{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"OLIVIA   A REIGEL","gend":1,"add":"717 WOODBOX DR","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1978-12-31","age":"","mstatus":"","insh":"2195326*01","cliId":"","pno":"757\/914-2624","cno":"757\/914-2624","email":"","ename":"","eno":"","pphy":"CHAKRABORTTY, SAGHANA B MD","ppno":"757\/738-1300","pcpadd":"4421 VA BEACH BLVD SUITE 114","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":207903,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/687-3202","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","R10.32","N77.1","F41.0","J20.9","K02.9","J30.89","J30.1","J01.90","R53.83","R73.02","E78.2","E11.21","NO DATA","E66.9","Z79.84","E11.65","F32.9","Z79.4","K08.89","H92.02","E11.9","F17.210","Z91.040","Z88.5","Z88.8","Z68.42","M25.561","J30.81","J32.8","J34.3","R30.0","F41.1","D50.8","F43.20","Z71.3","F33.1","E55.9","F41.9","S93.401A","N76.4","Z87.442","Z87.01","L98.9","N18.9","M67.88","E10.9","S83.91XA","S46.811A","J06.9","Z20.822"],"date":["2021-10-26","2021-10-26","2020-03-26","2020-03-26","2021-07-09","2020-07-20","2021-02-17","2021-07-09","2020-02-14","2021-07-09","2020-04-09","2021-05-21","2020-08-05","2020-04-20","2021-09-10","2020-04-20","2021-09-10","2020-08-05","2020-08-05","2020-07-20","2020-07-20","2021-07-14","2021-08-25","2020-07-20","2020-07-20","2020-07-20","2020-07-20","2020-09-23","2021-02-25","2021-02-25","2021-02-25","2021-04-11","2020-09-28","2020-03-04","2020-03-31","2020-05-01","2020-09-28","2021-05-21","2021-09-10","2021-06-21","2020-02-25","2020-02-25","2020-02-25","2020-02-25","2020-04-16","2021-05-28","2020-04-14","2021-05-18","2021-05-18","2021-08-25","2021-08-25"],"priorHcc":[null,null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","67877021901","CEPHALEXIN ","500MG","28","Select","Select",""],["","49884079011","OLM ","\/HCTZ","30","Select","Select",""],["","00093553801","ESZOPICLONE ","2MG","30","Select","Select",""],["","69238117309","DOXEPIN ","100MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","90","Select","Select",""],["","68180031909","BUPROPN ","150MG XL","30","Select","Select",""],["","00228203150","ALPRAZOLAM ","1MG","30","Select","Select",""],["","33342007410","VALSART\/HCTZ ","80-12.5","30","Select","Select",""],["","68462024805","RANITIDINE ","150MG","60","Select","Select",""],["","69097084905","ESCITALOPRAM ","20MG","30","Select","Select",""],["","51224000760","METFORMIN ","500MG ER","180","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","90","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","11917014296","ALCOHOL ","","200","Select","Select",""],["","68180072003","AMLODIPINE ","5MG","30","Select","Select",""],["","00143924920","AMOX\/K ","875-125","20","Select","Select",""],["","00169413212","OZEMPIC ","2\/1.5ML","2","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","1","Select","Select",""],["","60432027504","BROM\/PSE\/DM ","","118","Select","Select",""],["","00006027731","JANUVIA ","100MG","30","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","65162027210","SMZ\/TMP ","800-160","28","Select","Select",""],["","53885027150","ONETOUCH ","VERIO","200","Select","Select",""],["","00002143380","TRULICITY ","0.75\/0.5","6","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","14","Select","Select",""],["","00093317431","ALBUTEROL ","HFA","8","Select","Select",""],["","51672128901","NYSTATIN ","100000","15","Select","Select",""],["","31722095801","BENZONATATE ","200MG","30","Select","Select",""],["","08290320122","BD  PEN NEEDL","32GX4MM","100","Select","Select",""],["","00093005401","BUSPIRONE ","10MG","120","Select","Select",""],["","31722088390","ROSUVASTATIN ","10MG","30","Select","Select",""],["","51224002230","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00603533831","PREDNISONE ","10MG","48","Select","Select",""],["","65702010110","ACCU-CHEK ","AVIVA PL","1","Select","Select",""],["","00310653004","BYDUREON ","2MG","4","Select","Select",""],["","00169406013","VICTOZA ","18MG\/3ML","9","Select","Select",""],["","65862019899","GABAPENTIN ","100MG","30","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","10","Select","Select",""],["","60505082901","FLUTICASONE ","50MCG","48","Select","Select",""],["","65862001705","AMOXICILLIN ","500MG","28","Select","Select",""],["","00406051205","OXYCOD\/APAP ","5-325MG","15","Select","Select",""],["","60505265301","TRAZODONE ","50MG","120","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","30","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","40","Select","Select",""],["","29300012510","MELOXICAM ","15MG","30","Select","Select",""],["","43598081115","CETIRIZINE ","10MG","30","Select","Select",""],["","49281042050","FLUZONE ","2020-21","0","Select","Select",""],["","65862018501","CLINDAMYCIN ","150MG","25","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","65162062711","TRAMADOL ","50MG","18","Select","Select",""],["","00597015230","JARDIANCE ","10MG","30","Select","Select",""],["","69238161503","OFLOXACIN ","0.3%OTIC","5","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","60846050101","PYRIDIUM ","100MG","6","Select","Select",""],["","55111012205","ATORVASTATIN ","20MG","90","Select","Select",""],["","55111068405","IBU ","800MG","90","Select","Select",""],["","57237015630","MOXIFLOXACIN ","400MG","5","Select","Select",""],["","00031875718","ROBIT ","20-200","237","Select","Select",""],["","57237007710","ONDANSETRON ","4MG ODT","15","Select","Select",""],["","49884079011","OLM","\/HCTZ","30","Select","Select",""],["","69097084905","ESCITALOPRAM","20MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE","40MG","90","Select","Select",""],["","69238117309","DOXEPIN","100MG","5","Select","Select",""],["","31722072690","MONTELUKAST","10MG","90","Select","Select",""],["","00228203150","ALPRAZOLAM","1MG","30","Select","Select",""],["","68180031909","BUPROPN","150MG XL","30","Select","Select",""],["","68462024805","RANITIDINE","150MG","60","Select","Select",""],["","42806031250","DOXYCYCL","100MG","60","Select","Select",""],["","65162027210","SMZ\/TMP","800-160","28","Select","Select",""],["","60432027504","BROM\/PSE\/DM","","118","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","1","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","28","Select","Select",""],["","31722095801","BENZONATATE","200MG","30","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","65702010110","ACCU-CHEK","AVIVA PL","1","Select","Select",""],["","00006027731","JANUVIA","100MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","14","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","08290320122","BD PEN NEEDL","32GX4MM","100","Select","Select",""],["","68180072003","AMLODIPINE","5MG","30","Select","Select",""],["","00603533815","PREDNISONE","10MG","21","Select","Select",""],["","53885027150","ONETOUCH","VERIO","100","Select","Select",""],["","00093005401","BUSPIRONE","10MG","120","Select","Select",""],["","33342007410","VALSART\/HCTZ","80-12.5","30","Select","Select",""],["","31722088390","ROSUVASTATIN","10MG","90","Select","Select",""],["","66689000816","NYSTATIN","100000","200","Select","Select",""],["","51224000760","METFORMIN","500MG ER","180","Select","Select",""],["","51224002230","AZITHROMYCIN","250MG","6","Select","Select",""],["","11917014296","ALCOHOL","","200","Select","Select",""],["","00169413212","OZEMPIC","2\/1.5ML","2","Select","Select",""],["","00310653004","BYDUREON","2MG","4","Select","Select",""],["","00002143380","TRULICITY","0.75\/0.5","6","Select","Select",""],["","00169406013","VICTOZA","18MG\/3ML","9","Select","Select",""],["","65862019899","GABAPENTIN","100MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","10MG","30","Select","Select",""],["","66685100100","AMOX\/K","875-125","20","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","10","Select","Select",""],["","00406051205","OXYCOD\/APAP","5-325MG","15","Select","Select",""],["","65862001705","AMOXICILLIN","500MG","28","Select","Select",""],["","64380080707","IBUPROFEN","800MG","40","Select","Select",""],["","60505265301","TRAZODONE","50MG","120","Select","Select",""],["","49281042050","FLUZONE","2020-21","0","Select","Select",""],["","29300012510","MELOXICAM","15MG","30","Select","Select",""],["","60505082901","FLUTICASONE","50MCG","48","Select","Select",""],["","65862018501","CLINDAMYCIN","150MG","25","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","43598081115","CETIRIZINE","10MG","90","Select","Select",""],["","65162062711","TRAMADOL","50MG","18","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","60846050101","PYRIDIUM","100MG","6","Select","Select",""],["","55111068405","IBU","800MG","90","Select","Select",""],["","69238161503","OFLOXACIN","0.3%OTIC","5","Select","Select",""],["","55111012205","ATORVASTATIN","20MG","90","Select","Select",""],["","00597015230","JARDIANCE","10MG","90","Select","Select",""],["","00031875718","ROBIT","20-200","237","Select","Select",""],["","57237015630","MOXIFLOXACIN","400MG","5","Select","Select",""],["","57237007710","ONDANSETRON","4MG ODT","15","Select","Select",""],["","00093553801","ESZOPICLONE","2MG","30","Select","Select",""],["","00054429731","FUROSEMIDE ","TAB 20MG","30","Select","Select",""],["","68382013201","TAMSULOSIN ","CAP 0.4MG","30","Select","Select",""],["","69344014443","SPRIX ","SPR 15.75MG","5","Select","Select",""],["","10702000350","PROMETHAZINE ","TAB 25MG","30","Select","Select",""],["","51293061201","PHENAZOPYRID ","TAB 200MG","6","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","",""],["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":""}]}]}