{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RANA  C WILSON","gend":1,"add":"250 PINNER ST UNIT D","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1964-03-05","age":"","mstatus":"","insh":"20043484*01","cliId":"","pno":7573727558,"cno":7573727558,"email":"","ename":"","eno":"","pphy":"WILLIAMS, MICHAEL MD","ppno":7579838600,"pcpadd":"#200 114 N MAIN ST,","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23434-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Internal Medicine Physicians - Downtown Suffolk","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579341660,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J01.00","M54.41","G89.4","G89.29","I73.9","J43.9","J43.1","J44.9","E11.21","F31.75","K74.60","Z12.39","Z79.4","R18.8","S70.02XA","F31.9","I10.","I25.10","E11.36","B19.20","F41.9","Z86.73","M79.7","E78.00","E03.9","F17.210","Z90.49","Z88.8","Z82.49","A41.9","E43.","J13.","J96.01","NO DATA","E22.2","J44.1","J44.0","E11.65","D64.9","M06.9","I47.1","Z20.822","U09.9","J18.9","J42.","J96.21","F17.219","M25.552","S72.002A","E11.9","E78.5","Z72.0","Z71.6","U07.1","E16.1","E16.2","S79.912A","R09.02","R06.89","R10.31","E11.42","E78.2","N61.1","E87.1","E11.51","R65.20","F33.9","F43.10","G89.18","H26.9","Z87.81","Z88.6","Z91.040","Z88.0","Z56.0","Z88.2","E55.9","D50.0","R94.31","J45.20","F32.0","R79.9","J06.9","R52.","W19.XXXA","V54.13","I12.0","E11.22","N18.6","B18.2","G25.81","Z02.89","L60.3","Z86.39","Z71.89","J96.11","Z23.","G95.19","M07.60","F17.218","J96.12","S61.512A","S61.211A","L85.3","D45.","I74.09","D50.9","B34.9","F31.30","M19.90","M62.838","K21.9","R07.89","R53.83","M80.00XA","R19.7","N20.0","R10.33","R11.0","I35.1","M19.049","R11.2"],"date":["2021-10-27","2022-11-23","2023-05-09","2022-11-23","2021-05-10","2021-05-10","2023-06-23","2023-02-16","2021-06-25","2023-06-23","2022-04-27","2021-05-10","2022-11-23","2021-05-10","2021-12-13","2022-11-11","2022-11-11","2022-04-27","2022-04-27","2021-12-18","2022-11-18","2021-12-13","2022-01-03","2022-06-16","2022-11-11","2022-04-27","2021-12-13","2022-04-27","2021-12-13","2022-11-18","2023-06-23","2022-11-11","2022-11-18","2022-11-11","2022-11-11","2023-06-23","2022-11-11","2022-11-11","2022-11-11","2023-06-23","2023-06-23","2022-11-11","2022-11-11","2022-12-15","2022-11-11","2023-02-16","2023-02-16","2022-01-06","2021-12-21","2022-06-16","2022-01-03","2021-12-21","2021-12-21","2021-12-28","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-02-09","2023-06-23","2022-02-09","2022-06-16","2022-11-18","2022-11-18","2022-11-18","2021-01-07","2022-01-03","2022-01-06","2022-01-06","2022-01-06","2022-04-27","2022-04-27","2022-04-27","2022-01-06","2022-04-27","2022-05-18","2022-05-18","2022-11-16","2021-06-17","2021-10-27","2021-08-10","2021-10-18","2022-06-16","2021-12-13","2022-01-03","2022-01-03","2022-01-03","2022-01-03","2022-01-03","2022-01-03","2021-10-27","2021-10-27","2022-06-16","2022-11-12","2023-06-23","2022-11-23","2023-06-23","2023-06-23","2023-06-23","2022-11-23","2021-01-12","2021-02-22","2021-03-05","2021-03-05","2023-06-23","2021-09-15","2021-10-18","2021-12-18","2021-12-18","2021-12-18","2021-12-18","2021-07-16","2021-07-16","2022-01-05","2022-04-27","2022-04-27","2022-04-27","2022-04-27","2022-11-14","2021-06-25","2022-04-27"],"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":[["","00088222033","LANTUS","100\/ML","10","Select","Select",""],["","72140000021","EUCERIN","","454","Select","Select",""],["","00456120230","LINZESS","CAP 290MCG","30","Select","Select",""],["","10702005601","OXYCODONE","TAB 10MG","120","Select","Select",""],["","00555032302","HYDROXYZ PAM","CAP 25MG","120","Select","Select",""],["","00378797052","IPRATROPIUM","SOL 0.02%INH","125","Select","Select",""],["","53885065701","ONETOUCH","KIT VERIO","1","Select","Select",""],["","00093321301","CLONAZEPAM","2 MG","30","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00046110511","PREMPRO","0.3-1.5MG","28","Select","Select",""],["","70010006505","METFORMIN","TAB 1000MG","60","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00378932132","WIXELA INHUB","AER 250\/50","60","Select","Select",""],["","08290324911","INSULIN SYRG","MIS 0.5\/31G","30","Select","Select",""],["","00121086816","NYSTATIN","100000\/ML","473","Select","Select",""],["","68180063609","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","72888001405","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","68180096901","LEVOTHYROXIN","TAB 100MCG","90","Select","Select",""],["","65862049501","QUETIAPINE","TAB 400MG","90","Select","Select",""],["","00069046903","CHANTIX","PAK 1MG","56","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","65862035790","CLOPIDOGREL","75 MG","90","Select","Select",""],["","65162079108","LIDOCAINE","5 %","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","31722077801","ACYCLOVIR","800 MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","180","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","00093406801","PRAZOSIN HCL","2 MG","30","Select","Select",""],["","00173069500","ADVAIR DISKU","AER 100\/50","60","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","58160088752","FLUARIX QUAD","INJ 2021-22","0","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","24338011003","ERYTHROM ETH","TAB 400MG","40","Select","Select",""],["","69618002601","FERROUS SULF","TAB 325MG","90","Select","Select",""],["","60505476606","APO-VARENICL","TAB 1MG","60","Select","Select",""],["","59746017210","PREDNISONE","TAB 5MG","71","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00781324664","ENOXAPARIN","INJ 40\/0.4ML","11","Select","Select",""],["","00536124810","STIMULANT","TAB 8.6-50MG","20","Select","Select",""],["","00904585652","CALCIUM + D3","TAB 600MG","60","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","4","Select","Select",""],["","00904775127","MINERIN","","454","Select","Select",""],["","16103036907","CALCIUM","TAB VIT D","60","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","49884015676","VARENICLINE","TAB 1MG","56","Select","Select",""],["","00904699860","DOCUSATE SOD","CAP 100MG","30","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","28","Select","Select",""],["","00006483703","PNEUMOVAX 23","INJ 25\/0.5","0","Select","Select",""],["","00173088710","TRELEGY","AER 100MCG","60","Select","Select",""],["","41679067466","BOOST","0.04G-1\/ML","4266","Select","Select",""],["","70436001004","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","49348081813","SM LORATADIN","TAB 10MG","30","Select","Select",""],["","16714089803","LORATADINE","TAB 10MG","30","Select","Select",""],["","00093221001","SUCRALFATE","1 G","54","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","40 MG","180","Select","Select",""],["","10702005601","OXYCODONE HCL","10 MG","120","Select","Select",""],["","70436001004","BUPROPION XL","150 MG","30","Select","Select",""],["","53885004401","ONETOUCH VERIO FLEX METER","","1","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","30","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","68180096901","LEVOTHYROXINE SODIUM","100 MCG","90","Select","Select",""],["","08290328466","INSULIN SYRINGE","30GX1\/2\"","30","Select","Select",""],["","68382004101","PROMETHAZINE HCL","25 MG","30","Select","Select",""],["","65862049501","QUETIAPINE FUMARATE","400 MG","90","Select","Select",""],["","47335070352","ALBUTEROL SULFATE","2.5 MG\/3ML","270","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","70010006505","METFORMIN HCL","1000 MG","180","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","00173088710","TRELEGY ELLIPTA","100-62.5","60","Select","Select",""],["","63304082890","ATORVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","72888001405","CYCLOBENZAPRINE HCL","10 MG","60","Select","Select",""],["","53885065701","ONETOUCH VERIO METER","","1","Select","Select",""],["","00904585652","CALCIUM + D","3 TAB 600MG","60","Select","Select",""],["","47335070352","ALBUTEROL NEB","0.083%","270","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","10702005601","OXYCODONE TAB","10MG","120","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","30","Select","Select",""],["","68382004101","PROMETHAZINE TAB","25MG","30","Select","Select",""],["","00121086816","NYSTATIN SUS","100000","473","Select","Select",""],["","08290328466","INSULIN SYRG MIS","0.5\/30G","30","Select","Select",""],["","69618002601","FERROUS SULF TAB","325MG","90","Select","Select",""],["","29300022019","MONTELUKAST TAB","10MG","30","Select","Select",""],["","00093406801","PRAZOSIN HCL CAP","2MG","30","Select","Select",""],["","65162079108","LIDOCAINE PAD","5%","30","Select","Select",""],["","16729013800","CLONAZEPAM TAB","2MG","30","Select","Select",""],["","70010006505","METFORMIN TAB","1000MG","60","Select","Select",""],["","00173069500","ADVAIR DISKU AER","100\/50","60","Select","Select",""],["","60432026415","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","72888001405","CYCLOBENZAPR TAB","10MG","60","Select","Select",""],["","82607066026","FLOWFLEX KIT TEST","","4","Select","Select",""],["","00904775127","MINERIN CRE","","454","Select","Select",""],["","00555032302","HYDROXYZ PAM CAP","25MG","120","Select","Select",""],["","16103036907","CALCIUM TAB VIT D","","60","Select","Select",""],["","00088222033","LANTUS INJ","100\/ML","10","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","72140000021","EUCERIN CRE","","454","Select","Select",""],["","00046110511","PREMPRO TAB","0.3-1.5","28","Select","Select",""],["","31722071390","PANTOPRAZOLE TAB","40MG","180","Select","Select",""],["","00006483703","PNEUMOVAX","23 INJ 25\/0.5","0","Select","Select",""],["","31722099601","HYDROCO\/APAP TAB","5-325MG","20","Select","Select",""],["","65862049501","QUETIAPINE TAB","400MG","90","Select","Select",""],["","68180063609","ATORVASTATIN TAB","20MG","90","Select","Select",""],["","31722077801","ACYCLOVIR TAB","800MG","30","Select","Select",""],["","49884015676","VARENICLINE TAB","1MG","56","Select","Select",""],["","65862035790","CLOPIDOGREL TAB","75MG","90","Select","Select",""],["","00904699860","DOCUSATE SOD CAP","100MG","30","Select","Select",""],["","69238110005","DOXYCYCL HYC CAP","100MG","28","Select","Select",""],["","68180096901","LEVOTHYROXIN TAB","100MCG","90","Select","Select",""],["","53885065701","ONETOUCH KIT VERIO","","1","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","100","Select","Select",""],["","49348081813","SM LORATADIN TAB","10MG","30","Select","Select",""],["","29033000301","SUCRALFATE TAB","1GM","54","Select","Select",""],["","70436001004","BUPROPN HCL TAB","150MG XL","30","Select","Select",""],["","00173088710","TRELEGY AER","100MCG","60","Select","Select",""],["","16714089803","LORATADINE TAB","10MG","30","Select","Select",""],["","41679067466","BOOST LIQ VANILLA","","18","Select","Select",""],["","59746017210","PREDNISONE TAB","5MG","71","Select","Select",""],["","00173069500","ADVAIR DISKUS","100-50 MCG","60","Select","Select",""],["","53885026701","ONETOUCH VERIO IQ METER","","1","Select","Select",""],["","51660052601","ALLERGY RELIEF","10 MG","30","Select","Select",""],["","08290328447","SAFETYGLIDE INSULIN SYRINGE","31GX15\/64\"","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":""}]}]}