{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NATASHA M RAINEY","gend":1,"add":"4283 LLEWELLYN AVE APT 207","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1980-08-03","age":"","mstatus":"","insh":"1940989*01","cliId":"","pno":7573387448,"cno":7573387448,"email":"","ename":"","eno":"","pphy":"BRITT, CHARLENE MEBANE MD","ppno":7573636800,"pcpadd":"STE 100 816 INDEPENDENCE BLVD,","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23455-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Independence","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575079023,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R51.9","M54.2","R93.3","R10.84","I10.","E11.69","F43.23","E55.9","R22.2","N28.89","E11.59","E78.5","I15.2","J06.9","Z87.891","I16.0","R07.9","R77.8","R06.02","R79.89","E04.1","E66.01","F41.9","E11.9","G47.33","R05.9","R06.2","H92.01","F12.10","Z79.4","Z90.710","Z68.42","H10.45","Z23.","E11.29","R80.9","J18.9","Z20.822","I16.1","E78.00","I08.1","T78.3XXA","S00.521A","N30.00","E11.00","E11.65","H10.32","H25.13","H40.013","N39.0","B37.3","L68.0","R10.9","G44.209","Z09.","Z00.00","K21.9","K59.00","R10.30","F17.200","Z91.048","R35.0","M62.830","J02.0","Z20.828","F17.290","E66.9","Z87.440","M54.9","N76.2","M79.89","Z68.41","R73.9","H11.31","L02.91","R05.3","R06.83","R10.2","J10.1","NO DATA","R80.8"],"date":["2021-08-24","2021-08-24","2021-08-25","2021-08-25","2023-08-04","2021-08-25","2021-12-02","2021-08-25","2022-11-30","2021-08-25","2021-08-25","2023-04-14","2021-08-25","2022-09-28","2023-08-01","2021-12-09","2021-12-06","2021-12-06","2023-08-01","2023-08-01","2023-08-01","2023-08-01","2023-08-04","2023-09-01","2023-08-01","2023-08-01","2023-08-01","2023-08-01","2023-08-01","2023-08-01","2023-08-01","2023-08-01","2021-01-15","2022-11-30","2023-06-13","2023-06-13","2021-06-18","2023-04-03","2021-12-06","2021-12-02","2021-12-03","2022-08-05","2022-08-05","2023-02-28","2023-04-14","2023-04-14","2023-05-13","2023-09-01","2023-09-01","2023-03-22","2021-10-11","2022-11-30","2021-02-28","2022-09-05","2021-12-17","2022-06-30","2022-09-22","2023-02-11","2023-03-24","2023-03-24","2023-03-24","2023-03-24","2021-02-27","2023-04-03","2021-12-02","2023-03-22","2023-03-22","2023-03-22","2023-03-22","2021-06-26","2021-11-09","2021-12-06","2021-12-09","2022-01-13","2022-05-09","2022-11-02","2022-12-13","2023-03-24","2023-04-03","2023-04-03","2023-04-03"],"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":[["","57237000299","HYDROCHLOROT","CAP 12.5MG","90","Select","Select",""],["","68180097903","LISINOPRIL","40 MG","90","Select","Select",""],["","31722052101","HYDRALAZINE","TAB 50MG","90","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","29033003206","METFORMIN ER","TAB 1000MG","90","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","69097084805","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","00002318280","TRULICITY","4.5 MG\/0.5","2","Select","Select",""],["","00169368512","NOVOLOG MIX","INJ 70\/30","10","Select","Select",""],["","00002614511","BAQSIMI ONE","POW 3MG\/DOSE","1","Select","Select",""],["","27808023302","DOXYCYCL HYC","CAP 100MG","28","Select","Select",""],["","00002880359","HUMULIN","70\/30 KWIKPEN 70-30\/ML","15","Select","Select",""],["","57237000511","FLUCONAZOLE","150 MG","2","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","73070020011","INSULIN ASPA","INJ 70\/30","10","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","53885092701","ONETOUCH","KIT VERIO RE","1","Select","Select",""],["","00002614527","BAQSIMI TWO","POW 3MG\/DOSE","2","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","08290320119","BD PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","11917013481","LANCING","MIS DEVICE","1","Select","Select",""],["","70954005930","PREDNISONE","PAK 10MG","21","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","14","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","120","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","10","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE","5 MG","30","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","00955172805","INSULIN GLARGINE SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","00002822259","INSULIN LISPRO KWIKPEN U-","100 100\/ML","15","Select","Select",""],["","53885092701","ONETOUCH VERIO REFLECT METER","","1","Select","Select",""],["","29300012810","HYDROCHLOROTHIAZIDE","25 MG","30","Select","Select",""],["","70010049105","METFORMIN HCL ER","500 MG","348","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","43547028110","ESCITALOPRAM OXALATE","10 MG","30","Select","Select",""],["","08496311601","EASY-TOUCH INSULIN SYRINGE","31 GX5\/16\"","100","Select","Select",""],["","27808023302","DOXYCYCLINE HYCLATE","100 MG","14","Select","Select",""],["","61314062810","POLYMYXIN B SUL-TRIMETHOPRIM","10000-1\/ML","10","Select","Select",""],["","31722063231","OSELTAMIVIR PHOSPHATE","75 MG","10","Select","Select",""],["","43598083105","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","67877022005","CEPHALEXIN","250 MG","40","Select","Select",""],["","31722052001","HYDRALAZINE HCL","25 MG","90","Select","Select",""],["","68382005005","MELOXICAM","7.5 MG","14","Select","Select",""],["","08290320109","ULTRA-FINE SHORT PEN NEEDLE","31 GX5\/16\"","100","Select","Select",""],["","60432046400","LIDOCAINE HCL VISCOUS","2 %","100","Select","Select",""],["","00143992801","CIPROFLOXACIN HCL","500 MG","10","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","31722072690","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","47781030301","NITROFURANTOIN MONO-MACRO","100 MG","10","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":""}]}]}