{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LINDA S DONNELL","gend":1,"add":"APT 504 PO BOX 1413","city":"PORTSMOUTH","state":"VA","zip":"23705-9998","dob":"1959-01-19","age":"","mstatus":"","insh":"20043548*01","cliId":"","pno":7579209322,"cno":7579209322,"email":"","ename":"","eno":"","pphy":"REINEKE-PIPER, KRISTEN MD","ppno":7574883333,"pcpadd":"3925 PORTSMOUTH BLVD,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23321-9998","pcpcounty":"","pcpid":"","pcpname":"Family Medicine Healthcare, PLLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574880007,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.9","M25.562","J45.901","J96.01","J44.1","J96.02","Z87.891","J45.909","S80.02XA","E11.9","J44.9","M17.12","Z79.84","Z79.899","Z20.822","M21.331","M19.90","Z79.82","Z79.51","Z79.52","Z86.2","R20.0","M22.42","G89.29","T63.461A","M17.10","M25.511","J40.","J45.998","R06.02","F41.8","F32.9","F41.9","NO DATA","E55.9","M54.9","M79.605","G56.31","W19.XXXA","E78.5","Z13.31","Z23.","H25.813","H10.45","F10.20","F14.20","F17.210","G89.4","J43.9","K21.9","K59.00","T40.5X5A","Z72.0","I25.10","R94.31","M17.9","R09.02","J80.","R06.89","R06.2","J96.22","I10.","M25.50","M25.561","I35.8"],"date":["2021-06-15","2023-05-29","2022-08-16","2023-09-18","2023-09-19","2022-08-18","2023-05-29","2023-05-29","2021-10-30","2023-09-19","2023-07-19","2023-08-25","2023-05-29","2023-05-29","2023-04-08","2023-01-19","2023-05-29","2023-05-29","2023-05-29","2023-05-29","2023-01-12","2023-01-12","2021-11-01","2021-12-06","2021-12-13","2022-08-16","2022-11-09","2022-04-20","2022-06-14","2023-09-17","2022-08-17","2021-05-12","2022-08-16","2022-03-11","2022-06-14","2021-11-19","2021-11-19","2023-01-19","2023-01-19","2023-09-18","2021-05-12","2021-10-08","2022-04-19","2022-04-19","2022-08-16","2022-08-18","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2022-08-18","2022-08-18","2023-09-19","2023-05-29","2023-09-16","2023-09-16","2023-09-16","2023-09-16","2023-09-19","2023-09-19","2023-05-29","2023-05-29","2023-09-18"],"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":[["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","00603188016","LIDOCAINE","5 %","30","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","100","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","65162019050","NAPROXEN","500 MG","30","Select","Select",""],["","29300014801","QUETIAPINE FUMARATE","50 MG","90","Select","Select",""],["","16571040250","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","67877041401","METFORMIN HCL ER","750 MG","90","Select","Select",""],["","00310461612","BREZTRI AEROSPHERE","160-9-4.8","10.7","Select","Select",""],["","49483070210","FLUOXETINE HCL","20 MG","30","Select","Select",""],["","47335070349","ALBUTEROL SULFATE","2.5 MG\/3ML","300","Select","Select",""],["","00378932132","WIXELA INHUB","250-50 MCG","180","Select","Select",""],["","70377000315","SIMVASTATIN","20 MG","60","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","53885027150","ONETOUCH VERIO TEST STRIP","","50","Select","Select",""],["","59651021430","AZELASTINE HCL","137 MCG","30","Select","Select",""],["","00406012301","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","10","Select","Select",""],["","62332002891","LOSARTAN POTASSIUM","50 MG","30","Select","Select",""],["","00173069600","ADVAIR DISKUS","250-50 MCG","180","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","59310057922","PROAIR HFA","AER ","51","Select","Select",""],["","00487990130","ALBUTEROL","NEB 0.005","90","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","12","Select","Select",""],["","49483070210","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA","50","Select","Select",""],["","62332002891","LOSARTAN POT","TAB 50MG","30","Select","Select",""],["","59746017509","PREDNISONE","20 MG","8","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","24658031205","DOXYCYCL HYC","TAB 100MG","14","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","59651021430","AZELASTINE","SPR 0.001","30","Select","Select",""],["","00904671839","MUCUS RELIEF","TAB 600MG ER","28","Select","Select",""],["","00173069600","ADVAIR DISKU","AER 250\/50","180","Select","Select",""],["","67877041401","METFORMIN","TAB 750MG ER","30","Select","Select",""],["","65862049001","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","30","Select","Select",""],["","66993013597","FLUTIC\/VILAN","INH 100-25","60","Select","Select",""],["","65862057490","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00173085910","BREO ELLIPTA","INH 100-25","60","Select","Select",""],["","00378668910","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00904679480","ASPIRIN LOW","CHW 81MG","30","Select","Select",""],["","00310461612","BREZTRI AERO","AER SPHERE","11","Select","Select",""],["","49281042250","FLUZONE QUAD","INJ 2022-23","0","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","49483070210","FLUOXETINE CAP","20MG","30","Select","Select",""],["","00603188016","LIDOCAINE PAD","5%","30","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","00093317431","ALBUTEROL AER HFA","","17","Select","Select",""],["","62332002891","LOSARTAN POT TAB","50MG","30","Select","Select",""],["","59267100002","PFIZER VACC INJ COVID-","19","0","Select","Select",""],["","53885024450","ONETOUCH TES ULTRA","","50","Select","Select",""],["","64380094906","PREDNISONE TAB","50MG","5","Select","Select",""],["","00487990130","ALBUTEROL NEB","0.5%","90","Select","Select",""],["","64380071207","BENZONATATE CAP","100MG","30","Select","Select",""],["","65862057490","MONTELUKAST TAB","10MG","30","Select","Select",""],["","59746000103","METHYLPRED TAB","4MG","21","Select","Select",""],["","59651021430","AZELASTINE SPR","0.1%","30","Select","Select",""],["","67877041401","METFORMIN TAB","750MG ER","30","Select","Select",""],["","66993013597","FLUTIC\/VILAN INH","100-25","60","Select","Select",""],["","29300014801","QUETIAPINE TAB","50MG","30","Select","Select",""],["","00378932132","WIXELA INHUB AER","250\/50","180","Select","Select",""],["","68180016011","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","00904671839","MUCUS RELIEF TAB","600MG ER","28","Select","Select",""],["","00173069600","ADVAIR DISKU AER","250\/50","180","Select","Select",""],["","24658031205","DOXYCYCL HYC TAB","100MG","14","Select","Select",""],["","65162019050","NAPROXEN TAB","500MG","30","Select","Select",""],["","70377000315","SIMVASTATIN TAB","20MG","60","Select","Select",""],["","00904679480","ASPIRIN LOW CHW","81MG","30","Select","Select",""],["","00173085910","BREO ELLIPTA INH","100-25","60","Select","Select",""],["","53489011905","DOXYCYCL HYC CAP","100MG","10","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","100","Select","Select",""],["","00378668910","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","49281042250","FLUZONE QUAD INJ","2022-23","0","Select","Select",""],["","00310461612","BREZTRI AERO AER SPHERE","","11","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","30.6","Select","Select",""],["","00597010061","SPIRIVA RESPIMAT","2.5 MCG","4","Select","Select",""],["","50428050854","PURELAX","17 G","10","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","30.6","Select","Select",""],["","80681002000","MULTIVITAMIN","","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":""}]}]}