{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CHARLENE WALLACE","gend":1,"add":"3800 KECOUGHTAN RD APT B","city":"HAMPTON","state":"VA","zip":"23669-9998","dob":"1951-08-16","age":"","mstatus":"","insh":"20036834*01","cliId":"","pno":7572247790,"cno":7572247790,"email":"","ename":"","eno":"","pphy":"LUSTIG, MICHAEL R MD","ppno":7575943800,"pcpadd":"10510 JEFFERSON AVENUE STE A,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23601-9998","pcpcounty":"","pcpid":"","pcpname":"Riverside Brentwood Medical Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575943818,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K92.2","I63.9","I65.21","H54.61","I63.50","M62.81","I69.30","I65.29","I25.10","H54.7","B18.2","I65.23","G57.93","F17.210","Z79.82","H47.011","H25.813","H52.203","H52.4","I51.7","I45.81","R55.","I10.","E78.5","I69.351","K25.4","N39.0","D62.","Z68.1","K29.71","Z20.822","K21.9","K80.20","K44.9","R13.10","M1A.9XX0","R63.4","I25.2","I63.411","I69.398","H53.40","E78.00","M10.9","M06.9","Z72.0","E44.0","I63.40","G47.9","H53.9","G81.91","R07.9","R47.1","E04.1","I12.9","R29.810","N18.2","M25.572","D50.0","N18.9","D50.9","R53.83","Z95.818","I25.83","S09.90XA","I63.412","I82.611","R63.6","R29.704","NO DATA","D64.9","R00.1","E11.22","R70.0","Z86.73","M05.9","Z01.818","J45.909","M25.562","Z28.21","Z12.31","R14.1","K92.1","K25.7","K29.40","R53.1","R51.9","E11.9","I67.89","I20.0","M79.89","M79.669","Q21.1","I48.0","M25.472","L08.9","Z53.20","J31.0","H53.8","R09.89","R52.","Z23.","R03.0","R42.","R35.89","Z86.19","K92.0","R94.39","Z95.5","Z87.891","Z79.02","N30.00","R79.89","Z88.0","Z88.2","Z88.4","Z88.8","B96.89","B99.9","Z79.899","H47.20","I47.1","Q21.12","I63.231","E43.","R29.701","Z87.442","Z88.1","E11.51","S00.03XA","Z79.51","H47.291","H35.371","H04.123","I95.2","N17.9","D63.1","D72.829","Z78.0","D25.9","F32.2","I95.9","F32.5","R94.31","N95.0","N30.90","I35.8","R01.1"],"date":["2022-07-14","2023-07-18","2023-04-26","2022-06-01","2022-06-03","2022-06-03","2022-06-05","2022-10-27","2023-07-18","2022-09-20","2022-08-15","2023-04-04","2022-10-10","2023-04-26","2022-12-15","2023-04-25","2023-08-25","2023-04-25","2023-04-25","2022-10-27","2022-10-27","2023-07-18","2023-07-18","2023-03-24","2022-10-28","2022-05-20","2022-06-04","2022-05-20","2022-10-27","2022-05-20","2022-05-20","2022-08-15","2022-05-20","2022-05-20","2022-05-20","2022-07-14","2023-07-14","2022-12-15","2022-05-30","2022-06-09","2022-06-03","2022-08-15","2023-03-09","2022-06-03","2022-06-03","2022-07-14","2022-06-03","2022-06-09","2022-06-09","2022-06-09","2022-06-13","2022-06-22","2022-06-22","2023-07-17","2022-06-22","2022-07-14","2022-08-15","2022-10-31","2023-07-17","2023-03-16","2023-03-16","2023-07-18","2023-03-16","2022-10-27","2022-06-11","2022-06-15","2022-10-27","2022-06-11","2022-06-16","2022-06-13","2023-07-18","2022-12-15","2022-07-06","2023-03-09","2022-07-06","2023-09-14","2021-12-03","2021-12-03","2021-12-03","2021-12-03","2021-12-03","2022-05-20","2022-05-20","2022-05-20","2022-06-15","2022-06-15","2022-06-15","2022-06-16","2022-06-10","2022-08-05","2022-06-18","2022-06-18","2022-12-15","2022-08-15","2022-08-15","2022-08-15","2022-08-15","2022-08-15","2022-10-07","2022-10-27","2023-03-09","2022-08-05","2023-07-17","2022-11-23","2022-11-23","2022-05-20","2022-06-13","2023-07-18","2022-10-27","2023-03-24","2022-04-04","2022-04-04","2022-05-30","2022-04-04","2022-04-04","2022-04-04","2022-05-20","2022-06-04","2023-03-24","2022-09-20","2023-03-24","2023-03-24","2022-05-30","2022-05-30","2022-05-30","2022-05-30","2022-05-30","2022-12-15","2022-12-15","2022-12-15","2023-08-25","2023-08-25","2023-08-25","2022-10-27","2023-07-18","2022-10-27","2022-10-27","2023-07-17","2023-07-17","2023-07-14","2023-07-16","2023-09-01","2023-07-17","2023-09-15","2023-07-16","2023-07-17","2023-07-17"],"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":[["","68645051654","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","31722070090","LOSARTAN POT","TAB 25MG","30","Select","Select",""],["","80681007600","MULTIVITAMIN","TAB ","30","Select","Select",""],["","00143301810","COLCHICINE","CAP 0.6MG","30","Select","Select",""],["","45802005505","TRIAMCINOLON","OIN 0.001","75","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","90","Select","Select",""],["","81131031282","D3","CAP 2000UNIT","30","Select","Select",""],["","16714057601","ALLOPURINOL","100 MG","60","Select","Select",""],["","31722053301","METHOCARBAM","TAB 500MG","120","Select","Select",""],["","80681013200","VITAMIN D","TAB 50MCG","30","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00173071920","FLOVENT HFA","110 MCG","12","Select","Select",""],["","16714029904","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","67877041790","VALSARTAN","TAB 160MG","30","Select","Select",""],["","49035015712","EQ ASPIRIN","TAB 325MG","30","Select","Select",""],["","00093505798","ATORVASTATIN","TAB 80MG","30","Select","Select",""],["","55111064530","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","68645059090","CLOPIDOGREL","75 MG","30","Select","Select",""],["","49483034001","ACETAMIN","TAB 325MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","21","Select","Select",""],["","54629041120","VITAMIN D3","TAB 2000UNIT","30","Select","Select",""],["","00904678480","ASPIRIN","TAB 325MG EC","30","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","59762330403","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","00904198260","MAPAP","TAB 325MG","30","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","12","Select","Select",""],["","50228017910","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","00093720110","PRAVASTATIN","TAB 20MG","30","Select","Select",""],["","49035049401","PAIN RELIEVR","TAB 500MG","100","Select","Select",""],["","49035056314","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","68645059459","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","00168020437","LIDOCAINE","OIN 0.05","35","Select","Select",""],["","59746017310","PREDNISONE","TAB 10MG","20","Select","Select",""],["","49035048482","ACETAMINOPHN","TAB 500MG","100","Select","Select",""],["","00904073431","TRIPLE ANTIB","OIN ","28","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","81131009371","SV IRON","TAB 325MG","30","Select","Select",""],["","68645051654","AMLODIPINE BESYLATE","10 MG","30","Select","Select",""],["","00093720110","PRAVASTATIN SODIUM","20 MG","30","Select","Select",""],["","68382056410","METOPROLOL SUCCINATE","25 MG","90","Select","Select",""],["","31722070290","LOSARTAN POTASSIUM","100 MG","90","Select","Select",""],["","49035056314","ASPIRIN EC","81 MG","30","Select","Select",""],["","53746051101","SPIRONOLACTONE","25 MG","30","Select","Select",""],["","68462063945","NITROGLYCERIN","0.4 MG","25","Select","Select",""],["","79854041125",""," ","30","Select","Select",""],["","00023917715","ALPHAGAN P","0.15 %","15","Select","Select",""],["","61314014405","BRIMONIDINE TARTRATE","0.15 %","15","Select","Select",""],["","37864074301","MULTIVITAMIN TAB DAILY","","30","Select","Select",""],["","31722070090","LOSARTAN POT TAB","25MG","30","Select","Select",""],["","31604002585","VITAMIN D CAP","2000UNIT","90","Select","Select",""],["","81131031282","D","3 CAP 2000UNIT","30","Select","Select",""],["","80681007600","MULTIVITAMIN TAB","","30","Select","Select",""],["","16714004107","ALLOPURINOL TAB","100MG","60","Select","Select",""],["","67877019890","AMLODIPINE TAB","5MG","30","Select","Select",""],["","67877041790","VALSARTAN TAB","160MG","30","Select","Select",""],["","59267100001","PFIZER VACC INJ COVID-","19","0","Select","Select",""],["","68645056259","IBUPROFEN TAB","600MG","90","Select","Select",""],["","00173071920","FLOVENT HFA AER","110MCG","12","Select","Select",""],["","42806040021","METHYLPRED TAB","4MG","21","Select","Select",""],["","31722053301","METHOCARBAM TAB","500MG","120","Select","Select",""],["","51672128401","TRIAMCINOLON OIN","0.1%","60","Select","Select",""],["","55111064530","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","55111018015","TIZANIDINE TAB","4MG","90","Select","Select",""],["","49035041690","EQ ASPIRIN TAB","325MG","30","Select","Select",""],["","00904678480","ASPIRIN TAB","325MG EC","30","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","67877021905","CEPHALEXIN CAP","500MG","20","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","12","Select","Select",""],["","59762330403","NITROGLYCERN SUB","0.4MG","25","Select","Select",""],["","68462015713","ONDANSETRON TAB","4MG ODT","20","Select","Select",""],["","00904073431","TRIPLE ANTIB OIN","","28","Select","Select",""],["","00093505798","ATORVASTATIN TAB","80MG","30","Select","Select",""],["","38485012041","MULTIVITAMIN CAP","","100","Select","Select",""],["","68645059090","CLOPIDOGREL TAB","75MG","30","Select","Select",""],["","49035056314","ASPIRIN LOW TAB","81MG EC","30","Select","Select",""],["","49035049401","PAIN RELIEVR TAB","500MG","100","Select","Select",""],["","80681013200","VITAMIN D TAB","50MCG","30","Select","Select",""],["","49483034001","ACETAMIN TAB","325MG","30","Select","Select",""],["","50228017910","GABAPENTIN CAP","100MG","90","Select","Select",""],["","00904198260","MAPAP TAB","325MG","30","Select","Select",""],["","00093720110","PRAVASTATIN TAB","20MG","30","Select","Select",""],["","49035048482","ACETAMINOPHN TAB","500MG","100","Select","Select",""],["","00168020437","LIDOCAINE OIN","5%","35","Select","Select",""],["","68645059459","FAMOTIDINE TAB","20MG","60","Select","Select",""],["","59746017310","PREDNISONE TAB","10MG","20","Select","Select",""],["","81131009371","SV IRON TAB","325MG","30","Select","Select",""],["","00904759180","FEROSUL TAB","325MG","30","Select","Select",""],["","29300022705","METRONIDAZOLE","500 MG","14","Select","Select",""],["","68382009810","PAROXETINE HCL","20 MG","30","Select","Select",""],["","49483069901","ACETAMINOPHEN ER","650 MG","30","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":""}]}]}