{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBORAH  A WEBSTER","gend":1,"add":"PO BOX 214","city":"NEW MARKET","state":"VA","zip":"22844-9998","dob":"1961-06-14","age":"","mstatus":"","insh":"20038891*01","cliId":"","pno":5403339903,"cno":5403339903,"email":"","ename":"","eno":"","pphy":"SIMES, BRYCE C DO","ppno":5405645666,"pcpadd":"1790 EAST MARKET STREET SUITE 64B,","pcpcity":"HARRISONBURG","pcpstate":"VA","pcpzip":"22801-9998","pcpcounty":"","pcpid":"","pcpname":"SRMHMG - Sentara East Market Street Health Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"NORTHERN & WINCHESTER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575798594,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","R06.00","R94.39","E78.5","M54.16","M51.26","G89.29","F45.42","M51.16","M17.0","NO DATA","M53.3","Z79.899","G90.511","M17.11","M17.12","U07.1","R07.9","R06.02","R05.9","E11.9","M19.90","J45.909","Z87.11","Z98.890","Z88.0","Z88.8","Z88.5","Z88.1","M54.6","M51.36","G83.11","R29.898","M89.011","M89.021","G90.521","R25.2","E11.65","E88.89","M25.561","G47.33","I25.10","M51.17","G40.909","F32.9","Z79.51","Z79.84","G90.529","M62.838","G90.519","Z79.1","R60.0","R07.89","Z79.4","G90.50","G40.309","Z68.41","E66.01","J45.20","I47.1","F43.22","K21.9","E87.6","E55.9","F33.9","M79.604","K59.04","Z51.81","M54.5","G47.00","R05.","I51.7","Z23.","Z00.00","Z12.11","V62.84","N30.01","M25.562","M13.862","I20.9","F41.9","F51.02","Z68.42","I47.2","R29.6","R26.2","Z79.891","N39.41","N39.3","R73.9","R00.0","S39.012A","M13.861"],"date":["2023-01-11","2021-10-14","2021-10-14","2022-11-25","2023-03-20","2021-06-24","2023-03-20","2023-03-20","2022-06-16","2022-06-16","2023-03-20","2023-03-20","2022-11-25","2022-06-16","2022-08-23","2022-08-23","2023-01-11","2023-03-20","2023-01-11","2023-01-11","2023-06-10","2023-01-11","2023-01-11","2023-01-11","2023-01-11","2023-01-11","2023-01-11","2023-01-11","2023-01-11","2022-11-23","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2022-10-12","2023-03-20","2022-11-29","2022-11-29","2023-03-20","2022-11-25","2021-04-15","2021-06-24","2021-06-24","2021-06-24","2022-11-25","2021-06-24","2022-04-26","2022-04-26","2022-04-26","2022-04-26","2022-06-09","2022-11-29","2022-11-25","2022-11-25","2022-11-25","2022-11-25","2022-11-25","2022-11-25","2022-11-25","2022-11-25","2022-11-25","2022-11-25","2022-02-07","2022-02-07","2021-10-27","2022-02-07","2022-02-07","2021-05-17","2021-05-17","2021-05-17","2022-11-25","2022-05-11","2022-05-11","2022-05-11","2021-05-28","2021-05-28","2023-03-20","2023-03-20","2021-04-16","2021-04-16","2021-04-16","2021-04-16","2021-07-02","2021-07-02","2022-11-29","2023-03-20","2023-06-10","2023-06-10","2022-11-25","2022-11-25","2023-03-20","2023-03-20"],"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":[["","31722072610","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","57237017105","ROSUVASTATIN","TAB 40MG","30","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00597015230","JARDIANCE","10 MG","8","Select","Select",""],["","52817027010","BISOPROL FUM","TAB 5MG","30","Select","Select",""],["","53746052110","PROMETHAZINE","TAB 25MG","120","Select","Select",""],["","00071036924","DILANTIN","100 MG","180","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","30","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","51672411103","PHENYTOIN EX","CAP 100MG","180","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","67877049005","EZETIMIBE","10 MG","30","Select","Select",""],["","65862052790","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","65862020199","LOSARTAN POT","TAB 25MG","30","Select","Select",""],["","65862037401","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00093083205","CLONAZEPAM","0.5 MG","60","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","29300041901","AMITRIPTYLIN","TAB 10MG","240","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","270","Select","Select",""],["","68462039610","OMEPRAZOLE","20 MG","23","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","62559015710","POLYETH GLYC","POW 3350 NF","30","Select","Select",""],["","00173069700","ADVAIR DISKU","AER 500\/50","60","Select","Select",""],["","70710128501","BACLOFEN","TAB 10MG","90","Select","Select",""],["","29300034905","ALLOPURINOL","TAB 100MG","30","Select","Select",""],["","66993058697","FLUTIC\/SALME","AER 500\/50","60","Select","Select",""],["","69097015915","MELOXICAM","15 MG","30","Select","Select",""],["","68180029506","DULOXETINE","CAP 30MG","30","Select","Select",""],["","72205001590","PREGABALIN","150 MG","60","Select","Select",""],["","00054429731","FUROSEMIDE","20 MG","90","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","120","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","2","Select","Select",""],["","59267030401","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","58160082311","SHINGRIX","50 MCG\/0.5","1","Select","Select",""],["","00173068220","VENTOLIN HFA","90 MCG","54","Select","Select",""],["","08290320109","BD PEN NEEDL","MIS 31GX8MM","200","Select","Select",""],["","31722053301","METHOCARBAM","TAB 500MG","240","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","00002822259","INSULIN LISP","INJ 100\/ML","6","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","3","Select","Select",""],["","53885001110","ONETOUCH DEL","MIS PLUS 30G","100","Select","Select",""],["","00093598627","EPINEPHRINE","0.3MG\/0.3","2","Select","Select",""],["","00955172805","INSULIN GLAR","INJ 100U\/ML","6","Select","Select",""],["","53885039310","ONETOUCH US","MIS LANCETS","100","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","6","Select","Select",""],["","29300012601","BISOPROLOL FUMARATE","5 MG","90","Select","Select",""],["","10702000350","PROMETHAZINE HCL","25 MG","120","Select","Select",""],["","31722088530","ROSUVASTATIN CALCIUM","40 MG","30","Select","Select",""],["","43598043611","NITROGLYCERIN","0.4 MG","25","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","3","Select","Select",""],["","66993058697","FLUTICASONE-SALMETEROL","500-50 MCG","60","Select","Select",""],["","45802086866","POLYETHYLENE GLYCOL","3350 17 G","36","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","29300041901","AMITRIPTYLINE HCL","10 MG","90","Select","Select",""],["","00406012305","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","120","Select","Select",""],["","00002822259","INSULIN LISPRO KWIKPEN U-","100 100\/ML","3","Select","Select",""],["","00955172805","INSULIN GLARGINE SOLOSTAR","100\/ML (3)","3","Select","Select",""],["","00173069700","ADVAIR DISKUS","500-50 MCG","60","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","57599080000","FREESTYLE LIBRE","2 SENSOR","2","Select","Select",""],["","65162021210","PHENYTOIN SODIUM EXTENDED","100 MG","180","Select","Select",""],["","27241009990","DULOXETINE HCL","60 MG","16","Select","Select",""],["","00378932232","WIXELA INHUB","500-50 MCG","60","Select","Select",""],["","65862020190","LOSARTAN POTASSIUM","25 MG","90","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","00002143380","TRULICITY","0.75MG\/0.5","2","Select","Select",""],["","00169430330","RYBELSUS","3 MG","30","Select","Select",""],["","08290320109","ULTRA-FINE SHORT PEN NEEDLE","31 GX5\/16\"","200","Select","Select",""],["","68382091634","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","60758088005","FLUOROMETHOLONE","0.1 %","5","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00093083205","CLONAZEPAM TAB","0.5MG","60","Select","Select",""],["","57237016199","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","66993058697","FLUTIC\/SALME AER","500\/50","60","Select","Select",""],["","31722072610","MONTELUKAST TAB","10MG","30","Select","Select",""],["","53746052110","PROMETHAZINE TAB","25MG","120","Select","Select",""],["","64380073706","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","29300041901","AMITRIPTYLIN TAB","10MG","240","Select","Select",""],["","00071374066","DILANTIN CAP","30MG","30","Select","Select",""],["","70377000913","ROSUVASTATIN TAB","40MG","30","Select","Select",""],["","29300034905","ALLOPURINOL TAB","100MG","30","Select","Select",""],["","52817027010","BISOPROL FUM TAB","5MG","30","Select","Select",""],["","62559015710","POLYETH GLYC POW","3350 NF","30","Select","Select",""],["","00173069700","ADVAIR DISKU AER","500\/50","60","Select","Select",""],["","00597015230","JARDIANCE TAB","10MG","30","Select","Select",""],["","43598043611","NITROGLYCERN SUB","0.4MG","25","Select","Select",""],["","67877049005","EZETIMIBE TAB","10MG","30","Select","Select",""],["","65862020199","LOSARTAN POT TAB","25MG","30","Select","Select",""],["","70710128501","BACLOFEN TAB","10MG","90","Select","Select",""],["","69097015915","MELOXICAM TAB","15MG","30","Select","Select",""],["","69315011610","FUROSEMIDE TAB","20MG","30","Select","Select",""],["","68180029506","DULOXETINE CAP","30MG","30","Select","Select",""],["","72205001590","PREGABALIN CAP","150MG","60","Select","Select",""],["","00406012305","HYDROCO\/APAP TAB","5-325MG","120","Select","Select",""],["","00172392670","DIAZEPAM TAB","5MG","2","Select","Select",""],["","51672411103","PHENYTOIN EX CAP","100MG","180","Select","Select",""],["","70461032203","FLUCLVX QUAD INJ","2022-23","0","Select","Select",""],["","58160082311","SHINGRIX INJ","50\/0.5ML","1","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","59267030401","PFIZER BIVAL INJ BA","4\/BA5","0","Select","Select",""],["","31722053301","METHOCARBAM TAB","500MG","240","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","100","Select","Select",""],["","00093598627","EPINEPHRINE INJ","0.3MG","2","Select","Select",""],["","53885001110","ONETOUCH DEL MIS PLUS","30G","100","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","3","Select","Select",""],["","00002879959","HUMALOG KWIK INJ","100\/ML","6","Select","Select",""],["","00002822259","INSULIN LISP INJ","100\/ML","6","Select","Select",""],["","53885004401","ONE TOUCH KIT VERIO FL","","1","Select","Select",""],["","00955172805","INSULIN GLAR INJ","100U\/ML","6","Select","Select",""],["","08290320109","BD PEN NEEDL MIS","31GX8MM","200","Select","Select",""],["","53885039310","ONETOUCH US MIS LANCETS","","100","Select","Select",""],["","67877054360","CEFDINIR","300 MG","14","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":""}]}]}