{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RACHEL S KRUSE","gend":1,"add":"724 VALLEY STREAM ROAD","city":"CHESAPEAKE","state":"VA","zip":"23325-9998","dob":"1987-03-04","age":"","mstatus":"","insh":"1118209*01","cliId":"","pno":7573901882,"cno":7573901882,"email":"","ename":"","eno":"","pphy":"HUMADI, SAHIRA MD","ppno":7574465955,"pcpadd":"825 FAIRFAX AVE SUITE 118,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23507-9998","pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574465196,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K85.20","R10.13","R11.2","F10.10","Z72.0","E87.6","K21.9","G89.4","M17.12","S86.911A","Z01.818","M25.561","I49.8","R74.8","Z02.2","M25.562","G89.29","F17.210","F11.20","F10.20","F12.10","F17.200","K85.90","R10.9","S83.512A","V58.89","R26.89","N30.00","R40.0","R79.89","F19.10","K76.9","R00.0","K92.0","F31.9","F41.1","S83.511A","S83.249A","S83.241A","S83.411A","M25.361","Z83.71","K76.0","M25.569","M25.559","Z79.891","M17.0","S83.511S","S83.512S","Z98.890","R07.81","Z86.718","Z86.711","Z88.5","Z88.8","Z97.5","G89.18","M79.89","Z96.652","Z98.84","Z91.040","Z91.09","M79.605","N30.01","Z79.899","Z88.6","Z87.11","Z91.51","Z90.710","K04.7","I10.","F31.81","M19.90","F41.9","J45.909","M50.30","M79.7","E78.5","G43.909","NO DATA","Z47.1","M23.305","F10.239","K74.60","E66.9","F10.280","Z68.36","F43.12","Z91.048","Z63.5","Z90.79","Z90.49","Z90.721","Z82.49","Z80.3","G57.31","G58.9","Z23.","R06.00","M79.661","R06.02","E86.0","Z01.810","Z01.812","R94.31","Z20.822","K08.89","K02.9","R45.1","R13.10","Z20.828","I25.2","Z87.39","S89.91XA","R40.1","T48.901A","S83.281A","M17.11","M94.261","M23.303","T84.89XA","M25.761","Z68.34","M23.611","G43.719","M54.81","G44.40","G44.209","T39.95XA","S83.519A","S83.241S"],"date":["2022-05-12","2022-05-06","2021-03-26","2022-09-29","2021-10-03","2021-04-28","2022-10-28","2021-07-14","2021-11-20","2022-02-22","2023-08-21","2023-03-20","2022-05-24","2022-08-31","2022-10-01","2022-10-01","2022-10-01","2023-04-06","2023-09-20","2023-09-20","2023-09-20","2023-09-20","2021-05-06","2021-04-24","2021-11-09","2023-08-23","2021-12-13","2022-05-12","2022-08-09","2022-08-09","2022-08-09","2022-08-09","2022-09-29","2022-09-29","2022-11-09","2022-11-09","2023-04-06","2023-02-13","2023-04-06","2023-02-27","2023-09-06","2021-04-23","2021-04-23","2021-11-12","2021-05-26","2023-04-06","2021-11-09","2021-07-14","2021-07-14","2023-09-06","2021-10-03","2023-01-29","2023-01-29","2023-04-06","2023-04-06","2022-08-09","2023-04-06","2021-11-22","2022-10-28","2023-04-06","2023-04-06","2021-11-22","2021-11-22","2022-05-07","2022-10-28","2023-04-06","2022-05-07","2022-08-09","2022-05-07","2023-01-29","2023-04-06","2022-10-28","2022-09-30","2021-04-24","2023-04-06","2021-04-24","2022-10-28","2021-04-24","2023-07-25","2021-04-24","2021-11-20","2022-04-27","2022-09-30","2022-10-28","2023-04-06","2022-09-30","2023-01-29","2022-09-30","2023-04-06","2022-09-30","2022-08-09","2022-10-28","2022-08-09","2022-08-09","2022-08-09","2021-02-02","2021-02-02","2021-11-12","2022-10-28","2022-10-28","2022-10-28","2022-10-28","2022-05-23","2022-05-23","2022-05-23","2022-05-23","2023-01-29","2023-01-29","2022-09-30","2021-02-26","2021-03-04","2021-11-16","2022-01-16","2022-01-16","2022-08-09","2022-08-09","2023-04-06","2023-04-06","2023-04-06","2023-04-06","2023-04-06","2023-04-06","2023-04-06","2023-04-06","2023-07-25","2023-07-25","2023-07-25","2023-07-25","2023-07-25","2023-08-21","2023-08-21"],"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":[["","10702001801","OXYCODONE","TAB 5MG","24","Select","Select",""],["","59011042010","OXYCONTIN","TAB 20MG CR","60","Select","Select",""],["","65862050301","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","52817032110","BACLOFEN","20 MG","120","Select","Select",""],["","57237007530","ONDANSETRON","TAB 4MG","24","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00093220305","METOCLOPRAM","TAB 10MG","20","Select","Select",""],["","45802075930","PROMETHAZINE","SUP 25MG","10","Select","Select",""],["","68382050010","OMEPRAZOLE","40 MG","90","Select","Select",""],["","00536589688","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","00527128201","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","49483034010","ACETAMIN","TAB 325MG","30","Select","Select",""],["","76282057090","PREGABALIN","CAP 75MG","20","Select","Select",""],["","00904699880","DOCUSATE SOD","CAP 100MG","30","Select","Select",""],["","50458058030","XARELTO","TAB 10MG","12","Select","Select",""],["","69618006610","ASPIRIN LOW","TAB 81MG EC","84","Select","Select",""],["","16714073201","CELECOXIB","CAP 100MG","20","Select","Select",""],["","13107003105","MIRTAZAPINE","15 MG","30","Select","Select",""],["","69097084615","CYCLOBENZAPR","TAB 10MG","1","Select","Select",""],["","52817018010","CLONIDINE","TAB 0.1MG","14","Select","Select",""],["","69315090505","LORAZEPAM","TAB 1MG","1","Select","Select",""],["","65162079108","LIDOCAINE","PAD 0.05","15","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","5","Select","Select",""],["","00115180401","HYDROXYZ PAM","CAP 50MG","30","Select","Select",""],["","50111056101","TRAZODONE","TAB 100MG","7","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00378210001","LOPERAMIDE","CAP 2MG","30","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","15","Select","Select",""],["","00904699446","GAS RELIEF","CAP 125MG","30","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","80681008600","MELATONIN","TAB 3MG","30","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","2","Select","Select",""],["","69238207707","PROPRANOLOL","TAB 10MG","1","Select","Select",""],["","42806008201","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","68382056928","ACAMPRO CAL","TAB 333MG","42","Select","Select",""],["","00093117410","PENICILLN VK","TAB 500MG","28","Select","Select",""],["","43598096530","ARIPIPRAZOLE","TAB 2MG","1","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","00172392670","DIAZEPAM","5 MG","6","Select","Select",""],["","57237002801","AMOXICILLIN","500 MG","28","Select","Select",""],["","68382056928","ACAMPROSATE CALCIUM","333 MG","180","Select","Select",""],["","00093005301","BUSPIRONE HCL","5 MG","60","Select","Select",""],["","71288041081","ENOXAPARIN SODIUM","30MG\/0.3ML","12.6","Select","Select",""],["","10702001850","OXYCODONE HCL","5 MG","25","Select","Select",""],["","29300046810","CLONIDINE HCL","0.1 MG","15","Select","Select",""],["","57237007530","ONDANSETRON TAB","4MG","24","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","24","Select","Select",""],["","55111064505","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","52817018010","CLONIDINE TAB","0.1MG","14","Select","Select",""],["","69097084615","CYCLOBENZAPR TAB","10MG","2","Select","Select",""],["","00115101203","BACLOFEN TAB","20MG","90","Select","Select",""],["","65162079108","LIDOCAINE PAD","5%","14","Select","Select",""],["","65862085999","FAMOTIDINE TAB","20MG","15","Select","Select",""],["","00904699446","GAS RELIEF CAP","125MG","30","Select","Select",""],["","49483034010","ACETAMIN TAB","325MG","30","Select","Select",""],["","64380080807","IBUPROFEN TAB","600MG","30","Select","Select",""],["","50111056101","TRAZODONE TAB","100MG","1","Select","Select",""],["","13107000334","MIRTAZAPINE TAB","30MG","30","Select","Select",""],["","43547040211","FUROSEMIDE TAB","40MG","5","Select","Select",""],["","65862050301","AMOX\/K CLAV TAB","875-125","1","Select","Select",""],["","69315090505","LORAZEPAM TAB","1MG","1","Select","Select",""],["","69097052444","DICLOFENAC GEL","1%","100","Select","Select",""],["","80681008600","MELATONIN TAB","3MG","1","Select","Select",""],["","00115180401","HYDROXYZ PAM CAP","50MG","30","Select","Select",""],["","00378210001","LOPERAMIDE CAP","2MG","30","Select","Select",""],["","00904530660","BANOPHEN CAP","25MG","2","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","43598096530","ARIPIPRAZOLE TAB","2MG","1","Select","Select",""],["","69238207707","PROPRANOLOL TAB","10MG","1","Select","Select",""],["","42806008201","BUSPIRONE TAB","5MG","60","Select","Select",""],["","00093216568","NALOXONE HCL SPR","4MG","2","Select","Select",""],["","00093117410","PENICILLN VK TAB","500MG","28","Select","Select",""],["","68382056928","ACAMPRO CAL TAB","333MG","42","Select","Select",""],["","65862014836","SUMATRIPTAN SUCCINATE","100 MG","12","Select","Select",""],["","55513084101","AIMOVIG AUTOINJECTOR","70 MG\/ML","1","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":""}]}]}