{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KAREN V PHELPS","gend":1,"add":"555 S SOUTH ST UNIT 2C","city":"PETERSBURG","state":"VA","zip":"23803-9998","dob":"1962-01-03","age":"","mstatus":"","insh":"20042716*01","cliId":"","pno":8045854298,"cno":8045854298,"email":"","ename":"","eno":"","pphy":"SARAIYA, BHAVNA MD","ppno":"","pcpadd":"50 MEDICAL PARK BLVD SUITE C,","pcpcity":"PETERSBURG","pcpstate":"VA","pcpzip":"23805-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours - Southside Internal Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z00.00","E11.65","R63.0","R05.","F17.219","E78.00","K21.9","Z86.79","Z86.39","Z79.4","Z68.23","R63.4","Z79.899","H25.12","I10.","Z68.24","J44.9","F17.218","F43.21","Z86.73","Z86.11","Z12.11","E16.2","Z01.419","R91.1","E11.9","T78.3XXA","R91.8","E11.29","R80.9","Z68.20","F17.210","E78.2","I69.354","Z68.21","Z79.82","H25.11","Z11.3","Z12.31","R93.89","Z09.","E55.9","A15.0","Z23.","Z68.22"],"date":["2021-11-23","2023-01-25","2021-01-21","2021-01-07","2021-11-23","2023-01-25","2022-02-23","2022-03-08","2021-01-07","2023-01-25","2022-07-12","2022-03-08","2022-03-08","2022-07-28","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2022-09-08","2023-01-25","2022-07-12","2021-03-04","2022-06-15","2021-03-06","2021-03-04","2022-05-26","2022-05-26","2021-11-24","2021-03-06","2021-04-30","2021-04-30","2022-05-26","2021-04-30","2022-07-14","2022-07-12","2022-07-12","2021-04-22","2021-01-21","2021-01-21","2021-11-23","2022-05-26","2022-01-24"],"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":[["","00472037915","CLOTRIM\/BETA","CRE DIPROP","15","Select","Select",""],["","64980028005","GLIPIZIDE ER","TAB 5MG","30","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","43598044774","NICOTINE TD","DIS 14MG\/24H","28","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","70700015010","OMEPRAZOLE","20 MG","180","Select","Select",""],["","00093727356","PIOGLITAZONE","TAB 45MG","30","Select","Select",""],["","31722072250","LEVOFLOXACIN","TAB 500MG","7","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","6","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","65702010110","ACCU-CHEK","KIT AVIVA PL","1","Select","Select",""],["","60505014102","GLIPIZIDE","TAB 5MG","90","Select","Select",""],["","69097084705","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","00169185189","NOVOFINE","MIS 32GX6MM","100","Select","Select",""],["","86227013085","SURE COMFORT","MIS 32GX5\/32","100","Select","Select",""],["","00173086910","ANORO ELLIPT","AER 62.5-25","60","Select","Select",""],["","00135014502","NICODERM CQ","DIS 21MG\/24H","28","Select","Select",""],["","59651005230","EZETIMIBE","10 MG","30","Select","Select",""],["","00555007102","ISONIAZID","TAB 300MG","90","Select","Select",""],["","00536440601","VITAMIN B-6","TAB 25MG","30","Select","Select",""],["","59762135001","RIFABUTIN","CAP 150MG","30","Select","Select",""],["","00527131530","RIFAMPIN","CAP 300MG","30","Select","Select",""],["","67253066010","PYRAZINAMIDE","TAB 500MG","90","Select","Select",""],["","53885039310","ONETOUCH US","MIS LANCETS","100","Select","Select",""],["","65702073110","ACCU-CHECK","KIT GUIDE ME","1","Select","Select",""],["","73070010315","INSULIN ASPA","INJ FLEXPEN","9","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","9","Select","Select",""],["","54879000201","ETHAMBUTOL","TAB 400MG","90","Select","Select",""],["","57599080000","FREESTY LIBR","KIT 2 SENSOR","2","Select","Select",""],["","59267102501","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","65862020299","LOSARTAN POT","TAB 50MG","30","Select","Select",""],["","00169220125","NOVOLOG MIX","70-30 FLEXPEN 70-30\/ML","9","Select","Select",""],["","73070020315","INS ASP PROT","INJ FLEXPEN","6","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","61314063705","PREDNISOLONE","SUS 1% OP","10","Select","Select",""],["","64980051505","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","72511076002","REPATHA SURE","INJ 140MG\/ML","2","Select","Select",""],["","60505100302","KETOROLAC","SOL 0.005","10","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","73070020315","INSULIN ASPART PROT MIX","70-30 70-30\/ML","3","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","68180072003","AMLODIPINE BESYLATE","5 MG","30","Select","Select",""],["","69097084705","ESCITALOPRAM OXALATE","5 MG","30","Select","Select",""],["","00472037915","CLOTRIMAZOLE-BETAMETHASONE","1 %-0.05 %","15","Select","Select",""],["","65862020299","LOSARTAN POTASSIUM","50 MG","30","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","100","Select","Select",""],["","43598044774","NICOTINE PATCH","14MG\/24HR","28","Select","Select",""],["","68180013701","ESCITALOPRAM TAB","5MG","30","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","100","Select","Select",""],["","00472037915","CLOTRIM\/BETA CRE DIPROP","","15","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","6","Select","Select",""],["","00781569031","EZETIMIBE TAB","10MG","90","Select","Select",""],["","00536440601","VITAMIN B-","6 TAB 25MG","30","Select","Select",""],["","08290320550","BD PEN NEEDL MIS","32GX4MM","100","Select","Select",""],["","73070010315","INSULIN ASPA INJ FLEXPEN","","9","Select","Select",""],["","00169633910","NOVOLOG INJ FLEXPEN","","9","Select","Select",""],["","57599080000","FREESTY LIBR KIT","2 SENSOR","2","Select","Select",""],["","70700015010","OMEPRAZOLE CAP","20MG","180","Select","Select",""],["","00093727356","PIOGLITAZONE TAB","45MG","30","Select","Select",""],["","43598044774","NICOTINE TD DIS","14MG\/24H","28","Select","Select",""],["","65862020299","LOSARTAN POT TAB","50MG","90","Select","Select",""],["","59267102501","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","00169369619","NOVOLOG MIX INJ FLEXPEN","","12","Select","Select",""],["","53885039310","ONETOUCH US MIS LANCETS","","100","Select","Select",""],["","73070020315","INS ASP PROT INJ FLEXPEN","","9","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","68180072003","AMLODIPINE TAB","5MG","30","Select","Select",""],["","61314063705","PREDNISOLONE SUS","1% OP","5","Select","Select",""],["","64980051505","OFLOXACIN DRO","0.3% OP","5","Select","Select",""],["","60505100301","KETOROLAC SOL","0.5%","5","Select","Select",""],["","72511076002","REPATHA SURE INJ","140MG\/ML","2","Select","Select",""],["","53885024510","ONETOUCH TES ULTRA","","100","Select","Select",""],["","00093314705","CEPHALEXIN CAP","500MG","21","Select","Select",""],["","00597015230","JARDIANCE","10 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":""}]}]}