{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KELLY  J STEINS","gend":1,"add":"3500 SEWELLS POINT RD APT J","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1966-02-27","age":"","mstatus":"","insh":"20038871*01","cliId":"","pno":7579443591,"cno":7579443591,"email":"","ename":"","eno":"","pphy":"LAYNE, MICHAEL MD","ppno":7574465955,"pcpadd":"825 FAIRFAX AVE SUITE 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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L40.9","Z71.9","R39.81","G24.01","F31.12","G47.33","K52.9","E16.2","M54.40","Z01.810","Z01.812","D14.0","R94.31","J34.89","M47.9","M46.1","NO DATA","F17.210","Z68.41","Z13.31","F41.1","N39.490","N31.9","N39.3","H35.033","D31.32","I10.","H52.03","H53.8","E11.36","R68.89","H52.7","Z88.8","Z88.0","E88.81","I25.118","F17.200","Z95.5","E78.5","M54.31","M54.32","R26.9","Z01.818","M54.16","M43.16","M47.816","H73.813","H90.6","H69.82","K59.00","E11.9","K21.9","K25.9","E66.01","F31.2","R32.","H91.93","J44.9","R09.81","J34.2","D36.9","J31.0","J44.1","R73.03","K59.04","Z11.1","H90.3","F84.0","M19.90","Z79.1"],"date":["2021-08-23","2021-08-23","2022-07-12","2023-02-08","2022-12-13","2023-02-28","2022-01-25","2022-01-31","2022-01-25","2022-08-12","2022-08-12","2022-08-12","2022-08-12","2022-09-21","2022-11-10","2023-03-02","2022-12-28","2023-01-19","2023-02-09","2022-12-05","2023-02-22","2023-04-25","2023-04-25","2023-04-25","2023-01-19","2023-01-19","2023-03-30","2023-01-19","2023-01-19","2023-01-19","2023-01-19","2023-01-19","2023-01-19","2023-01-19","2021-02-24","2022-08-29","2022-09-06","2022-08-29","2022-08-29","2021-12-06","2021-12-06","2021-12-06","2022-09-06","2022-10-27","2022-10-27","2022-10-27","2021-08-06","2021-08-06","2021-08-06","2022-02-15","2022-02-15","2023-02-09","2022-02-15","2022-02-15","2023-02-22","2022-05-31","2021-06-04","2021-06-04","2022-07-06","2022-09-21","2022-09-21","2022-09-21","2022-12-30","2022-12-28","2023-02-09","2021-05-18","2022-12-22","2023-02-22","2023-03-30","2023-03-30"],"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":[["","57237016199","OMEPRAZOLE","20 MG","90","Select","Select",""],["","00378518693","PRASUGREL","TAB 10MG","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","72511076002","REPATHA SURE","INJ 140MG\/ML","2","Select","Select",""],["","45963043864","ENULOSE","10 G\/15 ML","450","Select","Select",""],["","00173071820","FLOVENT HFA","44 MCG","10.6","Select","Select",""],["","59779027408","ASPIRIN LOW","CHW 81MG","30","Select","Select",""],["","33342006707","OLANZAPINE","2.5 MG","30","Select","Select",""],["","70377003012","ATORVASTATIN","TAB 80MG","90","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","70370108001","INGREZZA","80 MG","30","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","80777027398","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","69238115409","EZETIMIBE","TAB 10MG","90","Select","Select",""],["","58406003204","ENBREL SRCLK","INJ 50MG\/ML","8","Select","Select",""],["","66993089749","AUG BETAMET","OIN 0.0005","50","Select","Select",""],["","50742024990","DILTIAZEM","24HR ER (CD) 180 MG","90","Select","Select",""],["","55513013760","OTEZLA","TAB 30MG","60","Select","Select",""],["","65162019050","NAPROXEN","500 MG","28","Select","Select",""],["","00168003315","BETAMETH VAL","OIN 0.001","60","Select","Select",""],["","47335070349","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","00121087316","LACTULOSE","SOL 10GM\/15","450","Select","Select",""],["","33332032101","AFLURIA QUAD","INJ 2021-22","0","Select","Select",""],["","69842097417","DICLOFENAC","GEL 0.01","50","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","40","Select","Select",""],["","66993007896","FLUTICAS HFA","AER 44MCG","11","Select","Select",""],["","27241009809","DULOXETINE","CAP 30MG","30","Select","Select",""],["","00225038080","AYR","SPR 0.0065","50","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","08271035100","LANCETS THIN","MIS ","100","Select","Select",""],["","53885001110","ONETOUCH DEL","MIS PLUS 30G","100","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","9","Select","Select",""],["","80777028299","MODERNA BIVA","INJ BA4\/BA5","0","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","13107008305","LORAZEPAM","0.5 MG","30","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","72511076002","REPATHA SURECLICK","140 MG\/ML","2","Select","Select",""],["","53885001110","ONETOUCH DELICA PLUS LANCET","30 GAUGE","100","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","47335070349","ALBUTEROL SULFATE","2.5 MG\/3ML","75","Select","Select",""],["","00904679480","ASPIRIN","81 MG","30","Select","Select",""],["","63304069301","CLINDAMYCIN HCL","300 MG","21","Select","Select",""],["","00378518693","PRASUGREL HCL","10 MG","90","Select","Select",""],["","70377003012","ATORVASTATIN CALCIUM","80 MG","90","Select","Select",""],["","00597007541","SPIRIVA HANDIHALER","18 MCG","30","Select","Select",""],["","66993007896","FLUTICASONE PROPIONATE HFA","44 MCG","10.6","Select","Select",""],["","53885099425","ONETOUCH ULTRA TEST STRIP","","100","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":""}]}]}