{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LUVENIA BRINKLEY","gend":1,"add":"5020 WAVERTON CT APT D","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1964-11-21","age":"","mstatus":"","insh":"20043521*01","cliId":"","pno":"757\/574-8650","cno":"757\/574-8650","email":"","ename":"","eno":"","pphy":"BHOWMIK, NIHAR MD","ppno":"757\/399-0701","pcpadd":"301 GOODE WAY #103","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23704,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/399-3731","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.9","NO DATA","M54.2","Z20.822","E11.52","H90.3","F33.1","M48.02","M47.812","M62.838","V58.89","M47.816","Z68.37","A60.9","B37.3","N76.0","I44.0","R07.9","Z20.828","F31.12","F32.1","L30.9","L75.0","Z71.9","E11.9","Z79.84","L91.8","L73.9","M46.03","R07.89","R06.00","F41.9","N30.00","R06.02","R00.2","B34.9","R05.","F32.9","F33.2","L21.9","L65.8","L74.510","U07.1","E11.65","I10.","D50.8","D50.9","E53.9","E55.9","R42.","J01.00","R25.2","F41.1","F32.2","R53.83","M20.42","E11.42","M20.41","S16.1XXA","M51.36","S39.012A","V89.2XXA","Z01.411","N81.9","G43.009","J45.901","N89.8","K20.9","S13.4XXA","S23.3XXA","E11.69","E66.9","Z98.890","Z86.39","Z86.69","R68.89","R13.10","R19.5","K21.9","R10.33","K59.00","H10.89","V89.2XXD","Z68.36","M20.22","M20.12","R29.2","R29.898","M50.30","G43.701","F43.20","Z63.0","Z20.2","Z88.1","Z91.040","Z88.8","Z87.09","R06.2","M25.561","M25.562","J45.909","E28.2","Z82.49","Z80.3","Z79.899","Z79.1","R61.","V62.84","F43.21","F43.10","G43.909","F41.8","Z62.810","Z62.811"],"date":["2022-10-17","2022-10-17","2022-11-14","2022-06-24","2022-07-08","2022-07-13","2022-11-17","2022-09-27","2022-11-14","2022-09-27","2022-09-27","2022-09-27","2022-09-27","2022-09-29","2022-09-29","2022-09-29","2020-12-30","2021-01-13","2021-08-21","2021-06-09","2022-02-28","2022-06-09","2022-06-09","2022-08-11","2022-06-30","2022-06-30","2022-08-11","2022-08-11","2022-11-14","2021-11-04","2020-04-16","2020-09-25","2020-11-09","2020-12-30","2021-01-14","2021-02-24","2021-09-04","2021-11-18","2022-11-21","2021-08-12","2021-08-12","2021-08-12","2021-08-26","2020-06-26","2022-06-11","2021-09-28","2021-07-14","2021-09-28","2021-07-14","2020-09-06","2021-06-16","2020-09-17","2020-12-16","2021-07-16","2021-09-28","2022-07-13","2022-05-17","2022-07-13","2022-06-07","2022-09-20","2022-06-07","2022-06-07","2022-10-12","2022-10-12","2022-04-30","2021-07-21","2021-12-01","2020-04-16","2022-06-04","2021-03-16","2022-04-05","2022-04-05","2022-04-05","2022-04-05","2022-04-05","2020-03-30","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2021-06-24","2022-02-07","2022-07-05","2022-07-05","2022-07-13","2022-07-13","2022-08-08","2022-08-08","2022-08-08","2022-04-09","2022-07-26","2022-07-26","2020-05-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-04","2020-04-23","2020-04-23","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2020-07-14","2020-07-30","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2021-07-14"],"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":[["","69238106901","POT  CHLORIDE","TAB 20MEQ ER","30","Select","Select",""],["","50111043303","TRAZODONE","TAB 50MG","30","Select","Select",""],["","10370010150","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","00527411837","PROPRANOLOL","CAP 120MG ER","30","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","50","Select","Select",""],["","51672400201","NORTRIPTYLIN","CAP 25MG","90","Select","Select",""],["","45802021696","BENZOYL","GEL 0.05","60","Select","Select",""],["","23155010310","METFORMIN","TAB 850MG","180","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","16714069803","VALACYCLOVIR","TAB 500MG","6","Select","Select",""],["","43598016430","OLANZAPINE","TAB 5MG","30","Select","Select",""],["","31722070290","LOSARTAN","TAB 100MG","30","Select","Select",""],["","57237002901","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","16714080001","CHLORTHALID","TAB 25MG","30","Select","Select",""],["","59746011306","PROCHLORPER","TAB 5MG","10","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","64764073030","TRINTELLIX","TAB 10MG","30","Select","Select",""],["","72578008602","DESONIDE","CRE 0.0005","60","Select","Select",""],["","11822048932","BP","MIS AUTOMATI","1","Select","Select",""],["","00536105556","ACNE","GEL 0.05","42","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","76385012350","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","00054040013","DESVENLAFAX","TAB 50MG ER","30","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","59310041012","QNASL","AER 80MCG","11","Select","Select",""],["","45802056202","CLINDAMYCIN","SOL 0.01","60","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","00172392780","DIAZEPAM","TAB 10MG","8","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","15","Select","Select",""],["","13668000901","CITALOPRAM","TAB 10MG","30","Select","Select",""],["","00456111030","VIIBRYD","TAB 10MG","30","Select","Select",""],["","62332023230","VILAZODONE","TAB 10MG","30","Select","Select",""],["","65162079108","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","65862052899","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","00832532515","POT  CL MICRO","TAB 20MEQ ER","30","Select","Select",""],["","29300024601","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","16714074703","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","23155019101","BUPROPION","TAB 75MG","21","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","16714095503","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","00096070737","DRYSOL","SOL 0.2","38","Select","Select",""],["","00904675180","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","00169406013","VICTOZA","INJ 18MG\/3ML","9","Select","Select",""],["","62332048650","CLOBETASOL","SOL 0.0005","100","Select","Select",""],["","23155051905","ISOSORB","TAB 30MG ER","90","Select","Select",""],["","11822334950","ALLERGY","CAP 25MG","28","Select","Select",""],["","59762371904","ALPRAZOLAM","TAB 0.25MG","30","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","74312019377","VITAMIN","CAP 5000UNIT","30","Select","Select",""],["","31722082030","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","65862064169","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","21","Select","Select",""],["","29300014901","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","00121077504","GG\/CODEINE","SOL 100-10\/5","118","Select","Select",""],["","24090047388","INDERAL","CAP 120MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","08373747800","OPTICHAMBER","MIS DIAMOND","1","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","52569013530","HM","POW 0.309","538","Select","Select",""],["","52544008201","FIORICET","CAP CODEINE","60","Select","Select",""],["","00591264101","BUT\/APAP\/CAF","CAP CODEINE","60","Select","Select",""],["","57237001899","DULOXETINE","CAP 30MG","30","Select","Select",""],["","00456120330","LINZESS","CAP 72MCG","30","Select","Select",""],["","00135008969","CITRUCEL","POW ORANGE","454","Select","Select",""],["","16714037102","LAMOTRIGINE","TAB 25MG","60","Select","Select",""],["","13107008305","LORAZEPAM","TAB 0.5MG","5","Select","Select",""],["","68382079801","LABETALOL","TAB 100MG","60","Select","Select",""],["","00002143480","TRULICITY","INJ 1.5\/0.5","2","Select","Select",""],["","00168005760","BETAMETH","LOT 0.0005","60","Select","Select",""],["","59762040105","SUCRALFATE","TAB 1GM","30","Select","Select",""],["","45802086803","POLYETH","POW 3350 NF","510","Select","Select",""],["","00168008016","HYDROCORT","CRE 0.025","60","Select","Select",""],["","64980027201","GLYCOPYRROL","TAB 1MG","60","Select","Select",""],["","42192080201","PHENAZOPYRID","TAB 200MG","9","Select","Select",""],["","53746027205","SMZ\/TMP","TAB 800-160","6","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":""}]}]}