{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SONDRA   L WYATT","gend":1,"add":"7008 BELVEDERE DR","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1960-12-06","age":"","mstatus":"","insh":"20058611*01","cliId":"","pno":"757\/914-5380","cno":"757\/914-5380","email":"","ename":"","eno":"","pphy":"LAZOS, HEIDI J NP","ppno":"757\/875-2009","pcpadd":"1000 OLD DENBIGH BLVD STE 1020A","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23602,"pcpcounty":"","pcpid":"","pcpname":"Riverside Lifelong Health & Aging Services","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/369-1042","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I73.9","F31.81","F43.12","F41.9","F90.0","S42.214A","E11.65","Z79.4","E78.5","E11.9","K21.9","T84.120A","V58.89","E11.51","E11.628","F41.8","Z87.891","Z89.512","Z79.899","Z79.02","V54.11","E11.40","F43.10","Z86.31","Z48.01","R06.02","M89.8X5","Z89.612","K02.9","M86.152","I25.5","I10.","G47.00","Z87.440","Z87.01","Z91.81","E11.69","R15.9","Z99.3","A41.9","NO DATA","N17.9","N30.00","R64.","E11.649","E86.0","Z20.822","N20.0","R29.6","E87.2","N28.9","R19.7","Z78.9","R73.9","A41.51","W19.XXXA","D72.829","I15.1","F01.50","F51.01","R26.2","M62.81","M79.605","R41.82","R41.841","R48.8","G62.9","G60.9","A41.59","I50.21","I21.4","N12.","I47.2","L89.010","F90.9","I25.10","F17.200","M75.01","F32.9","I42.9","T87.89","M85.852","K52.9","E87.1","E46.","Z91.19","R41.9","R60.0","I25.118","Z74.09","R39.81","K52.89","Z47.81","E87.6","Z53.20","Z90.49","S42.211A","Z74.3","R10.9","U07.1","N82.3","G63.","E11.8","I51.89","R52.","R94.31","F03.90","N39.0","Z86.19","B96.89","R91.8","E04.2","R77.8","Z20.828","I34.0","R41.0","R41.89","R33.9","D64.9","Z66.","R32.","Z62.810","R79.82","R23.1","I50.20","I95.9","M81.0","E11.42","R19.5","R42.","E11.52","E03.9","E11.00","T87.9","Z12.39","R63.0","G89.29","T87.81","T87.44","T81.89XA","Z01.810","I49.3","W01.0XXA","Z01.818","G54.6","I70.202","S49.90XA","R00.0","R30.0","Z23.","F17.210","R63.4"],"date":["2022-05-02","2022-05-17","2022-05-17","2022-05-17","2022-05-17","2020-10-02","2022-04-29","2022-04-29","2022-04-29","2022-04-13","2022-03-17","2020-10-02","2020-10-03","2022-04-29","2022-02-02","2022-03-17","2021-09-10","2021-09-15","2021-09-22","2020-10-08","2022-03-17","2022-04-13","2022-04-29","2020-10-08","2020-10-08","2022-03-17","2020-11-19","2022-09-29","2020-11-19","2021-01-19","2021-10-09","2022-04-29","2022-04-29","2021-01-19","2021-01-19","2021-01-19","2021-01-19","2022-09-29","2022-09-29","2021-09-22","2022-05-02","2022-04-29","2021-10-25","2021-09-10","2021-09-10","2022-03-01","2021-09-10","2021-09-22","2021-09-10","2022-03-01","2022-03-01","2022-07-27","2021-12-15","2022-03-01","2021-09-14","2021-09-15","2022-05-02","2021-09-14","2021-09-28","2021-09-28","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2022-03-01","2021-11-10","2020-10-11","2020-10-17","2020-10-11","2020-10-17","2020-10-11","2020-10-11","2020-11-11","2020-10-17","2020-10-11","2020-10-11","2021-09-15","2020-10-17","2020-11-19","2020-12-16","2022-05-02","2022-04-29","2021-09-15","2021-09-15","2021-09-27","2021-11-10","2022-03-17","2022-03-17","2022-09-29","2022-05-02","2020-01-24","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2021-09-10","2021-08-16","2022-01-31","2022-01-31","2022-02-21","2022-05-02","2020-10-14","2021-09-10","2021-09-11","2022-03-17","2022-07-27","2022-07-27","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-10","2020-10-11","2021-09-17","2021-09-22","2021-09-22","2022-04-29","2022-04-29","2022-04-29","2022-04-29","2022-04-29","2020-01-27","2020-10-12","2020-11-11","2020-11-11","2020-11-11","2021-09-27","2022-03-17","2020-02-25","2020-01-21","2020-01-21","2020-11-12","2020-01-21","2020-01-21","2020-01-21","2020-02-27","2020-02-27","2020-02-27","2020-11-12","2020-08-31","2020-09-01","2020-02-25","2020-02-25","2020-02-25","2020-08-31","2020-10-11","2021-10-21","2022-02-04","2020-10-15","2021-10-09"],"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":[["","67877056110","METFORMIN","TAB 500MG","60","Select","Select",""],["","65862048901","QUETIAPINE","TAB 25MG","270","Select","Select",""],["","68382065001","ISOSORB","TAB 30MG ER","30","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","30","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","00904679480","ASPIRIN","CHW 81MG","30","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","59651017401","DOXEPIN","CAP 25MG","60","Select","Select",""],["","10702001050","HYDROXYZ","TAB 10MG","90","Select","Select",""],["","65862020199","LOSARTAN","TAB 25MG","30","Select","Select",""],["","55111032101","GLIMEPIRIDE","TAB 2MG","30","Select","Select",""],["","27241009809","DULOXETINE","CAP 30MG","30","Select","Select",""],["","62559039050","VANCOMYCIN","CAP 125MG","40","Select","Select",""],["","57664049983","MIRTAZAPINE","TAB 15MG","30","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","20","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","00378041510","DIPHEN\/ATROP","TAB 2.5MG","20","Select","Select",""],["","00002871501","HUMULIN","INJ 70\/30","10","Select","Select",""],["","00228207710","TEMAZEPAM","CAP 30MG","30","Select","Select",""],["","60505265901","TRAZODONE","TAB 300MG","30","Select","Select",""],["","65862067899","ALPRAZOLAM","TAB 1MG","90","Select","Select",""],["","64980052810","SODIUM","TAB 650MG","2","Select","Select",""],["","60258017101","MAG","TAB 400MG","7","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA BL","200","Select","Select",""],["","63402030430","LATUDA","TAB 40MG","5","Select","Select",""],["","65862022801","LAMOTRIGINE","TAB 100MG","15","Select","Select",""],["","00169183711","NOVOLIN","INJ 70\/30","10","Select","Select",""],["","08290328438","INSULIN","MIS 0.3\/31G","100","Select","Select",""],["","13107008501","LORAZEPAM","TAB 2MG","1","Select","Select",""],["","31722054501","LITHIUM","CAP 300MG","10","Select","Select",""],["","47781019601","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","60505384901","CELECOXIB","CAP 200MG","60","Select","Select",""],["","70000041501","CLEARLAX","POW ","119","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","69097015807","MELOXICAM","TAB 7.5MG","30","Select","Select",""],["","68382009205","CARVEDILOL","TAB 3.125MG","60","Select","Select",""],["","43547040110","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","31722072320","LEVOFLOXACIN","TAB 750MG","7","Select","Select",""],["","50228012490","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","21","Select","Select",""],["","71093014005","METHOCARBAM","TAB 500MG","14","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":""}]}]}