{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDA E BRAY","gend":1,"add":"1046 HOLT ST","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1964-01-24","age":"","mstatus":"","insh":"1574363*01","cliId":"","pno":7573199464,"cno":7573199464,"email":"","ename":"","eno":"","pphy":"FEDRO, RANDALL C MD","ppno":7576863516,"pcpadd":"3235 BRIDGE RD STE 15,","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23435-9998","pcpcounty":"","pcpid":"","pcpname":"North Suffolk Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576860230,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.41","N31.9","M54.5","A41.51","N12.","L02.01","I10.","K21.9","M51.36","Z20.822","K02.9","E78.5","G47.33","K04.7","F32.9","K76.89","I25.10","D73.89","E11.65","E66.01","A41.9","E11.9","M67.432","R73.09","U07.1","NO DATA","R09.02","E11.21","E55.9","F33.41","M25.511","G89.29","Z68.36","Z87.891","Z79.84","J06.9","J04.0","H25.813","H40.013","R53.82","G47.30","R40.0","G47.20","M54.41","M54.42","Z91.14","N89.8","M17.12","Z82.49","Z83.3","Z82.3","Z79.899","Z88.8","R73.9","M79.89","M79.661","R65.10","D72.829","N10.","M25.532","Z99.89","K76.0","R05.","M43.16","M54.16","T38.0X5A","R06.89","M17.11","Z96.651","E66.9","Z68.35","R50.9","Z01.810","Z01.812","Z01.818","N30.00","J96.01","T84.84XA","M77.8","Z87.39","M25.561","L30.9","V58.69","L53.9","Z91.128","L29.9","S80.01XA","R05.9","B96.89","M67.40","M13.161","M70.51","M76.31","R78.81","K12.2","N39.0","R11.2","E16.2","R53.83","R09.81","Z68.34","H61.22","Z09.","E11.00","Z91.199","Z79.4"],"date":["2023-09-05","2023-09-05","2021-05-20","2021-09-09","2021-09-15","2021-09-09","2023-08-24","2023-08-21","2021-09-09","2023-08-04","2021-09-15","2023-08-21","2023-08-21","2021-09-13","2022-07-05","2021-09-09","2021-09-09","2021-09-09","2023-08-23","2023-08-21","2021-09-15","2023-08-24","2022-06-13","2021-03-08","2023-08-16","2023-08-23","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2021-03-16","2022-07-05","2023-08-21","2023-08-04","2021-05-20","2021-12-01","2021-12-01","2022-01-13","2022-01-13","2022-02-09","2022-10-19","2022-02-09","2022-02-09","2022-08-09","2022-08-09","2022-10-19","2022-10-19","2022-10-19","2023-08-21","2023-08-21","2023-08-21","2023-08-21","2023-08-21","2022-10-19","2022-11-17","2022-11-17","2021-09-12","2021-09-12","2021-09-12","2022-03-20","2023-04-05","2021-07-07","2021-07-07","2021-02-22","2021-02-22","2021-03-08","2021-03-16","2023-08-16","2023-08-21","2023-08-04","2021-05-20","2021-09-08","2022-06-10","2022-06-10","2022-06-10","2023-08-21","2021-03-18","2021-06-03","2022-03-20","2022-03-20","2022-08-09","2022-06-06","2022-06-06","2022-06-06","2022-06-06","2022-06-06","2022-11-15","2023-08-04","2021-11-24","2022-04-06","2021-06-25","2021-06-25","2021-06-25","2021-09-10","2021-09-13","2023-08-23","2023-08-23","2023-08-21","2023-08-04","2023-08-04","2023-08-04","2023-08-16","2023-08-24","2023-08-21","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":[["","00186037220","SYMBICORT AER","80-4.5","10","Select","Select",""],["","60505257808","ATORVASTATIN TAB","10MG","30","Select","Select",""],["","65862020299","LOSARTAN POT TAB","50MG","30","Select","Select",""],["","16714073302","CELECOXIB CAP","200MG","30","Select","Select",""],["","51991074810","DULOXETINE CAP","60MG","30","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","65862001005","METFORMIN TAB","1000MG","60","Select","Select",""],["","00310737220","BUDES\/FORMOT AER","80-4.5","10","Select","Select",""],["","08290320550","BD PEN NEEDL MIS","32GX4MM","100","Select","Select",""],["","49483048110","ASPIRIN LOW TAB","81MG EC","30","Select","Select",""],["","08222440006","ULTICARE PAD ALCOHOL","","100","Select","Select",""],["","55111015810","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","49502039475","INSULIN GLAR INJ","100U\/ML","15","Select","Select",""],["","00093216568","NALOXONE HCL SPR","","2","Select","Select",""],["","65162046650","IBUPROFEN TAB","800MG","90","Select","Select",""],["","67877069601","CHLORTHALID TAB","25MG","30","Select","Select",""],["","52817033010","CYCLOBENZAPR TAB","5MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP TAB","5-325MG","15","Select","Select",""],["","67877021905","CEPHALEXIN CAP","500MG","9","Select","Select",""],["","08489831510","PEN NEEDLES MIS","32GX4MM","100","Select","Select",""],["","68462011944","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","00378718705","METFORMIN HCL","1000 MG","60","Select","Select",""],["","70700015010","OMEPRAZOLE","20 MG","30","Select","Select",""],["","08489831510","DROPLET PEN NEEDLE","32GX 5\/32\"","100","Select","Select",""],["","27241009903","DULOXETINE HCL","60 MG","90","Select","Select",""],["","65862090901","CELECOXIB","200 MG","30","Select","Select",""],["","60505257808","ATORVASTATIN CALCIUM","10 MG","30","Select","Select",""],["","27241021601","CHLORTHALIDONE","25 MG","90","Select","Select",""],["","42806071501","BENZONATATE","200 MG","270","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","31722070110","LOSARTAN POT","TAB 50MG","30","Select","Select",""],["","60505257808","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","51991074810","DULOXETINE","CAP 60MG","90","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","49502039475","INSULIN GLAR","INJ 100U\/ML","15","Select","Select",""],["","00093216568","NALOXONE HCL","SPR ","2","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","65862001005","METFORMIN","TAB 1000MG","60","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","67877069601","CHLORTHALID","TAB 25MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","9","Select","Select",""],["","49483048110","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","08222440006","ULTICARE","PAD ALCOHOL","100","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","08489831510","PEN NEEDLES","MIS 32GX4MM","100","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00955172805","INSULIN GLARGINE SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","53885004401","ONETOUCH VERIO FLEX METER","","100","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","08271036100","LANCETS ULTRA THIN","26 GAUGE","100","Select","Select",""],["","65862017760","CEFDINIR","300 MG","6","Select","Select",""],["","00002822259","INSULIN LISPRO KWIKPEN U-","100 100\/ML","15","Select","Select",""],["","65862020299","LOSARTAN POTASSIUM","50 MG","90","Select","Select",""],["","53885024450","ONETOUCH ULTRA TEST STRIP","","50","Select","Select",""],["","53885004601","ONETOUCH ULTRA","2","1","Select","Select",""],["","86227013085","SURE COMFORT PEN NEEDLE","32GX 5\/32\"","200","Select","Select",""],["","57599080000","FREESTYLE LIBRE","2 SENSOR","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":""}]}]}