{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALICIA  D MCCLAIN","gend":1,"add":"520 PINE VALLEY RUN APT 103","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1969-10-17","age":"","mstatus":"","insh":"20045210*01","cliId":"","pno":7579774437,"cno":7579774437,"email":"","ename":"","eno":"","pphy":"SAMUELS, GARFIELD HUE MD","ppno":7575188823,"pcpadd":"4452 CORPORATION LN STE 300","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23462-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575188832,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J32.4","J30.1","R42.","R09.89","NO DATA","M62.81","F43.10","F31.31","F25.0","I83.813","M51.36","M99.03","M47.812","M99.05","V58.89","M99.04","G57.01","M99.02","M99.01","M54.2","F31.63","V62.84","F43.12","E11.9","K58.9","E55.9","K21.9","Z59.0","F60.3","R32.","K57.90","K59.00","K31.84","Z79.84","E28.2","S16.1XXA","S39.012A","M54.5","G43.009","M54.12","I10.","E78.5","G47.33","M51.17","M47.816","Z71.89","Z71.3","E66.01","Z68.42","N39.3","R15.9","N81.2","K58.0","K90.89","M54.9","D72.819","R10.32","K91.89","R10.13","E11.65","E66.9","Z01.89","R09.81","R53.83","G47.10","R07.9","R06.00","E11.43","F41.9","J45.909","K76.0","E78.00","F31.9","F90.9","Z79.899","R94.5","R07.89","R73.9","Z68.41","T38.0X5A","N39.0","R31.9","H10.12","S80.222A","M25.562","E11.628","F31.4","E11.69","M62.838","R26.9","F33.1","F41.1","F39.","M75.41","M75.42","M99.08","M99.07","M99.06","M99.09","R03.0","Z00.01","R73.03","I89.0","S29.019A","V89.2XXS","M48.02","M54.16","Z88.9","G56.22","M50.122","Z12.11","K62.5","R06.02","R11.0","M65.4","M67.431","Z20.828","Z13.1","R53.81","Z83.3","J30.2","R25.2","L02.92","Z71.9","H81.393","N62.","E86.0","Z87.19","Z99.89","R10.9","F31.81","H65.02","M25.50","R76.8","L65.9","H04.129","R68.2","M79.7","R76.0","H93.13","H93.293","J45.40","M25.531","I87.392","M79.604","M47.22","M54.17","K42.9","K44.9","Z90.49","K30.","K29.50","F31.32","M54.6","M47.814","M50.30","M25.512","L73.9","Z01.411","F90.2","R14.0","D72.818","M47.819","L30.4","L72.9","L82.1","S50.01XA","G44.309","Z13.31","M79.605","F33.3","R14.2","G89.29","M07.611","R19.7","R10.30","N91.5","L71.8","L68.0","Z87.2","T63.461A","L02.91","K59.02","K58.2"],"date":["2022-11-30","2023-04-26","2023-04-26","2023-04-26","2023-03-17","2023-03-17","2022-09-26","2022-02-10","2023-04-18","2021-07-07","2021-09-13","2023-01-18","2022-12-20","2023-01-18","2021-11-18","2023-01-18","2021-09-13","2023-01-18","2023-01-18","2022-12-20","2021-03-02","2021-02-24","2022-09-08","2023-03-22","2022-11-14","2022-04-12","2022-11-14","2021-02-24","2021-02-24","2021-02-24","2021-02-24","2022-01-13","2022-11-14","2021-02-24","2022-11-14","2021-05-18","2021-05-18","2021-09-29","2022-03-10","2022-03-10","2022-11-14","2023-03-22","2022-12-15","2022-08-05","2023-02-22","2022-08-05","2022-08-05","2023-03-22","2022-10-15","2023-04-24","2023-04-24","2023-04-24","2023-04-24","2023-04-24","2022-03-31","2021-01-28","2022-11-26","2022-09-28","2022-11-26","2022-08-17","2022-11-14","2022-08-17","2022-11-07","2022-11-07","2022-11-07","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-14","2022-11-15","2022-11-15","2022-06-20","2023-03-22","2022-06-20","2022-06-23","2022-06-23","2022-10-15","2022-10-15","2022-10-15","2022-10-15","2022-10-27","2023-03-22","2023-02-22","2023-02-22","2022-11-29","2022-11-29","2022-11-29","2023-01-18","2023-01-18","2023-01-18","2023-01-18","2023-01-18","2023-01-18","2021-04-15","2021-04-15","2021-04-15","2021-07-07","2021-08-02","2022-02-22","2022-12-20","2022-12-20","2022-06-08","2022-06-08","2022-04-18","2023-01-30","2022-11-26","2022-11-26","2022-11-26","2023-04-12","2023-03-09","2021-06-21","2021-06-21","2021-06-21","2022-03-22","2021-06-21","2021-07-19","2021-07-29","2023-03-06","2021-11-01","2022-01-05","2022-03-22","2022-03-22","2022-03-22","2022-06-23","2023-04-18","2021-09-14","2021-10-11","2021-10-11","2021-10-11","2021-10-11","2021-10-11","2021-10-11","2021-10-11","2021-10-12","2021-10-12","2021-10-27","2021-11-03","2021-12-09","2021-12-09","2022-01-25","2022-01-25","2022-02-02","2022-02-02","2022-02-02","2023-01-30","2022-04-27","2022-07-17","2022-12-20","2022-12-20","2022-12-20","2023-02-28","2023-03-06","2022-03-07","2022-09-26","2022-01-13","2021-03-15","2021-04-09","2021-09-07","2021-09-07","2021-09-07","2021-10-07","2022-01-03","2022-01-03","2021-12-09","2022-02-16","2022-05-10","2022-08-03","2022-08-03","2022-01-13","2022-04-07","2022-04-07","2022-06-24","2022-06-24","2022-06-24","2022-09-21","2022-09-21","2023-01-30","2023-01-30"],"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":[["","70010049105","METFORMIN","TAB 500MG ER","60","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","15","Select","Select",""],["","65862078430","ESOMEPRA MAG","CAP 40MG DR","90","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","300","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","60","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00299382060","METROGEL","GEL 0.01","60","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","57237001999","DULOXETINE","CAP 60MG","30","Select","Select",""],["","51991029305","OXCARBAZEPIN","TAB 300MG","60","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","14","Select","Select",""],["","64380073706","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","68382005005","MELOXICAM","7.5 MG","60","Select","Select",""],["","67618010030","COLACE","CAP 50MG","14","Select","Select",""],["","69097067805","PREGABALIN","CAP 50MG","30","Select","Select",""],["","60505258008","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","23155050110","HYDROXYZ HCL","TAB 25MG","120","Select","Select",""],["","00065008515","NAPHCON-A","SOL OP","15","Select","Select",""],["","00591352530","LIDOCAINE","5 %","30","Select","Select",""],["","00904672059","ACETAMIN","TAB 500MG","60","Select","Select",""],["","00093100301","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","16714024601","CLINDAMYCIN","LOT 0.01","60","Select","Select",""],["","45802028001","BENZOYL PER","LIQ 5% WASH","142","Select","Select",""],["","69584061150","METHOCARBAM","TAB 500MG","21","Select","Select",""],["","00093321915","KETOCONAZOLE","CRE 0.02","30","Select","Select",""],["","52536013301","MECLIZINE","TAB 25MG","30","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","28","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","59651021430","AZELASTINE","SPR 0.001","30","Select","Select",""],["","65862056099","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","29300041101","ATENOLOL","50 MG","30","Select","Select",""],["","65862014836","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","00172572960","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","35046000057","CALCIUM CARB","TAB \/VIT D","60","Select","Select",""],["","00169430730","RYBELSUS","TAB 7MG","30","Select","Select",""],["","57599080000","FREESTY LIBR","KIT 2 SENSOR","2","Select","Select",""],["","65862020399","LOSARTAN POT","TAB 100MG","30","Select","Select",""],["","51645073306","CALCIUM+D","TAB 600-800","60","Select","Select",""],["","00093720110","PRAVASTATIN","TAB 20MG","30","Select","Select",""],["","65862018830","ONDANSETRON","TAB 8MG","60","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","00456120330","LINZESS","CAP 72MCG","30","Select","Select",""],["","57599000101","FREESTYLE","KIT SENSOR","1","Select","Select",""],["","56151146304","TRUE METRIX","TES GLUCOSE","100","Select","Select",""],["","56151014701","TRUPLUS LANC","MIS 33G","100","Select","Select",""],["","00115521116","COLESTIPOL","TAB 1GM","120","Select","Select",""],["","71403000330","RHOFADE","CRE 0.01","30","Select","Select",""],["","51672421509","METRONIDAZOL","GEL 0.01","55","Select","Select",""],["","00002143480","TRULICITY","1.5 MG\/0.5","2","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","50","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","69315015510","HYDROCHLOROT","TAB 12.5MG","30","Select","Select",""],["","65702028810","FASTCLIX","MIS LANCETS","102","Select","Select",""],["","51672203506","MICONAZOLE","CRE 0.02","45","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","102","Select","Select",""],["","00904530680","BANOPHEN","25 MG","60","Select","Select",""],["","65702072910","ACCU-CHEK","KIT GUIDE","1","Select","Select",""],["","00904671772","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","67877022005","CEPHALEXIN","CAP 250MG","40","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","12","Select","Select",""],["","72065012012","GVOKE HYPO 2","INJ .5\/.1ML","0","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","65649030302","XIFAXAN","TAB 550MG","42","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00378110110","PRAZOSIN HCL","CAP 1MG","30","Select","Select",""],["","42806031250","DOXYCYCL HYC","TAB 100MG","14","Select","Select",""],["","65702073110","ACCU-CHECK","KIT GUIDE ME","1","Select","Select",""],["","50458056301","INVEGA SUST","INJ 156MG\/ML","1","Select","Select",""],["","53746052101","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","60","Select","Select",""],["","13668000705","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","57664051083","MIRTAZAPINE","TAB 7.5MG","30","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","400","Select","Select",""],["","00168020360","CLINDAMYCIN PHOSPHATE","1 %","60","Select","Select",""],["","68462019005","NAPROXEN","500 MG","20","Select","Select",""],["","69315015510","HYDROCHLOROTHIAZIDE","12.5 MG","30","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","20","Select","Select",""],["","45802010901","TRIAMCINOLONE ACETONIDE","55 MCG","16.9","Select","Select",""],["","51991029305","OXCARBAZEPINE","300 MG","60","Select","Select",""],["","56151014701","TRUEPLUS LANCETS","33 GAUGE","100","Select","Select",""],["","57237001999","DULOXETINE HCL","60 MG","30","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","300","Select","Select",""],["","68462034690","LEVOCETIRIZINE DIHYDROCHLORIDE","5 MG","90","Select","Select",""],["","00234057532","HIBICLENS","4 %","946","Select","Select",""],["","00093720198","PRAVASTATIN SODIUM","20 MG","90","Select","Select",""],["","53885027150","ONETOUCH VERIO TEST STRIP","","50","Select","Select",""],["","51672421509","METRONIDAZOLE","1 %","55","Select","Select",""],["","70010049105","METFORMIN HCL ER","500 MG","180","Select","Select",""],["","05928000100","NEILMED SINUS RINSE","","150","Select","Select",""],["","60505258008","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","65862020399","LOSARTAN POTASSIUM","100 MG","30","Select","Select",""],["","17478071710","KETOTIFEN FUMARATE","0.025 %","5","Select","Select",""],["","63402030230","LATUDA","20 MG","30","Select","Select",""],["","67877063830","LURASIDONE HCL","20 MG","30","Select","Select",""],["","59310058020","PROAIR RESPICLICK","90 MCG","1","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":""}]}]}