{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARIE P ELOY-BELL","gend":1,"add":"220 W 30TH ST APT 108","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1977-10-11","age":"","mstatus":"","insh":"1256959*01","cliId":"","pno":7576637403,"cno":7576637403,"email":"","ename":"","eno":"","pphy":"VILLATE PRIETO, SUSANA MD","ppno":7572782240,"pcpadd":"155 KINGSLEY LN STE 400,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23505-9998","pcpcounty":"","pcpid":"","pcpname":"Depaul Medical Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574896469,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z32.01","V23.87","Z20.828","K21.9","F43.9","O03.9","Z32.02","I11.9","NO DATA","Z68.41","I47.1","M54.5","E78.00","E11.9","R43.2","Z30.42","Z30.09","Z01.419","Z12.39","Z12.4","Z11.51","N76.0","F43.29","G47.00","F34.9","R42.","I10.","Z90.49","Z79.899","R11.10","J11.1","R00.0","R53.83","R53.81","R11.2","Z20.822","K85.20","R10.13","L30.9","R21.","N39.0","F10.20","R45.0","G90.09","B35.3","B35.1","R60.0","I87.2","I08.0","M25.462","M25.532","M25.522","M25.512","A54.42","R31.9","A41.9","H10.33","R63.4","A09.","R43.0","A54.86","F10.239","D63.8","K76.0","K70.10","G62.1","A41.51","M13.0","E87.6","I82.4Y3","M25.562","M17.12","Z45.2","M13.862","F10.10","D64.9","M62.81","R26.9","Z91.81","Z79.2","R65.20","R55.","K59.00","R16.0","A54.49","I82.611","R53.1","R26.89","F32.89","Z09.","A54.9","G60.3","F10.188","R43.1","A54.09","R29.6","I25.2","R94.31","T80.211A","E66.01","Z79.84","G47.30","Z68.35","G62.9","R50.9","R40.4","R41.82","R41.0","G93.89"],"date":["2021-04-28","2021-04-28","2022-06-16","2022-08-04","2022-08-04","2021-05-05","2021-06-07","2022-05-31","2023-06-21","2022-05-31","2023-06-05","2021-01-06","2021-01-06","2023-06-23","2023-05-26","2021-06-07","2021-06-07","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2022-02-13","2022-08-04","2022-08-04","2022-08-04","2023-07-20","2023-06-19","2023-06-19","2022-08-04","2022-12-20","2023-06-19","2022-12-20","2022-12-20","2022-12-20","2022-12-20","2023-02-25","2023-02-25","2021-03-01","2021-04-20","2023-06-15","2023-06-16","2022-02-13","2022-08-01","2022-08-01","2022-08-01","2023-06-19","2022-08-01","2022-09-22","2023-06-21","2023-06-05","2023-06-05","2023-06-05","2023-07-20","2023-06-12","2023-06-24","2023-05-26","2023-05-26","2023-05-26","2023-08-08","2023-06-05","2023-06-23","2023-06-05","2023-06-05","2023-06-15","2023-06-15","2023-06-05","2023-06-05","2023-06-05","2023-06-23","2023-06-23","2023-06-09","2023-06-15","2023-06-15","2023-06-15","2023-06-19","2023-06-15","2023-06-15","2023-06-15","2023-06-15","2023-06-24","2023-06-09","2023-06-23","2023-06-05","2023-06-23","2023-06-23","2023-06-23","2023-06-07","2023-06-16","2023-06-16","2023-06-16","2023-08-08","2023-07-03","2023-08-02","2023-06-14","2023-06-14","2023-06-19","2023-06-19","2023-06-19","2023-06-19","2023-06-19","2023-06-19","2023-06-19","2023-07-20","2023-06-23","2023-06-18","2023-06-18","2023-06-18","2023-08-02"],"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":[["","68682070730","DILTIAZEM ER","TAB 300MG","90","Select","Select",""],["","62037060090","CARTIA XT","CAP 300\/24HR","90","Select","Select",""],["","70377002813","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","43547036011","LOSARTAN POT","TAB 25MG","45","Select","Select",""],["","00472037945","CLOTRIM\/BETA","CRE DIPROP","45","Select","Select",""],["","65649030302","XIFAXAN","TAB 550MG","42","Select","Select",""],["","00555077902","MEDROXYPR AC","TAB 10MG","10","Select","Select",""],["","80777027315","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","24979002907","DILTIAZEM","24HR ER (CD) 300 MG","60","Select","Select",""],["","54629061500","MELATONIN","SUB 5MG","30","Select","Select",""],["","64980056210","FUROSEMIDE","20 MG","90","Select","Select",""],["","21922002505","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","51672131802","CICLOPIROX","CRE 0.0077","30","Select","Select",""],["","51672130100","AMMONIUM LAC","CRE 0.12","385","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","00904672059","ACETAMIN","TAB 500MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","500 MG","14","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","65862020199","LOSARTAN POTASSIUM","25 MG","45","Select","Select",""],["","00555015902","CHLORDIAZEPOXIDE HCL","25 MG","17","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","75834025601","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","00574402435","ERYTHROMYCIN","5 MG\/GRAM","3.5","Select","Select",""],["","43547036011","LOSARTAN POT TAB","25MG","45","Select","Select",""],["","24979002907","DILTIAZEM CAP","300MG ER","60","Select","Select",""],["","00472037945","CLOTRIM\/BETA CRE DIPROP","","45","Select","Select",""],["","54629061500","MELATONIN SUB","5MG","30","Select","Select",""],["","69315011610","FUROSEMIDE TAB","20MG","90","Select","Select",""],["","21922002505","KETOCONAZOLE CRE","2%","60","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","28","Select","Select",""],["","70377002813","ATORVASTATIN TAB","20MG","30","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","51672131802","CICLOPIROX CRE","0.77%","30","Select","Select",""],["","51672130100","AMMONIUM LAC CRE","12%","385","Select","Select",""],["","00904672059","ACETAMIN TAB","500MG","30","Select","Select",""],["","64380080807","IBUPROFEN TAB","600MG","30","Select","Select",""],["","00093314705","CEPHALEXIN CAP","500MG","21","Select","Select",""],["","68462015713","ONDANSETRON TAB","4MG ODT","12","Select","Select",""],["","11822015796","VITAMIN B-","1 100 MG","30","Select","Select",""],["","57237016199","OMEPRAZOLE","20 MG","30","Select","Select",""],["","51672203506","MICONAZOLE NITRATE","2 %","45","Select","Select",""],["","45802086866","POLYETHYLENE GLYCOL","3350 17 G","15","Select","Select",""],["","68462019005","NAPROXEN","500 MG","60","Select","Select",""],["","00406012301","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","5","Select","Select",""],["","50228018001","GABAPENTIN","300 MG","30","Select","Select",""],["","27241009706","DULOXETINE HCL","20 MG","60","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":""}]}]}