{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMANDA SMALLWOOD","gend":1,"add":"5764 HOLLAND ROAD","city":"SUFFOLK","state":"VA","zip":"23437-9998","dob":"1972-05-06","age":"","mstatus":"","insh":"1661501*01","cliId":"","pno":7579980320,"cno":7579980320,"email":"","ename":"","eno":"","pphy":"MUGAISI, HESED N MD","ppno":7577381375,"pcpadd":"148 BURNETTS WAY STE 107,","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23434-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours Suffolk Primary Care","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579346935,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K43.9","E11.65","I10.","E78.5","E66.01","Z68.35","K59.00","E66.3","R10.84","E11.43","K31.84","E11.40","F17.210","Z85.44","Z88.0","Z88.5","Z88.8","R10.9","R11.2","K52.9","R93.5","D72.829","K21.9","E66.9","F17.200","R51.9","Z20.822","D07.1","Z68.37","I05.8","J45.21","E11.21","Z68.38","Z72.0","F41.9","NO DATA","J41.1","E11.9","E78.00","Z79.4","Z79.899","Z79.51","Z79.82","R05.9","Z23.","B37.3","R21.","B37.0","F39.","F43.10","J02.0","J32.4","R00.2","K43.2","Z71.6","R19.7","K64.8","Z86.010","R10.30","K62.5","R07.9","E55.9","E07.9","R11.0","N64.4","R06.2","J02.9","Z09.","K31.89","R01.1","Z82.49","Z68.39","G43.009","R07.89","K64.4","C67.9","R14.3","Z90.710","K63.5","E86.0","G43.909","R55.","K64.0","A63.0"],"date":["2022-08-15","2023-07-05","2023-07-05","2022-03-01","2022-07-07","2021-02-23","2023-09-07","2023-07-19","2022-08-15","2023-09-01","2023-09-01","2023-09-01","2023-09-01","2022-08-15","2022-08-15","2022-08-15","2022-08-15","2021-09-16","2023-07-19","2021-11-18","2021-09-29","2022-01-11","2023-07-19","2023-07-05","2023-07-19","2022-08-15","2022-08-15","2022-03-01","2022-03-03","2022-01-18","2022-03-01","2022-03-01","2022-07-07","2022-03-01","2022-03-01","2022-03-01","2022-07-13","2022-07-13","2022-07-13","2022-07-13","2022-07-13","2022-07-13","2022-07-13","2022-07-13","2021-10-26","2022-01-11","2021-10-26","2021-10-26","2022-01-11","2021-03-23","2022-01-11","2022-01-11","2022-07-07","2021-06-11","2022-07-07","2023-07-19","2022-06-27","2023-08-14","2023-07-05","2021-02-04","2022-07-07","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2021-09-20","2021-09-20","2021-11-18","2022-01-06","2022-03-03","2023-07-05","2023-05-03","2023-05-03","2023-07-19","2023-07-05","2023-07-05","2023-07-05","2023-08-14","2023-09-01","2023-09-01","2023-09-01","2023-09-07","2023-09-07"],"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":[["","53885000810","ONETOUCH DEL","MIS PLUS 33G","200","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","00069046956","CHANTIX","TAB 1MG","56","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","30","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","60","Select","Select",""],["","00456120230","LINZESS","290 MCG","90","Select","Select",""],["","45802047253","HC PRAMOXINE","CRE 2.5-1%","48","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","60","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","200","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","08290320109","BD PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","00378827052","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","68180097903","LISINOPRIL","40 MG","90","Select","Select",""],["","70377002711","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","120","Select","Select",""],["","68382003416","VENLAFAXINE","CAP 37.5 ER","90","Select","Select",""],["","65649000330","TRULANCE","TAB 3MG","90","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","59310057922","PROAIR HFA","AER ","17","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","18","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","67877075560","DRONABINOL","CAP 10MG","60","Select","Select",""],["","16571041250","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","51672126303","NYSTAT\/TRIAM","CRE ","60","Select","Select",""],["","00121086802","NYSTATIN","SUS 100000","60","Select","Select",""],["","00169750111","NOVOLOG","INJ 100\/ML","30","Select","Select",""],["","51672200306","CLOTRIMAZOLE","CRE 1% VAG","45","Select","Select",""],["","49884015676","VARENICLINE","TAB 1MG","60","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","20","Select","Select",""],["","64764017530","DEXILANT","CAP 60MG DR","30","Select","Select",""],["","62088000036","INPEN 100NN","MIS PINK","1","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","73070010215","INSULIN ASPA","INJ PENFILL","15","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","65702028810","FASTCLIX","MIS LANCETS","102","Select","Select",""],["","56151060101","KETONE","TES ","100","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","65702071210","ACCU-CHEK","TES GUIDE","100","Select","Select",""],["","08373081311","ADULT MASK","MIS LARGE","2","Select","Select",""],["","08373747800","OPTICHAMBER","MIS DIAMOND","1","Select","Select",""],["","23155013525","DOXYCYC MONO","TAB 100MG","20","Select","Select",""],["","72065012112","GVOKE HYPO 2","INJ 1MG\/.2ML","0","Select","Select",""],["","69842005767","CVS MUCUS DM","TAB 30-600MG","20","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","12","Select","Select",""],["","63824005632","MUCINEX DM","TAB 30-600ER","20","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN","100\/ML (3)","15","Select","Select",""],["","65862085901","FAMOTIDINE","20 MG","28","Select","Select",""],["","70377002711","ATORVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","00378668910","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","76385012450","METHOCARBAMOL","750 MG","14","Select","Select",""],["","00603188016","LIDOCAINE","5 %","21","Select","Select",""],["","85001599439",""," ","2","Select","Select",""],["","65702071210","ACCU-CHEK GUIDE TEST STRIP","","300","Select","Select",""],["","68180097903","LISINOPRIL TAB","40MG","90","Select","Select",""],["","62088000036","INPEN","100NN MIS PINK","1","Select","Select",""],["","80777027399","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","68180016011","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","00169633910","NOVOLOG INJ FLEXPEN","","15","Select","Select",""],["","70710113908","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","00456120230","LINZESS CAP","290MCG","60","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","10","Select","Select",""],["","56151060101","KETONE TES","","100","Select","Select",""],["","65702071210","ACCU-CHEK TES GUIDE","","100","Select","Select",""],["","65702028810","FASTCLIX MIS LANCETS","","102","Select","Select",""],["","00169750111","NOVOLOG INJ","100\/ML","30","Select","Select",""],["","72065012112","GVOKE HYPO","2 INJ 1MG\/.2ML","0","Select","Select",""],["","00378668910","PANTOPRAZOLE TAB","40MG","90","Select","Select",""],["","00093220401","METOCLOPRAM TAB","5MG","120","Select","Select",""],["","08373081311","ADULT MASK MIS LARGE","","2","Select","Select",""],["","59310057922","PROAIR HFA AER","","17","Select","Select",""],["","00378064110","PREDNISONE TAB","10MG","18","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","17","Select","Select",""],["","23155013525","DOXYCYC MONO TAB","100MG","20","Select","Select",""],["","08373747800","OPTICHAMBER MIS DIAMOND","","1","Select","Select",""],["","00378827052","ALBUTEROL NEB","0.083%","75","Select","Select",""],["","70377002711","ATORVASTATIN TAB","10MG","90","Select","Select",""],["","68382003416","VENLAFAXINE CAP","37.5 ER","90","Select","Select",""],["","45802047253","HC PRAMOXINE CRE","2.5-1%","48","Select","Select",""],["","65162074510","PROMETHAZINE TAB","12.5MG","12","Select","Select",""],["","63824005632","MUCINEX DM TAB","30-600ER","20","Select","Select",""],["","69842005767","CVS MUCUS DM TAB","30-600MG","20","Select","Select",""],["","27241009903","DULOXETINE CAP","60MG","30","Select","Select",""],["","00121086802","NYSTATIN SUS","100000","60","Select","Select",""],["","16571041250","CIPROFLOXACN TAB","500MG","10","Select","Select",""],["","00574709012","HYDROCORTISONE ACETATE","25 MG","7","Select","Select",""],["","54092054701","MOTEGRITY","2 MG","90","Select","Select",""],["","55566680001","CLENPIQ","10-3.5\/175","350","Select","Select",""],["","00093220401","METOCLOPRAMIDE HCL","5 MG","120","Select","Select",""],["","00143122701","DICYCLOMINE HCL","20 MG","30","Select","Select",""],["","68382003416","VENLAFAXINE HCL ER","37.5 MG","90","Select","Select",""],["","63000044515","GUARDIAN","4 TRANSMITTER","1","Select","Select",""],["","53746010901","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","20","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":""}]}]}