{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THERESA  M ROBERTS-SPRUILL","gend":1,"add":"222 W 34TH ST APT A","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1968-05-10","age":"","mstatus":"","insh":"20034124*01","cliId":"","pno":7577387590,"cno":7577387590,"email":"","ename":"","eno":"","pphy":"LATIMER, KELLY M MD","ppno":7574465955,"pcpadd":"825 FAIRFAX AVE STE 118","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23507-9998","pcpcounty":"","pcpid":"","pcpname":"EVMS Ghent Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574465196,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I11.0","I50.43","I50.23","E11.9","I10.","I63.9","G92.","I47.1","I47.2","I50.22","R53.1","E66.09","Z68.34","T50.905A","Z79.4","Z79.82","Z80.0","Z80.1","Z82.3","Z82.49","Z87.891","I49.3","I49.1","I50.9","J30.9","Z86.73","E11.40","L60.2","M79.675","M79.674","I50.20","N17.9","E11.65","R04.0","E78.5","M25.571","I08.0","I69.328","Z79.84","I13.0","I69.351","Z68.43","Z83.3","Z82.61","NO DATA","N18.9","R32.","R10.9","S82.831A","S89.301A","Z87.39","R23.8","R50.9","Z20.822","I69.331","I50.42","E11.22","N18.30","I25.10","I69.392","I47.9","I45.10","E66.9","D50.0","G40.909","Z68.41","I45.2","R09.02","V58.69","J30.2","R06.89","I50.21","R26.89","B37.3","Z91.14","Z76.0","H40.023","Z91.199","E83.9","M89.9","E66.3","E16.2","L90.0","E55.9","E61.1","D47.2","R06.02","I21.4","G47.33","Z68.33","Z79.899","G81.91","R26.9","R13.12","E66.01","E11.8","M25.511","M62.81","I69.90","R07.9","I42.9","I69.391","R13.10","I69.322","Z68.39","J81.0","R39.81","E65.","J96.01","I16.1","I63.02","H35.033","H52.4","R73.09","R11.2","R77.8","R50.81","E08.8","R06.00","R73.9","L60.3","I25.2","M70.21","M25.562","R94.31","N89.8","Z92.82","R29.898","R10.11","Z90.49","N90.89","L89.319","I12.9","R11.0","R53.83","R53.81","R35.0","Z53.20","E87.70","K92.0","M76.892","I77.810","M25.521","Z91.19","M79.672","M79.89","E11.42","I69.354","R52."],"date":["2022-05-14","2021-03-17","2021-11-23","2023-04-14","2023-04-14","2021-04-14","2021-03-24","2021-08-30","2021-11-19","2023-01-10","2021-03-24","2021-11-19","2021-03-26","2021-03-24","2023-02-22","2022-05-14","2022-01-08","2022-01-08","2022-01-08","2022-06-05","2023-04-04","2021-11-19","2021-05-03","2022-08-16","2021-05-21","2022-10-09","2023-03-07","2021-05-27","2022-02-24","2022-02-24","2022-12-09","2022-03-02","2023-02-22","2022-03-02","2023-02-22","2022-05-29","2021-11-22","2022-08-12","2022-10-09","2022-01-08","2022-05-14","2022-01-08","2022-10-09","2022-01-08","2023-03-15","2022-08-16","2023-01-30","2022-05-14","2022-05-28","2022-05-28","2022-05-28","2022-08-11","2021-03-18","2021-03-18","2021-06-04","2021-06-04","2022-06-05","2021-06-04","2023-01-10","2021-11-19","2021-06-04","2021-11-23","2022-08-11","2021-11-19","2021-11-19","2021-06-04","2021-11-19","2021-08-30","2021-08-30","2021-11-19","2021-11-19","2021-11-21","2021-11-22","2022-08-12","2022-08-16","2022-08-12","2022-11-21","2023-01-10","2023-03-15","2023-03-15","2023-03-15","2022-06-05","2022-06-21","2023-02-22","2023-03-15","2023-03-15","2021-11-19","2021-02-26","2021-03-17","2021-03-17","2022-05-14","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2021-06-21","2021-06-21","2021-03-17","2021-11-19","2021-04-02","2021-04-02","2021-04-02","2021-04-02","2021-05-03","2023-04-14","2021-02-26","2021-05-02","2021-05-02","2021-05-02","2022-09-08","2022-09-08","2022-10-08","2022-10-09","2021-02-04","2021-03-17","2021-03-24","2021-11-19","2022-06-05","2022-02-24","2021-11-19","2022-05-04","2022-05-04","2022-05-04","2022-08-11","2021-03-24","2021-03-24","2022-05-14","2022-05-14","2022-06-05","2022-06-05","2022-06-05","2022-06-05","2022-06-05","2022-06-05","2022-06-05","2022-06-05","2021-11-19","2022-01-08","2022-05-04","2022-05-04","2022-05-04","2022-06-14","2023-04-04","2023-04-04","2023-04-04","2023-04-04","2023-04-04"],"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":[["","50458014090","INVOKANA","TAB 100MG","30","Select","Select",""],["","68462016405","CARVEDILOL","12.5 MG","90","Select","Select",""],["","69315011710","FUROSEMIDE","TAB 40MG","90","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","47335030688","METFORMIN","TAB 1000 ER","30","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","90","Select","Select",""],["","42799012001","BUMETANIDE","TAB 1MG","30","Select","Select",""],["","68180063802","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","68462063945","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","30","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","00088502005","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","00088222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","00904679480","ASPIRIN LOW","CHW 81MG","30","Select","Select",""],["","00228202950","ALPRAZOLAM","TAB 0.5MG","10","Select","Select",""],["","62559015730","POLYETH GLYC","POW 3350 NF","30","Select","Select",""],["","00536100836","ASPIRIN","CHW 81MG","90","Select","Select",""],["","60258017101","MAG OXIDE","TAB 400MG","30","Select","Select",""],["","08290320122","BD PEN NEEDL","MIS 32GX4MM","90","Select","Select",""],["","68180033707","METFORMIN ER","TAB 1000MG","180","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00310621030","FARXIGA","10 MG","30","Select","Select",""],["","16729022517","SPIRONOLACT","TAB 25MG","15","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","30","Select","Select",""],["","68382013510","LOSARTAN POT","TAB 25MG","30","Select","Select",""],["","00078065920","ENTRESTO","TAB 24-26MG","60","Select","Select",""],["","00904759180","FEROSUL","TAB 325MG","30","Select","Select",""],["","00002143480","TRULICITY","1.5 MG\/0.5","4","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","53885019401","ONETOUCH","KIT VERIO FL","1","Select","Select",""],["","68180033801","METFORMIN ER GASTRIC","500 MG","60","Select","Select",""],["","29300039810","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","08290320883","ULTRA-FINE NANO PEN NEEDLE","32GX 5\/32\"","100","Select","Select",""],["","53885027150","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","100","Select","Select",""],["","53885065701","ONETOUCH VERIO METER","","1","Select","Select",""],["","43598083305","ATORVASTATIN CALCIUM","80 MG","90","Select","Select",""],["","53885092701","ONETOUCH VERIO REFLECT METER","","1","Select","Select",""],["","70010049105","METFORMIN HCL ER","500 MG","60","Select","Select",""],["","53885004401","ONETOUCH VERIO FLEX METER","","1","Select","Select",""],["","53885014301","ONETOUCH DELICA","33 GAUGE","200","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","60505009400","DOXAZOSIN MESYLATE","2 MG","90","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":""}]}]}