{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHANTEL E WILLIAMS","gend":1,"add":"1130 WOOLAND TERRACE DR","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1972-05-24","age":"","mstatus":"","insh":"20058020*01","cliId":"","pno":7577061191,"cno":7577061191,"email":"","ename":"","eno":"","pphy":"ESPIRITU, KEITH MD","ppno":7579831777,"pcpadd":"213 RIVER WALK PKWY STE 101,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23320-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Riverwalk","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575079043,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M25.519","M25.511","M25.512","Z20.828","M50.20","M25.571","M25.671","R26.89","M47.22","Z79.899","G47.33","M75.42","M75.82","M77.9","F43.21","R39.16","R10.30","R39.14","R35.0","R39.198","R39.15","N28.1","R10.32","R10.11","R14.2","K58.1","K21.9","K44.9","E66.3","K31.84","K76.0","K30.","R00.2","G56.22","J30.9","J45.909","G56.01","M79.605","I87.2","R07.9","K31.7","M79.2","U07.1","J06.9","J45.901","R51.9","H66.003","R00.1","I47.2","I49.1","M25.522","M25.622","G43.909","Q07.01","H81.13","R06.02","R20.0","R06.09","R20.2","U09.9","R13.10","M65.9","R07.89","M25.50","Z53.21","R03.0","E78.5","E66.09","Z68.37","Z01.411","L29.3","R30.0","Z90.721","Z90.722","Z12.11","N95.2","N39.46","R61.","E11.9","G47.00","B02.9","B00.9","F41.9","J02.9","G56.02","L90.5","M54.16","J30.89","R05.3","M75.41","R53.83","R43.2","M54.12","Z11.3","N39.42","J01.00","G95.9","G43.711","H47.093","H52.03","H52.223","H52.4","G56.23","E55.9","I73.9","G56.21","B34.9","R60.0","G56.03","K59.00","M75.111","M19.90","E66.9","I34.1","Z01.419","Z12.39","Z12.72","Z90.710","N93.9","Z20.822","N95.1","NO DATA","M79.7","G47.30","R32.","I10.","M51.17","M75.100","M54.2","M50.13","I63.9","L82.1","L82.0","L91.0","J18.9","Q21.12","R42.","I49.3","E11.42","M76.61","M79.671","M79.672","M25.531","M25.631","R10.13","H53.9","N39.0","I08.1","Z86.73","G89.29","H53.2","M54.30","G56.00","Z79.85","Z98.890","Z87.728","L74.9","E04.9","E11.69","J45.20","R05.2","Z79.4","G43.809","H25.813","H18.613"],"date":["2022-09-06","2021-01-06","2021-05-14","2022-05-26","2021-03-05","2021-07-29","2021-07-29","2021-07-29","2021-06-02","2021-06-08","2023-02-21","2022-08-10","2022-08-10","2022-08-10","2021-09-30","2021-12-10","2021-12-10","2021-12-10","2021-12-10","2021-12-10","2021-11-19","2021-12-10","2022-01-12","2022-01-12","2023-01-06","2022-01-12","2023-01-11","2022-01-12","2022-01-12","2022-01-12","2022-02-22","2022-02-22","2023-06-14","2022-09-06","2023-01-11","2023-01-11","2023-07-03","2021-04-07","2021-04-07","2021-06-25","2021-06-25","2021-07-02","2022-09-21","2022-11-07","2022-11-15","2022-04-13","2022-04-13","2022-05-05","2022-05-05","2023-06-14","2022-09-06","2022-09-06","2023-07-21","2022-11-15","2022-12-08","2023-06-28","2022-12-16","2022-12-21","2023-07-21","2022-12-21","2023-01-10","2023-03-23","2021-05-06","2023-07-03","2021-07-31","2022-05-05","2023-08-30","2022-04-13","2022-04-13","2022-09-27","2022-09-27","2023-03-08","2022-09-27","2022-09-27","2022-09-27","2023-03-08","2022-09-27","2023-08-02","2023-08-30","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2022-11-07","2023-04-03","2023-06-01","2023-07-03","2022-06-01","2022-06-01","2022-08-10","2023-03-08","2021-01-29","2021-05-25","2021-07-14","2021-12-10","2022-03-18","2022-02-14","2023-07-03","2021-07-13","2021-07-13","2021-07-13","2021-07-13","2023-07-03","2022-03-24","2022-03-24","2022-04-11","2022-05-26","2022-05-26","2022-12-19","2023-01-06","2021-01-11","2021-03-26","2021-03-26","2023-07-21","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2022-05-18","2023-03-08","2023-07-21","2023-08-01","2021-06-25","2021-07-19","2023-07-21","2022-04-15","2022-09-06","2022-09-06","2023-07-03","2023-05-04","2023-06-16","2023-06-16","2023-06-16","2023-06-17","2023-06-14","2023-06-14","2023-06-14","2023-06-21","2023-06-21","2023-06-21","2023-06-21","2023-06-01","2023-06-01","2023-06-30","2023-07-21","2023-07-21","2023-07-21","2023-07-21","2023-07-21","2023-07-21","2023-07-21","2023-07-21","2023-07-21","2023-07-21","2023-07-21","2023-08-30","2023-08-30","2023-08-30","2023-08-30","2023-08-30","2023-08-30","2023-07-25","2023-07-25","2023-07-25"],"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":[["","33342002507","FAMCICLOVIR","TAB 250MG","21","Select","Select",""],["","68462039710","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","90","Select","Select",""],["","72578008206","ACYCLOVIR","5 %","30","Select","Select",""],["","00006011231","JANUVIA","TAB 50MG","30","Select","Select",""],["","00187099445","ZOVIRAX","CRE 0.05","5","Select","Select",""],["","00766080155","ABREVA","CRE 0.1","2","Select","Select",""],["","31722070490","VALACYCLOVIR","500 MG","180","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","100","Select","Select",""],["","00904671740","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","69452014430","BENZONATATE","200 MG","90","Select","Select",""],["","62542030117","HYD POL\/CPM","SUS 10-8\/5ML","70","Select","Select",""],["","51224012230","AZITHROMYCIN","TAB 500MG","10","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","68682036790","DILTIAZEM","24HR ER 120 MG","30","Select","Select",""],["","65862016001","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","00378718705","METFORMIN","TAB 1000MG","60","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00781717612","NALOXONE","SPR 4MG","2","Select","Select",""],["","59310057922","PROAIR HFA","AER ","17","Select","Select",""],["","00781106110","ALPRAZOLAM","TAB 0.25MG","20","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","8","Select","Select",""],["","68001039803","FAMOTIDINE","40 MG","30","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","59746017506","PREDNISONE","20 MG","21","Select","Select",""],["","65862052790","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","80777027399","MODERNA VAC","INJ COVID-19","0","Select","Select",""],["","68001025317","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","42858010250","OXYCOD\/APAP","TAB 5-325MG","10","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","270","Select","Select",""],["","10702001850","OXYCODONE","TAB 5MG","20","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","8","Select","Select",""],["","00173089310","TRELEGY","AER 200MCG","60","Select","Select",""],["","00069034530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","31722017030","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00093216568","NALOXONE HCL","SPR 4MG","2","Select","Select",""],["","11917004918","ACETAMIN","TAB 500MG","60","Select","Select",""],["","00487980130","IPRATROPIUM","SOL 0.02%INH","75","Select","Select",""],["","00002143380","TRULICITY","0.75MG\/0.5","2","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","60","Select","Select",""],["","83490031065","VIOS","MIS SYSTEM","1","Select","Select",""],["","69367031056","SODIUM FLUOR","GEL 0.011","112","Select","Select",""],["","00126007292","PREVDNT 5000","PST 0.011","100","Select","Select",""],["","65862053750","LEVOFLOXACIN","TAB 500MG","10","Select","Select",""],["","68001036103","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","53885027025","ONETOUCH VERIO TEST STRIP","","25","Select","Select",""],["","68462034690","LEVOCETIRIZINE DIHYDROCHLORIDE","5 MG","30","Select","Select",""],["","00093720110","PRAVASTATIN SODIUM","20 MG","90","Select","Select",""],["","68382009705","PAROXETINE HCL","10 MG","30","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","17","Select","Select",""],["","00093354143","ESTRADIOL","0.01 %","42.5","Select","Select",""],["","65862052790","VENLAFAXINE HCL ER","37.5 MG","30","Select","Select",""],["","76204010060","IPRATROPIUM BROMIDE","0.2 MG\/ML","150","Select","Select",""],["","50111056003","TRAZODONE HCL","50 MG","60","Select","Select",""],["","68001043697","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","70010006510","METFORMIN HCL","1000 MG","60","Select","Select",""],["","64980041110","PREGABALIN","50 MG","60","Select","Select",""],["","00168009960","KETOCONAZOLE","2 %","60","Select","Select",""],["","24385048490","PAIN RELIEF EXTRA STRENGTH","500 MG","90","Select","Select",""],["","69489041130","QBREXZA","2.4 %","30","Select","Select",""],["","43598051010","ESOMEPRAZOLE MAGNESIUM","40 MG","30","Select","Select",""],["","00023114501","BOTOX","100 UNIT","1","Select","Select",""],["","00169418113","OZEMPIC .","25 OR 0.5","3","Select","Select",""],["","65862056099","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","60505083305","AZELASTINE HCL","137 MCG","30","Select","Select",""],["","82607066026","FLOWFLEX COVID-","19 AG HOME TEST","8","Select","Select",""],["","68382005105","MELOXICAM","15 MG","30","Select","Select",""],["","49884006601","GLYCOPYRROLATE","2 MG","60","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","30.6","Select","Select",""],["","52817033200","CYCLOBENZAPRINE HCL","10 MG","30","Select","Select",""],["","00766080155","ABREVA CRE","10%","2","Select","Select",""],["","33342002507","FAMCICLOVIR TAB","250MG","21","Select","Select",""],["","00006011231","JANUVIA TAB","50MG","30","Select","Select",""],["","55111064501","OMEPRAZOLE CAP","40MG","90","Select","Select",""],["","00456120130","LINZESS CAP","145MCG","30","Select","Select",""],["","45802004475","ACYCLOVIR CRE","5%","5","Select","Select",""],["","00187099445","ZOVIRAX CRE","5%","5","Select","Select",""],["","31722070430","VALACYCLOVIR TAB","500MG","60","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","100","Select","Select",""],["","00781717612","NALOXONE SPR","4MG","2","Select","Select",""],["","59310057922","PROAIR HFA AER","","17","Select","Select",""],["","00781106110","ALPRAZOLAM TAB","0.25MG","20","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","12","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","60","Select","Select",""],["","27808008602","HYD POL\/CPM SUS","10-8\/5ML","100","Select","Select",""],["","51224002230","AZITHROMYCIN TAB","250MG","8","Select","Select",""],["","16571040210","CETIRIZINE TAB","10MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE TAB","40MG","90","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","42806071401","BENZONATATE CAP","100MG","45","Select","Select",""],["","31722072690","MONTELUKAST TAB","10MG","30","Select","Select",""],["","80777027399","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","65162010250","GABAPENTIN CAP","300MG","90","Select","Select",""],["","00781185220","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","10702001850","OXYCODONE TAB","5MG","20","Select","Select",""],["","47335066981","DILTIAZEM CAP","120MG\/24","30","Select","Select",""],["","60432026415","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","65862053750","LEVOFLOXACIN TAB","500MG","10","Select","Select",""],["","65862052790","VENLAFAXINE CAP","37.5 ER","30","Select","Select",""],["","00378718705","METFORMIN TAB","1000MG","60","Select","Select",""],["","59746017310","PREDNISONE TAB","10MG","18","Select","Select",""],["","72578008201","ACYCLOVIR OIN","5%","15","Select","Select",""],["","68001025317","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","42858010250","OXYCOD\/APAP TAB","5-325MG","10","Select","Select",""],["","65862016001","ZOLPIDEM TAB","10MG","30","Select","Select",""],["","65162046650","IBUPROFEN TAB","800MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","10","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","36","Select","Select",""],["","83490031065","VIOS MIS SYSTEM","","1","Select","Select",""],["","53885014301","ONETOUCH MIS LANCETS","","100","Select","Select",""],["","00069034530","PAXLOVID TAB","300-100","30","Select","Select",""],["","00487980130","IPRATROPIUM SOL","0.02%INH","75","Select","Select",""],["","62332000931","VENLAFAXINE TAB","37.5MG","30","Select","Select",""],["","00173089310","TRELEGY AER","200MCG","60","Select","Select",""],["","27241009903","DULOXETINE CAP","60MG","30","Select","Select",""],["","00904672059","ACETAMIN TAB","500MG","60","Select","Select",""],["","11877001140","BINAXNOW COV KIT HOME TES","","8","Select","Select",""],["","69367031056","SODIUM FLUOR GEL","1.1%","112","Select","Select",""],["","00002143380","TRULICITY INJ","0.75\/0.5","2","Select","Select",""],["","00126007292","PREVDNT","5000 PST 1.1%","100","Select","Select",""],["","00093216568","NALOXONE HCL SPR","4MG","2","Select","Select",""],["","60505265301","TRAZODONE TAB","50MG","60","Select","Select",""],["","76204020030","ALBUTEROL NEB","0.083%","90","Select","Select",""],["","00093221001","SUCRALFATE","1 G","45","Select","Select",""],["","68001041508","DULOXETINE HCL","60 MG","30","Select","Select",""],["","00713065615","CLOBETASOL PROPIONATE","0.05 %","15","Select","Select",""],["","62135098505","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","00904722320","ROBAFEN DM","50-5MG\/5ML","118","Select","Select",""],["","00002143611","EMGALITY PEN","120 MG\/ML","1","Select","Select",""],["","00169406012","VICTOZA","2-PAK 0.6 MG\/0.1","6","Select","Select",""],["","08290320122","ULTRA-FINE NANO PEN NEEDLE","32GX 5\/32\"","100","Select","Select",""],["","00781713654","ESTRADIOL (ONCE WEEKLY) .","075MG\/24H","4","Select","Select",""],["","00597010061","SPIRIVA RESPIMAT","2.5 MCG","4","Select","Select",""],["","69315011710","FUROSEMIDE","40 MG","60","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":""}]}]}