{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRACY M COTTEE-SWEAT","gend":1,"add":"4922 EDWIN LN","city":"HAYES","state":"VA","zip":"23072-9998","dob":"1985-05-25","age":"","mstatus":"","insh":"20059385*01","cliId":"","pno":7579475724,"cno":7579475724,"email":"","ename":"","eno":"","pphy":"VALLS, FRANCISCO X MD","ppno":8046932720,"pcpadd":"STE 2200 7547 MEDICAL DRIVE,","pcpcity":"GLOUCESTER","pcpstate":"VA","pcpzip":"23061-9998","pcpcounty":"","pcpid":"","pcpname":"Internal Medicine Associates of Gloucester","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":8045940597,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["S93.402A","M25.512","J06.9","B97.89","J45.901","Z20.822","G89.4","M53.3","M54.41","M54.42","Z91.81","Z98.890","G47.33","G47.19","G47.10","R06.83","M47.816","M96.1","J45.51","Z87.891","Z77.120","Z98.84","Z91.09","G43.509","G89.29","J45.20","F17.210","Z90.3","NO DATA","Z51.81","R20.2","M54.2","R42.","M79.622","S91.331A","G43.009","I10.","G12.21","G25.81","Z59.6","Z90.49","D58.2","J45.50","F32.5","R20.0","R20.8","M75.52","M77.8","M54.12","G54.2","Z98.1","E66.9","K21.9","E78.5","E55.9","E53.8","E61.1","G43.709","E07.9","M79.7","Z87.39","Z93.1","Z96.82","M25.572","J30.1","M54.16","M46.1","Z11.7","Z96.89","R49.0","G95.19","Z23.","G62.9","M51.36","H04.123","H02.721","H02.724","K64.8","K62.5","R10.84","R19.7","R11.0","R13.19","Z83.79","G47.30","Z68.29","K92.1"],"date":["2022-04-17","2022-04-17","2023-02-13","2022-06-08","2022-06-08","2022-06-08","2022-09-06","2022-09-06","2023-03-08","2023-03-08","2022-09-06","2023-03-08","2022-10-03","2022-10-17","2022-10-03","2022-10-17","2022-12-08","2022-12-08","2022-07-05","2022-06-24","2022-06-24","2023-09-07","2022-06-24","2022-07-06","2023-03-08","2023-03-22","2023-09-03","2023-03-22","2023-03-08","2022-10-19","2021-02-26","2021-12-01","2021-10-07","2021-11-01","2022-07-19","2023-07-28","2023-09-03","2023-09-03","2023-03-06","2023-03-06","2023-03-06","2021-01-19","2023-02-13","2021-01-19","2021-02-26","2021-02-26","2021-12-01","2021-12-01","2021-12-01","2023-03-22","2023-03-22","2023-09-03","2023-09-07","2023-03-22","2023-03-22","2023-03-22","2023-03-22","2023-09-05","2023-09-03","2022-04-17","2022-04-17","2022-04-17","2023-09-03","2022-04-17","2022-10-17","2023-04-07","2022-09-23","2022-09-16","2023-03-22","2022-08-15","2023-03-22","2022-09-30","2022-09-30","2022-09-30","2023-02-21","2023-02-21","2023-02-21","2023-09-03","2023-09-07","2023-09-07","2023-09-07","2023-09-07","2023-09-07","2023-09-07","2023-09-03","2023-09-03","2023-09-03"],"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":[["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","59310057922","PROAIR HFA","AER ","17","Select","Select",""],["","80681017400","VITAMIN D3","CAP 50000UNT","4","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","31722070730","FAMCICLOVIR","TAB 250MG","60","Select","Select",""],["","00406048501","APAP\/CODEINE","TAB 300-60MG","21","Select","Select",""],["","00093342501","LORAZEPAM","0.5 MG","30","Select","Select",""],["","50228017705","GABAPENTIN","600 MG","90","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","70700015010","OMEPRAZOLE","20 MG","90","Select","Select",""],["","29300041519","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","16729017317","AMITRIPTYLIN","TAB 50MG","30","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","57664037713","TRAMADOL HCL","TAB 50MG","60","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","51663000500","OPTIMAL-D","CAP 50000UNT","4","Select","Select",""],["","53191036201","D3-50","CAP 50000UNT","4","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","118","Select","Select",""],["","50111078751","AZITHROMYCIN","250 MG","6","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","1","Select","Select",""],["","00487020160","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","65862014836","SUMATRIPTAN","TAB 100MG","27","Select","Select",""],["","65862017260","TOPIRAMATE","50 MG","60","Select","Select",""],["","59746017509","PREDNISONE","20 MG","10","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","81131011187","B-12","SUB 500MCG","30","Select","Select",""],["","70069000510","CYANOCOBALAM","INJ 1000MCG","1","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","2","Select","Select",""],["","00406048501","ACETAMINOPHEN-CODEINE","300MG-60MG","120","Select","Select",""],["","00487020103","IPRATROPIUM-ALBUTEROL","0.5-3MG\/3","360","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","29300042110","AMITRIPTYLINE HCL","50 MG","30","Select","Select",""],["","00002143611","EMGALITY PEN","120 MG\/ML","1","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","70069000510","CYANOCOBALAMIN INJECTION","1000MCG\/ML","1","Select","Select",""],["","65862014836","SUMATRIPTAN SUCCINATE","100 MG","9","Select","Select",""],["","29300041519","CYCLOBENZAPRINE HCL","10 MG","90","Select","Select",""],["","00574402435","ERYTHROMYCIN","5 MG\/GRAM","3.5","Select","Select",""],["","80681012800","VITAMIN B-","12 500 MCG","30","Select","Select",""],["","00093221005","SUCRALFATE","1 G","120","Select","Select",""],["","68645059459","FAMOTIDINE","20 MG","60","Select","Select",""],["","80681017400","VITAMIN D","3 1250 MCG","12","Select","Select",""],["","53191036201","D","3-50 1250 MCG","4","Select","Select",""],["","99866050669",""," ","30","Select","Select",""],["","59310057922","PROAIR HFA AER","","17","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","29300022019","MONTELUKAST TAB","10MG","30","Select","Select",""],["","00406048501","APAP\/CODEINE TAB","300-60MG","120","Select","Select",""],["","16729017317","AMITRIPTYLIN TAB","50MG","30","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","57664037713","TRAMADOL HCL TAB","50MG","60","Select","Select",""],["","00093342501","LORAZEPAM TAB","0.5MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","10","Select","Select",""],["","50228017705","GABAPENTIN TAB","600MG","90","Select","Select",""],["","70700015010","OMEPRAZOLE CAP","20MG","90","Select","Select",""],["","00487950103","ALBUTEROL NEB","0.083%","75","Select","Select",""],["","51663000500","OPTIMAL-D CAP","50000UNT","4","Select","Select",""],["","29300041519","CYCLOBENZAPR TAB","10MG","90","Select","Select",""],["","59746017509","PREDNISONE TAB","20MG","15","Select","Select",""],["","65862014836","SUMATRIPTAN TAB","100MG","9","Select","Select",""],["","50111078751","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","00487020103","IPRATROPIUM\/ SOL ALBUTER","","360","Select","Select",""],["","65862017260","TOPIRAMATE TAB","50MG","60","Select","Select",""],["","00002143611","EMGALITY INJ","120MG\/ML","1","Select","Select",""],["","60432060416","PROMETHAZINE SYP DM","","118","Select","Select",""],["","67877021905","CEPHALEXIN CAP","500MG","40","Select","Select",""],["","50383066730","LIDO\/PRILOCN CRE","2.5-2.5%","30","Select","Select",""],["","70069000510","CYANOCOBALAM INJ","1000MCG","1","Select","Select",""],["","81131011187","B-","12 SUB 500MCG","30","Select","Select",""],["","11877001140","BINAXNOW COV KIT HOME TES","","2","Select","Select",""],["","69367020301","BUTALBITAL-ACETAMINOPHEN-CAFFE","50-325-40","30","Select","Select",""],["","72618300002","NURTEC ODT","75 MG","8","Select","Select",""],["","49035026201","ARTHRITIS PAIN","1 %","100","Select","Select",""],["","00067003028","BENEFIBER","3 G\/3.5 G","90","Select","Select",""],["","45802095301","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","00143122701","DICYCLOMINE HCL","20 MG","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":""}]}]}