{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHANTE A WHITEHURST","gend":1,"add":"439 MANOR RD APT 16","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1983-06-05","age":"","mstatus":"","insh":"20037302*01","cliId":"","pno":7579983556,"cno":7579983556,"email":"","ename":"","eno":"","pphy":"AMES, MELANIE R NP","ppno":7575944111,"pcpadd":"12 BRUTON AVENUE","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23601-9998","pcpcounty":"","pcpid":"","pcpname":"Bruton Avenue Family Practice","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575944115,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.9","F25.0","N17.9","E11.22","N18.9","R65.10","R06.02","R00.0","R94.31","N17.0","E87.0","E87.2","M32.9","E11.9","M06.9","F12.10","E86.0","K52.9","Z78.1","F17.210","Z88.0","Z91.19","F43.12","F70.","R07.9","F31.64","Z00.00","Z23.","R53.81","R11.2","F25.9","F20.9","Z09.","Z87.448","R82.81","E87.1","R80.8","R31.29","F06.8","N28.9","R10.31","R41.82","A41.9","R65.20","E11.65","E87.6","E83.52","R79.89","R74.8","G93.41","I24.8","Z20.822","T43.595A","N30.90","R79.1","I11.9","R56.9","I49.9","R10.12","E83.51","Z79.84","F79.","N39.0","J45.909","Z02.2","R11.0","R11.10","R77.8","R53.1","I95.9","F23.","I21.4","F31.2","R11.15","R10.30","Z79.899","Z87.891","R10.816","NO DATA","Z91.010","R09.81","T40.7X1A","F29.","Z53.21","I44.4","I45.81","J45.41","Z68.21","R63.4","D72.829","R80.9","K21.9","Z87.440","Z87.442","I51.7","E83.39","Z99.2","G40.909","N20.2","E87.8","E87.5","N25.89","N20.0","E11.29","R05.1","R10.84"],"date":["2021-01-02","2022-09-02","2023-04-04","2022-10-16","2022-10-16","2022-09-02","2022-12-23","2023-04-01","2022-09-01","2022-09-02","2023-04-01","2022-09-02","2023-04-22","2023-04-01","2023-04-01","2023-04-01","2023-04-01","2022-09-02","2022-09-02","2023-04-22","2022-12-27","2022-09-02","2022-09-02","2022-09-02","2022-10-16","2023-04-01","2021-12-21","2021-12-21","2021-11-11","2023-04-22","2022-10-18","2023-04-22","2022-09-07","2022-09-07","2022-09-07","2022-10-17","2022-10-17","2022-10-17","2022-12-23","2022-12-27","2021-01-03","2022-04-13","2023-04-01","2023-04-01","2022-04-12","2023-04-04","2022-04-12","2022-07-08","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-04-13","2022-05-23","2022-05-25","2023-04-03","2022-06-08","2023-04-01","2022-07-06","2022-10-13","2022-10-13","2022-10-13","2022-04-13","2023-04-22","2022-09-02","2021-06-21","2022-04-11","2022-10-12","2022-12-23","2022-12-23","2022-12-27","2022-12-23","2022-12-27","2023-04-04","2022-12-27","2022-12-27","2021-01-02","2021-08-18","2021-11-11","2022-04-12","2022-04-12","2022-07-08","2022-07-08","2022-07-08","2022-08-31","2022-10-16","2022-10-16","2022-10-16","2023-04-22","2022-04-11","2023-04-03","2023-04-01","2023-04-01","2023-04-01","2023-04-01","2023-04-04","2023-04-03","2023-04-03","2023-04-03","2023-04-22","2023-04-22"],"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":[["","65862018730","ONDANSETRON","TAB 4MG","15","Select","Select",""],["","69784018014","POLYETH GLYC","POW 3350 NF","3","Select","Select",""],["","11822013729","RA COL-RITE","CAP 100MG","10","Select","Select",""],["","10702000301","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","67877024910","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","50458056301","INVEGA SUST","INJ 156MG\/ML","1","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","30","Select","Select",""],["","00603243832","BENZTROPINE","TAB 1MG","60","Select","Select",""],["","66993007996","FLUTICAS HFA","AER 110MCG","12","Select","Select",""],["","59746017506","PREDNISONE","TAB 20MG","10","Select","Select",""],["","42806071401","BENZONATATE","100 MG","30","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","6","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","43975035003","PALIPERIDONE","TAB ER 3MG","15","Select","Select",""],["","67877084201","FAMOTIDINE","20 MG","28","Select","Select",""],["","67877024910","QUETIAPINE FUMARATE","50 MG","30","Select","Select",""],["","00378230210","PRAZOSIN HCL","2 MG","30","Select","Select",""],["","68382011405","RISPERIDONE","1 MG","30","Select","Select",""],["","66993007996","FLUTICASONE PROPIONATE HFA","110 MCG","12","Select","Select",""],["","70010006309","METFORMIN HCL","500 MG","60","Select","Select",""],["","00173071920","FLOVENT HFA","110 MCG","12","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","30","Select","Select",""],["","53885004601","ONETOUCH ULTRA","2","1","Select","Select",""],["","53885001110","ONETOUCH DELICA PLUS LANCET","30 GAUGE","100","Select","Select",""],["","53885091101","ONETOUCH ULTRAMINI","","1","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","100","Select","Select",""],["","51660007021","GUAIFENESIN ER","600 MG","60","Select","Select",""],["","00832605211","DICYCLOMINE HCL","20 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":""}]}]}