{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARMIN T HOWARD","gend":1,"add":"333 73RD ST APT C","city":"NEWPORT NEWS","state":"VA","zip":"23607-9998","dob":"1959-12-28","age":"","mstatus":"","insh":"20057454*01","cliId":"","pno":4344042008,"cno":4344042008,"email":"","ename":"","eno":"","pphy":"WEBSTER, ELIZABETH MD","ppno":7579755200,"pcpadd":"7401 WARWICK BLVD,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23607-9998","pcpcounty":"","pcpid":"","pcpname":"Riverside Center for Internal & Family Medicine","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7572230829,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","J30.2","J30.1","K21.9","M19.90","F31.9","F17.210","Z56.0","Z79.899","F14.20","M76.61","M77.31","M77.32","M25.571","R05.8","G43.009","F32.2","M25.532","G89.29","M25.512","M25.562","M25.561","Z82.61","M25.569","R09.81","R04.2","R19.5","K59.00","F19.10","F33.2","R41.3","R52.","Z02.2","J30.89","M17.0","F33.9","K08.89","T82.898A","H25.13","H04.123","F14.10","V62.84","R05.9","Z20.822","F17.200","R00.1","I49.9","R05.","F14.90","NO DATA","R04.0","R19.00","R10.32","L85.1","B35.3","L60.3","M72.2","S49.90XA","J34.89","R69.","R51.9","R19.7","R22.32","M25.461","M25.462","R25.2","T14.8XXA","J31.0","J32.9","Z72.0","R93.5","S99.911A","M67.01","F32.9","K59.01","J06.9","H40.003","H52.03","H52.4","J02.8","K12.2","Z90.89","J02.9","Z01.419","Z12.4","Z11.3","E55.9","Z13.31","Z12.11","Z12.39","R55.","B97.89","D25.9","J30.9","Z79.1","Z59.86","R09.82"],"date":["2023-03-23","2023-06-27","2021-04-26","2023-08-25","2021-10-11","2023-08-14","2023-08-25","2021-10-11","2023-08-14","2023-05-24","2023-08-25","2023-03-14","2023-03-14","2023-03-14","2021-11-24","2021-12-15","2021-01-06","2021-01-16","2021-04-11","2021-03-07","2021-09-27","2021-12-15","2021-04-11","2021-04-11","2021-04-22","2022-04-26","2022-04-26","2023-07-15","2022-04-26","2023-09-20","2022-04-12","2023-08-13","2022-12-09","2022-05-11","2022-05-11","2022-12-08","2021-10-11","2021-08-19","2023-08-02","2021-11-12","2021-12-01","2022-12-08","2023-08-14","2023-08-14","2021-12-02","2022-05-11","2022-12-09","2021-09-27","2021-09-27","2022-05-10","2021-12-15","2022-12-08","2022-12-09","2021-01-05","2021-01-05","2021-01-05","2021-01-05","2021-03-07","2021-04-22","2021-04-26","2021-08-18","2021-08-18","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2021-11-23","2022-04-26","2022-04-26","2022-04-26","2022-12-09","2023-03-14","2023-08-25","2023-06-07","2023-06-07","2023-08-14","2023-08-02","2023-08-02","2023-08-02","2023-08-21","2023-08-25","2023-08-25","2023-08-25","2023-08-30","2023-08-30","2023-08-30","2023-08-30","2023-08-30","2023-08-30","2023-08-30","2023-08-14","2023-08-13","2023-07-15","2023-08-14","2023-08-14","2023-08-14","2023-08-14"],"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":[["","42808020428","UREA NAIL","GEL 0.45","28","Select","Select",""],["","00904572514","MINTOX","SUS MAX ST","355","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","10","Select","Select",""],["","45802086866","POLYETH GLYC","POW 3350 NF","14","Select","Select",""],["","00113201339","ALLERGY\/CONG","TAB 5-120MG","20","Select","Select",""],["","43598082314","FEXOFEN\/PSE","TAB 60-120MG","20","Select","Select",""],["","49348054301","LORATA-DINE","TAB D 24HR","20","Select","Select",""],["","11523716202","CLARITIN-D","TAB 5-120MG","20","Select","Select",""],["","68645052354","SERTRALINE","TAB 100MG","45","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","68382080601","TRAZODONE","TAB 100MG","30","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","41167431002","ALLEGRA-D","TAB 12 HOUR","20","Select","Select",""],["","70677003601","LORATADINE D","TAB 5-120MG","20","Select","Select",""],["","29300041319","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","42","Select","Select",""],["","00067606910","LORATADINE","TAB 10MG","30","Select","Select",""],["","55111015330","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","49483034010","ACETAMIN","TAB 325MG","20","Select","Select",""],["","16714017001","BUT\/APAP\/CAF","CAP ","60","Select","Select",""],["","00225038080","AYR","SPR 0.0065","50","Select","Select",""],["","00904674740","IBUPROFEN","200 MG","64","Select","Select",""],["","00067627550","GAS-X","CAP 125MG","30","Select","Select",""],["","23155050101","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","10","Select","Select",""],["","65162079108","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","23155002601","VERAPAMIL","TAB 80MG","28","Select","Select",""],["","42806071401","BENZONATATE","100 MG","20","Select","Select",""],["","55111029236","SUMATRIPTAN","TAB 50MG","9","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","49281042150","FLUZONE QUAD","INJ 2021-22","0","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","37000045504","PRILOSEC OTC","TAB 20MG","42","Select","Select",""],["","49348003210","SM GENTLE","TAB LAXATIVE","60","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","2","Select","Select",""],["","80681008500","MELATONIN","TAB 3MG","30","Select","Select",""],["","00378210001","LOPERAMIDE","CAP 2MG","12","Select","Select",""],["","00115180401","HYDROXYZ PAM","CAP 50MG","30","Select","Select",""],["","68382005105","MELOXICAM","15 MG","30","Select","Select",""],["","68382080601","TRAZODONE HCL","100 MG","30","Select","Select",""],["","68645052354","SERTRALINE HCL","100 MG","30","Select","Select",""],["","62011028702","CLEARLAX","17 G\/DOSE","510","Select","Select",""],["","80681000900","VITAMIN D","3 50 MCG","30","Select","Select",""],["","68462039501","OMEPRAZOLE","10 MG","30","Select","Select",""],["","00904699880","DOCUSATE SODIUM","100 MG","60","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","54162033505","PEG","3350-GRX","454","Select","Select",""],["","70010016305","CETIRIZINE HCL","10 MG","90","Select","Select",""],["","00603020922","MAGNESIUM OXIDE","400 MG","30","Select","Select",""],["","16714017001","BUT\/APAP\/CAF CAP","","60","Select","Select",""],["","00225038080","AYR SPR","0.65%","50","Select","Select",""],["","45802091987","CETIRIZINE TAB","10MG","10","Select","Select",""],["","68645052354","SERTRALINE TAB","100MG","45","Select","Select",""],["","45802065078","LORATADINE TAB","10MG","30","Select","Select",""],["","29300041319","CYCLOBENZAPR TAB","5MG","30","Select","Select",""],["","64380080807","IBUPROFEN TAB","600MG","20","Select","Select",""],["","45802086866","POLYETH GLYC POW","3350 NF","14","Select","Select",""],["","00781261305","AMOXICILLIN CAP","500MG","42","Select","Select",""],["","68382080601","TRAZODONE TAB","100MG","30","Select","Select",""],["","00054327099","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","31722071390","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","43547040111","FUROSEMIDE TAB","20MG","1","Select","Select",""],["","37000045504","PRILOSEC OTC TAB","20MG","42","Select","Select",""],["","00904530660","BANOPHEN CAP","25MG","2","Select","Select",""],["","65162079108","LIDOCAINE PAD","5%","30","Select","Select",""],["","49483034010","ACETAMIN TAB","325MG","20","Select","Select",""],["","00378210001","LOPERAMIDE CAP","2MG","12","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","10","Select","Select",""],["","00115180401","HYDROXYZ PAM CAP","50MG","30","Select","Select",""],["","80681008500","MELATONIN TAB","3MG","30","Select","Select",""],["","49348003210","SM GENTLE TAB LAXATIVE","","60","Select","Select",""],["","00006409602","VAQTA","50 UNIT\/ML","1","Select","Select",""],["","49035007021","MUCUS ER","600 MG","20","Select","Select",""],["","00904505359","SUDOGEST","30 MG","20","Select","Select",""],["","45802086803","POLYETHYLENE GLYCOL","3350 17 G\/DOSE","510","Select","Select",""],["","00006499541","RECOMBIVAX HB","10 MCG\/ML","1","Select","Select",""],["","58160082311","SHINGRIX","50 MCG\/0.5","1","Select","Select",""],["","00005200002","PREVNAR","20 0.5 ML","0.5","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","00904672080","ACETAMINOPHEN","500 MG","30","Select","Select",""],["","58160084211","BOOSTRIX TDAP","2.5-8-5\/.5","0.5","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":""}]}]}