPIUM","0.03%","30","Select","Select",""],["","66689000816","NYSTATIN","100000","240","Select","Select",""],["","62332042771","BENZONATATE","200MG","60","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","2","Select","Select",""],["","67877021560","CEFUROXIME","250MG","20","Select","Select",""],["","00093227534","AMOX\/K","875-125","20","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00173068220","VENTOLIN","","18","Select","Select",""],["","00469260230","MYRBETRIQ","50MG","30","Select","Select",""],["","37205061273","CLEARLAX","","510","Select","Select",""],["","76385012350","METHOCARBAM","500MG","40","Select","Select",""],["","57896070310","IRON","325MG","60","Select","Select",""],["","00173052400","IMITREX","5MG\/ACT","6","Select","Select",""],["","23155010205","METFORMIN","500MG","30","Select","Select",""],["","00115169449","EPINEPHRINE","0.3MG","2","Select","Select",""],["","42543009801","BUT\/ASA\/CAF","","90","Select","Select",""],["","00536105227","PEG3350","","510","Select","Select",""],["","00527155201","BUT\/ASA\/CAFF","","90","Select","Select",""],["","45802006405","TRIAMCINOLON","0.10%","30","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","59651015201","PROGESTERONE","100MG","30","Select","Select",""],["","69547035302","NARCAN","","2","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","00603533932","PREDNISONE","20MG","21","Select","Select",""],["","65862039010","ONDANSETRON","4MG ODT","10","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","00591352530","LIDOCAINE","5%","30","Select","Select",""],["","65862056099","PANTOPRAZOLE","40MG","30","Select","Select",""],["","00172392670","DIAZEPAM","5MG","10","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","65862051601","NAPROXEN","550MG","40","Select","Select",""],["","65162027250","SMZ\/TMP","800-160","10","Select","Select",""],["","00172572880","FAMOTIDINE","20MG","30","Select","Select",""],["","00002143611","EMGALITY","120MG\/ML","1","Select","Select",""],["","43386031214","GAVILAX","","510","Select","Select",""],["","45802014167","CICLOPIROX","8%","7","Select","Select",""],["","55513084301","AIMOVIG","140MG\/ML","1","Select","Select",""],["","00536035510","DSS\/SENNA","8.6-50MG","60","Select","Select",""],["","67877022305","GABAPENTIN","300MG","90","Select","Select",""],["","45963070996","METOPROL","25MG ER","30","Select","Select",""],["","53885024510","ONETOUCH","ULTRA","50","Select","Select",""],["","57896045501","SENNA","8.6-50MG","60","Select","Select",""],["","00006011254","JANUVIA","50MG","30","Select","Select",""],["","60505004101","ETODOLAC","400MG","20","Select","Select",""],["","56151147002","TRUE","METER","1","Select","Select",""],["","51660052605","ALLERGY","10MG","30","Select","Select",""],["","42571014405","CELECOXIB","200MG","30","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","16","Select","Select",""],["","23155007001","METHIMAZOLE","5MG","30","Select","Select",""],["","00527169501","BUT\/APAP\/CAF","","12","Select","Select",""],["","47335093890","AZELASTINE","0.05%","5","Select","Select",""],["","55111012705","CIPROFLOXACN","500MG","14","Select","Select",""],["","52817021010","CYPROHEPTAD","4MG","60","Select","Select",""],["","00456120130","LINZESS ","CAP 145MCG","30","Select","Select",""],["","65649030302","XIFAXAN ","TAB 550MG","42","Select","Select",""],["","47335093890","AZELASTINE ","DRO 0.0005","5","Select","Select",""],["","31722055190","LEVOCETIRIZI ","TAB 5MG","30","Select","Select",""],["","55111012705","CIPROFLOXACN ","TAB 500MG","14","Select","Select",""],["","52817021010","CYPROHEPTAD ","TAB 4MG","60","Select","Select",""],["","0",""," ","300","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":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}