{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TOYA LARRYMORE","gend":1,"add":"600 HUNTERS BRIDGE DR","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1971-03-22","age":"","mstatus":"","insh":"20030901*01","cliId":"","pno":7577764331,"cno":7577764331,"email":"","ename":"","eno":"","pphy":"RAMSEY, KRISTIN D DO","ppno":7574104488,"pcpadd":"1024 S BATTLEFIELD BLVD,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23322-9998","pcpcounty":"","pcpid":"","pcpname":"Princess Anne Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574104450,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J30.1","N39.41","R47.81","R26.81","B20.","D63.8","E11.9","H69.83","I10.","H80.90","J30.89","J32.9","E04.9","F81.9","H90.6","K21.9","R05.","E04.1","J01.90","M25.562","M17.12","R68.89","R26.89","M25.662","R00.2","N32.81","N39.3","R35.1","I48.0","E03.9","R33.9","R79.89","Z12.11","R13.10","K30.","G44.209","R12.","M76.891","M17.11","R06.83","R03.0","Z23.","M17.0","N17.9","E11.65","E86.0","R00.0","R07.89","R06.00","E87.6","R07.9","D64.9","R53.83","J45.909","J45.40","Z21.","Z11.3","G47.00","E55.9","J30.2","E07.9","G47.30","F84.5","F41.9","Z79.84","Z79.899","Z79.51","Z88.0","Z00.00","Z20.822","M25.561","E66.9","Z68.31","Z13.220","G57.90","M25.511","G72.9","J98.4","R42.","R82.998","R29.898","R29.818","E78.00","G47.19","F70.","R11.0","R32.","E87.5","I12.9","N18.6","Z99.2","T82.868A","I38.","I42.9","Z86.59","H35.033","H25.13","H52.13","N39.0","R31.9","I95.9","J84.9","Z13.31","R91.8","E11.40","R27.0","R41.82","Z71.3","Z79.85","M54.2","H25.12","H25.11"],"date":["2023-09-26","2023-08-06","2023-08-06","2023-08-06","2023-05-05","2023-05-05","2023-05-12","2021-08-25","2023-05-15","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2021-08-25","2023-05-15","2021-08-25","2023-05-15","2023-05-15","2022-06-02","2022-06-02","2022-06-02","2022-05-05","2022-05-05","2022-11-22","2023-01-30","2023-01-30","2022-05-27","2022-09-29","2022-11-01","2023-01-30","2023-03-06","2023-02-09","2022-06-14","2021-02-26","2021-03-16","2021-03-16","2021-09-17","2021-09-17","2021-09-21","2021-09-20","2022-11-01","2022-04-19","2022-05-14","2023-03-06","2022-05-14","2022-05-26","2022-11-22","2022-08-16","2022-08-16","2022-08-16","2023-03-06","2022-11-01","2022-11-01","2023-04-28","2022-11-08","2023-02-01","2021-09-21","2021-10-04","2022-11-14","2022-05-13","2022-05-13","2022-05-13","2022-05-13","2023-05-12","2022-05-13","2022-05-13","2022-05-13","2021-05-14","2022-11-08","2021-02-05","2021-07-27","2021-07-27","2023-02-01","2021-10-04","2022-04-06","2023-04-28","2023-04-28","2023-08-22","2023-03-06","2023-05-04","2023-05-04","2023-03-06","2021-09-21","2021-04-09","2021-07-14","2021-11-08","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2021-11-22","2022-04-22","2023-07-28","2023-05-12","2022-08-31","2022-08-31","2022-11-22","2023-02-22","2022-06-24","2023-04-28","2023-08-22","2023-08-22","2023-06-01","2023-05-10","2023-05-10","2023-08-21","2023-08-03","2023-08-24"],"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":[["","16714097901","ESOMEPRA MAG","CAP 20MG DR","30","Select","Select",""],["","00469260230","MYRBETRIQ","50 MG","30","Select","Select",""],["","00574011830","TROSPIUM CHL","CAP 60MG ER","30","Select","Select",""],["","00378180077","LEVOTHYROXIN","TAB 25MCG","30","Select","Select",""],["","45802065065","LORATADINE","TAB 10MG","30","Select","Select",""],["","68382080605","TRAZODONE","TAB 100MG","30","Select","Select",""],["","80681016900","VITAMIN D3","TAB 25MCG","60","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","61958250101","BIKTARVY","50-200-25","30","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","50","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","00169266015","TRESIBA FLEX","INJ 100UNIT","15","Select","Select",""],["","00006027731","JANUVIA","100 MG","30","Select","Select",""],["","70010006510","METFORMIN","TAB 1000MG","60","Select","Select",""],["","50228015801","CELECOXIB","CAP 200MG","30","Select","Select",""],["","65862039110","ONDANSETRON","TAB 8MG ODT","90","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","99073013001","FREESTYLE","MIS LANCETS","100","Select","Select",""],["","00002143380","TRULICITY","0.75MG\/0.5","2","Select","Select",""],["","00172208380","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","43547035310","LISINOPRIL","10 MG","30","Select","Select",""],["","10631000830","KAPSPARGO","CAP 25MG","30","Select","Select",""],["","16714085201","METOPROL SUC","TAB 25MG ER","30","Select","Select",""],["","50228042830","SOLIFENACIN","TAB 10MG","30","Select","Select",""],["","16714043901","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00186037220","SYMBICORT","80-4.5 MCG","10.2","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","69238106901","POT CHLORIDE","TAB 20MEQ ER","30","Select","Select",""],["","00310737220","BUDESONIDE-FORMOTEROL FUMARATE","80-4.5 MCG","10.2","Select","Select",""],["","53885026701","ONETOUCH VERIO IQ METER","","1","Select","Select",""],["","70710116101","MECLIZINE HCL","12.5 MG","30","Select","Select",""],["","69238106901","POTASSIUM CHLORIDE","20 MEQ","30","Select","Select",""],["","60505257909","ATORVASTATIN CALCIUM","20 MG","30","Select","Select",""],["","00193725201","CONTOUR NEXT EZ","","1","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","16714085201","METOPROLOL SUCCINATE","25 MG","30","Select","Select",""],["","65702072910","ACCU-CHEK GUIDE MONITOR SYSTEM","","1","Select","Select",""],["","99073070914","FREESTYLE FREEDOM LITE","","1","Select","Select",""],["","53885004601","ONETOUCH ULTRA","2","1","Select","Select",""],["","56151149002","TRUE METRIX AIR GLUCOSE METER","","1","Select","Select",""],["","53885027150","ONETOUCH VERIO TEST STRIP","","50","Select","Select",""],["","00172208380","HYDROCHLOROTHIAZIDE","25 MG","30","Select","Select",""],["","00591363630","TROSPIUM CHLORIDE ER","60 MG","30","Select","Select",""],["","23155010410","METFORMIN HCL","1000 MG","60","Select","Select",""],["","54629005024","VITAMIN D","3 25 MCG","60","Select","Select",""],["","57599000101","FREESTYLE LIBRE","14 DAY SENSOR","2","Select","Select",""],["","65702073110","ACCU-CHEK GUIDE ME GLUCOSE MTR","","1","Select","Select",""],["","53885004401","ONETOUCH VERIO FLEX METER","","1","Select","Select",""],["","08627001401","DEXCOM G","5 TRANSMITTER","1","Select","Select",""],["","53885065701","ONETOUCH VERIO METER","","1","Select","Select",""],["","53885014301","ONETOUCH DELICA","33 GAUGE","100","Select","Select",""],["","50228042830","SOLIFENACIN SUCCINATE","10 MG","30","Select","Select",""],["","53885092701","ONETOUCH VERIO REFLECT METER","","1","Select","Select",""],["","00093645156","ESOMEPRAZOLE MAGNESIUM","40 MG","30","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","68180096501","LEVOTHYROXINE SODIUM","25 MCG","30","Select","Select",""],["","16714097901","ESOMEPRA MAG CAP","20MG DR","30","Select","Select",""],["","00469260230","MYRBETRIQ TAB","50MG","30","Select","Select",""],["","00006027731","JANUVIA TAB","100MG","30","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","00591363630","TROSPIUM CHL CAP","60MG ER","30","Select","Select",""],["","53885027150","ONETOUCH TES VERIO","","50","Select","Select",""],["","68382005101","MELOXICAM TAB","15MG","30","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","8","Select","Select",""],["","45802065065","LORATADINE TAB","10MG","30","Select","Select",""],["","70010006510","METFORMIN TAB","1000MG","60","Select","Select",""],["","00378180077","LEVOTHYROXIN TAB","25MCG","30","Select","Select",""],["","61958250101","BIKTARVY TAB","","30","Select","Select",""],["","57599000101","FREESTYLE KIT SENSOR","","2","Select","Select",""],["","57599000200","FREESTYLE MIS READER","","1","Select","Select",""],["","99073013001","FREESTYLE MIS LANCETS","","100","Select","Select",""],["","16714085201","METOPROL SUC TAB","25MG ER","30","Select","Select",""],["","00172208380","HYDROCHLOROT TAB","25MG","30","Select","Select",""],["","99073071499","FREESTYLE KIT FREEDOM","","1","Select","Select",""],["","43547035311","LISINOPRIL TAB","10MG","30","Select","Select",""],["","00002143380","TRULICITY INJ","0.75\/0.5","2","Select","Select",""],["","53885092701","ONETOUCH KIT VERIO RE","","1","Select","Select",""],["","69238106901","POT CHLORIDE TAB","20MEQ ER","30","Select","Select",""],["","50228042830","SOLIFENACIN TAB","10MG","30","Select","Select",""],["","10631000830","KAPSPARGO CAP","25MG","30","Select","Select",""],["","16714043901","NITROFURANTN CAP","100MG","10","Select","Select",""],["","31722072610","MONTELUKAST TAB","10MG","30","Select","Select",""],["","00186037220","SYMBICORT AER","80-4.5","10","Select","Select",""],["","00310737220","BUDES\/FORMOT AER","80-4.5","10","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","00832141003","MOXIFLOXACIN","0.5 %","3","Select","Select",""],["","60758011905","PREDNISOLONE ACETATE","1 %","5","Select","Select",""],["","60758077305","KETOROLAC TROMETHAMINE","0.4 %","5","Select","Select",""],["","00487990401","ALBUTEROL SULFATE","1.25MG\/3ML","360","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":""}]}]}