{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VICKI FILLMORE","gend":1,"add":"1604 OLD DONATION PKWY COLONIAL HEALTH AND REHAB","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1957-10-13","age":"","mstatus":"","insh":"2214625*01","cliId":"","pno":"757\/228-8425","cno":"757\/228-8425","email":"","ename":"","eno":"","pphy":"LADEVEZE, JENNIFER FNP","ppno":"804\/281-3311","pcpadd":"6860 HARBOUR VIEW BLVD","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/213-9783","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","A41.9","N17.9","E83.51","K52.9","L89.40","E87.2","R94.31","Z91.19","V58.89","NO DATA","A02.1","I25.810","E87.5","I50.9","N18.4","R53.81","M25.562","I50.42","F33.9","F41.9","E78.00","Z89.511","M62.81","Z20.828","R26.9","R62.7","Z74.1","I25.10","N20.0","Z23.","U07.1","R05.9","R09.89","R53.83","R10.9","J96.91","J96.92","I50.43","F17.200","J96.01","I73.9","J96.02","R26.89","E11.40","R56.9","R00.0","I34.0","I36.1","R06.02","I12.9","E11.22","E87.6","I10.","N18.9","E78.5","L60.3","E11.51","I79.8","M79.676","F32.9","L03.315","B37.2","Z09.","R19.5","E11.65","F09.","L03.116","F41.8","R26.2","R48.9","J96.00","I70.244","I70.245","I70.243","F17.211","Z79.4","L03.90","K59.04","I13.0","I50.23","N39.0","M86.8X7","N18.3","E11.69","D64.9","I25.5","I82.403","E11.00","B37.89","E87.1","R31.0","R10.84","K92.1","N39.45","G93.41","N17.0","E83.42","V58.69","Z91.138","R60.0","G63.","Z99.3","G56.01","Z95.1","Z72.0","F32.2","I50.22","Z11.4","Z11.59","L97.509","E11.621","R39.81","L22.","M25.531","K58.1","R19.7","K59.00","L30.9","N39.3","G93.40","E66.9","D63.1","B37.3","I25.2","E86.0","D50.0","M24.572","Z89.412","Z79.82","Z79.02","I50.33","D72.9","R23.3","R65.10","E08.00","E08.41","R47.02","R10.30","E78.2","G56.31","G56.12","E11.42"],"date":["2022-08-01","2021-03-01","2021-02-26","2021-02-26","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-16","2021-02-17","2022-08-23","2021-02-21","2021-04-05","2021-09-01","2022-08-23","2022-08-01","2021-09-01","2021-04-07","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-02-01","2022-08-01","2022-08-01","2022-07-13","2022-07-13","2022-07-13","2022-06-17","2022-06-17","2022-06-17","2022-06-17","2020-02-22","2020-02-22","2020-02-24","2021-04-04","2021-09-01","2021-04-04","2020-02-26","2021-05-07","2020-04-20","2021-02-18","2021-02-18","2021-02-19","2021-02-19","2021-02-19","2021-02-26","2022-08-23","2021-02-26","2022-03-24","2022-03-24","2021-04-04","2021-11-01","2021-11-01","2021-11-01","2021-11-01","2022-01-13","2020-09-11","2020-09-11","2020-09-15","2021-01-20","2021-02-17","2021-02-23","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-04-03","2021-04-04","2021-09-01","2022-08-23","2021-02-17","2020-02-22","2020-02-22","2020-02-22","2020-09-08","2020-02-22","2020-02-22","2020-09-08","2020-02-24","2020-09-11","2020-09-11","2020-09-11","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2021-02-17","2021-02-17","2021-02-17","2021-02-17","2021-02-17","2021-05-04","2021-05-04","2021-05-04","2021-05-07","2020-02-24","2020-09-08","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-04-26","2020-04-26","2020-10-08","2020-10-08","2021-06-04","2022-08-01","2022-05-06","2022-05-06","2021-04-13","2020-05-06","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2020-01-07","2020-01-07","2020-01-07","2020-01-07","2020-01-07","2020-02-23","2020-02-23","2020-02-23","2020-02-23","2020-09-08","2020-11-03","2021-01-20","2020-11-19","2021-01-04","2021-09-14","2021-09-14","2021-09-14"],"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":[["","88008802340","OC","ONV ERS KIT","1","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","6","Select","Select",""],["","88008802337","OC  MAXPLUS C","EAR NEEDLES","4","Select","Select",""],["","70377000415","SIMVASTATIN","TAB 40MG","90","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","3","Select","Select",""],["","55111015430","ONDANSETRON","TAB 8MG","10","Select","Select",""],["","68382000105","PAROXETINE","TAB 40MG","30","Select","Select",""],["","68180035109","SERTRALINE","TAB 25MG","5","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","60","Select","Select",""],["","00002822259","INSULIN","INJ 100\/ML","39","Select","Select",""],["","16729021816","CLOPIDOGREL","TAB 75MG","90","Select","Select",""],["","16729016917","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","68462016505","CARVEDILOL","TAB 25MG","180","Select","Select",""],["","64764024060","AMITIZA","CAP 24MCG","60","Select","Select",""],["","00169750111","NOVOLOG","INJ 100\/ML","10","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","420","Select","Select",""],["","00456120330","LINZESS","CAP 72MCG","30","Select","Select",""],["","43547035211","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","00378668999","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","4","Select","Select",""],["","00536730001","NEPHRO-VITE","TAB ","30","Select","Select",""],["","00904676320","ROBAFEN","LIQ 200\/10ML","118","Select","Select",""],["","00121086800","NYSTATIN","SUS 100000","200","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","60","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","18","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","180","Select","Select",""],["","63304007601","POT  CHLORIDE","TAB 10MEQ ER","90","Select","Select",""],["","00002879959","HUMALOG","INJ 100\/ML","39","Select","Select",""],["","69618001001","ACETAMIN","TAB 325MG","30","Select","Select",""],["","94688018470","BANATROL","PAK PLUS","30","Select","Select",""],["","00054429931","FUROSEMIDE","TAB 40MG","90","Select","Select",""],["","00832532411","POT  CL MICRO","TAB 10MEQ ER","30","Select","Select",""],["","16729000301","GLIMEPIRIDE","TAB 4MG","60","Select","Select",""],["","00378718705","METFORMIN","TAB 1000MG","180","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","16714069301","FLUCONAZOLE","TAB 200MG","13","Select","Select",""],["","23155005701","GLYBURIDE","TAB 2.5MG","180","Select","Select",""],["","00310653004","BYDUREON","INJ 2MG","12","Select","Select",""],["","00245021111","MIDODRINE","TAB 2.5MG","42","Select","Select",""],["","16714049401","AMOX\/K","TAB 500-125","10","Select","Select",""],["","00316023225","ZEASORB-AF","POW 0.02","71","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":""}]}]}