{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DESTINEE  L COKLEY","gend":1,"add":"4508 GREENWOOD DR","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1989-08-22","age":"","mstatus":"","insh":"20064027*01","cliId":"","pno":3476684763,"cno":3476684763,"email":"","ename":"","eno":"","pphy":"AMBROSINO, JENNY PA","ppno":7576276220,"pcpadd":"SUITE 100 400 W BRAMBLETON AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23510-9998","pcpcounty":"","pcpid":"","pcpname":"Hague Medical Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576270200,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E10.10","E86.0","N17.9","E87.1","E10.65","E87.5","E10.43","D72.828","Z20.822","K31.84","J45.909","Z83.3","Z88.8","Z79.4","Z79.899","Z79.51","Z28.21","K21.9","Z96.41","R73.09","D72.829","E87.2","A41.9","G93.40","K85.80","R65.20","Z91.19","E10.11","Z68.1","M54.9","R10.10","G93.41","B37.0","I82.4Y2","V58.69","Z91.128","D64.9","I10.","Z79.01","NO DATA","N17.0","I82.502","E08.10","E34.8","Z68.20","R41.82","E87.6","E83.39","E11.65","E86.1","R40.4","R06.89","I95.9","R52.","G43.909","D63.8","E27.8","J45.20","F43.10","F32.9","Z91.14","E10.69","E16.2","R56.9","N30.01","E11.43","E78.5","R53.83","R63.6","R32.","G89.29","M54.6","M54.40","M54.2","R00.0","L03.111","R65.10","R11.2","M79.662","D53.9","Z86.718","R79.89","I82.5Y2","R73.9","R07.9","I48.91","I51.7","E10.8","R74.8","R94.5","Z68.22","R68.84","I82.512","I82.532","I82.542","I82.812","Z51.5","J80.","Z71.89","I82.412","Z68.23","E10.21","R11.0","M62.838","R12.","R10.13","R14.0","R13.10","R68.81","Z12.11","K29.70","K85.90","E44.0","R77.8","Z28.311","E13.10","R78.81","R68.89","T68.XXXA","I82.402","G43.109","A41.1","J96.01","J69.0","R65.21","R57.8","E83.51","Z56.0","F41.9","I82.432","R57.1","E87.0","Z53.20","Z91.199","N17.1","R40.0","N30.00","R10.84","E10.9","L02.91","R21.","I45.10","L97.919","E11.621","Z87.898","B96.89","R06.82","R06.02","R74.01","R79.9","L02.411","M79.89","E11.9","R65.11","I36.1","R09.02","I82.5Z9","Z68.25","R53.1","R46.4","E86.9","E11.21","B37.3","F32.1","F06.4","F41.0","F41.1","K04.7","M79.605","M79.604","I08.1","I50.23","E55.9","R94.31"],"date":["2023-01-18","2023-01-09","2023-01-17","2023-01-14","2023-01-14","2023-01-14","2023-01-14","2021-11-27","2023-01-14","2023-01-09","2022-04-26","2022-04-26","2023-01-09","2023-01-09","2023-01-09","2021-11-27","2021-11-27","2023-01-14","2022-06-29","2021-12-14","2023-01-14","2022-07-20","2023-01-18","2023-01-16","2022-06-22","2022-03-06","2022-07-22","2023-01-16","2023-01-11","2022-04-14","2022-04-14","2023-01-16","2022-05-07","2022-05-07","2023-01-09","2022-05-07","2023-01-14","2022-09-29","2023-01-09","2023-01-17","2022-05-10","2023-01-09","2022-05-28","2022-05-28","2022-07-21","2023-01-18","2023-01-14","2023-01-14","2022-12-24","2023-01-10","2023-01-14","2023-01-14","2023-01-14","2023-01-14","2021-02-15","2022-12-24","2022-01-04","2021-02-19","2021-02-15","2023-01-14","2023-01-09","2021-05-08","2021-11-09","2021-01-28","2021-09-28","2021-02-19","2021-05-04","2021-05-06","2021-05-05","2021-05-05","2022-02-23","2021-05-05","2021-05-08","2021-05-05","2023-03-29","2022-03-06","2022-07-20","2022-04-29","2022-04-30","2022-05-26","2022-06-29","2023-01-14","2023-01-11","2023-01-09","2022-06-29","2022-12-24","2021-02-18","2023-04-02","2023-01-14","2022-02-24","2022-02-24","2022-03-24","2023-01-10","2023-01-10","2022-06-23","2022-06-23","2022-07-01","2022-07-01","2022-07-01","2023-01-10","2023-01-16","2022-10-12","2022-05-12","2022-09-29","2021-09-16","2021-09-16","2021-09-16","2021-11-22","2021-09-16","2021-09-16","2021-11-22","2022-06-24","2022-05-15","2022-04-26","2022-04-26","2022-05-26","2022-05-28","2022-06-17","2022-06-22","2022-09-29","2022-09-29","2022-12-24","2022-12-24","2022-12-24","2023-01-18","2022-12-24","2022-12-24","2022-12-24","2022-12-24","2022-12-24","2023-01-16","2022-06-23","2023-01-09","2023-01-11","2021-02-18","2021-02-18","2021-12-14","2021-12-14","2021-12-14","2022-02-09","2022-02-09","2022-02-23","2022-05-30","2022-05-30","2022-05-27","2022-07-20","2022-07-20","2023-03-30","2023-01-14","2021-02-16","2022-03-07","2022-12-24","2022-03-07","2023-01-14","2022-12-25","2022-12-25","2022-12-25","2023-01-18","2023-01-17","2023-01-17","2023-01-14","2022-01-04","2022-03-22","2022-03-24","2022-03-22","2022-03-24","2022-03-24","2022-03-22","2023-03-30","2023-03-30","2023-03-29","2023-04-02","2023-04-02","2023-03-29"],"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":[["","00093220401","METOCLOPRAM","TAB 5MG","90","Select","Select",""],["","57664051083","MIRTAZAPINE","7.5 MG","30","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","200","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","9","Select","Select",""],["","00002751017","HUMALOG","INJ 100\/ML","3","Select","Select",""],["","72888001405","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","70010010801","GABAPENTIN","CAP 100MG","60","Select","Select",""],["","69543038810","KETOROLAC","TAB 10MG","20","Select","Select",""],["","00115174501","METAXALONE","TAB 400MG","15","Select","Select",""],["","65862018830","ONDANSETRON","TAB 8MG","30","Select","Select",""],["","65862052205","NAPROXEN","TAB 500MG","10","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","00536104815","ANTACID","CHW 500MG","60","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","10","Select","Select",""],["","55111064501","OMEPRAZOLE","CAP 40MG","60","Select","Select",""],["","53885039310","ONETOUCH US","MIS LANCETS","100","Select","Select",""],["","00002614527","BAQSIMI TWO","POW 3MG\/DOSE","2","Select","Select",""],["","00713022615","TRIAMCINOLON","CRE 0.00025","15","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","69097083305","SERTRALINE","TAB 25MG","30","Select","Select",""],["","70710122501","AMITRIPTYLIN","TAB 10MG","10","Select","Select",""],["","46581083006","SALONPAS GEL","PAD 0.04","10","Select","Select",""],["","50458057930","XARELTO","20 MG","30","Select","Select",""],["","68180058901","RAMIPRIL","CAP 2.5MG","30","Select","Select",""],["","08317234132","PEN NEEDLES","MIS 32GX4MM","100","Select","Select",""],["","65862050320","AMOX\/K CLAV","TAB 875-125","22","Select","Select",""],["","74312019377","VITAMIN D3","CAP 5000UNIT","30","Select","Select",""],["","71351001250","LACTOBACILLU","TAB ","48","Select","Select",""],["","50458058451","XARELTO STAR","TAB 15\/20MG","51","Select","Select",""],["","42858086706","DRONABINOL","CAP 2.5MG","60","Select","Select",""],["","50428054089","CVS D3","CAP 5000UNIT","30","Select","Select",""],["","65162079108","LIDOCAINE","5 %","30","Select","Select",""],["","29300039705","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","64980010401","PHOSPHA 250","TAB NEUTRAL","6","Select","Select",""],["","00002822259","INSULIN LISP","INJ 100\/ML","15","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","9","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","68382009305","CARVEDILOL","6.25 MG","60","Select","Select",""],["","00002879959","HUMALOG KWIKPEN U-","100 100\/ML","15","Select","Select",""],["","00078065920","ENTRESTO","24 MG-26MG","180","Select","Select",""],["","00955172805","INSULIN GLARGINE SOLOSTAR","100\/ML (3)","45","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","100","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","50428048545","B-","1 100 MG","30","Select","Select",""],["","66733082259","INSULIN LISPRO KWIKPEN U-","100 100\/ML","30","Select","Select",""],["","08290326895","SINGLE USE SWAB","","100","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","72888001405","CYCLOBENZAPRINE HCL","10 MG","90","Select","Select",""],["","68180035109","SERTRALINE HCL","25 MG","30","Select","Select",""],["","53885004601","ONETOUCH ULTRA","2","1","Select","Select",""],["","00093220401","METOCLOPRAMIDE HCL","5 MG","90","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","100","Select","Select",""],["","65862056090","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","53885001110","ONETOUCH DELICA PLUS LANCET","30 GAUGE","100","Select","Select",""],["","08290320119","ULTRA-FINE MINI PEN NEEDLE","31 GX3\/16\"","100","Select","Select",""],["","56151211101","TRUEPLUS PEN NEEDLE","31 GX3\/16\"","100","Select","Select",""],["","00904679480","ASPIRIN","81 MG","90","Select","Select",""],["","99073070827","FREESTYLE LITE TEST STRIP","","100","Select","Select",""],["","54629005701","VITAMIN B-","1 100 MG","30","Select","Select",""],["","31722053101","TORSEMIDE","20 MG","30","Select","Select",""],["","08317234132","TECHLITE PEN NEEDLE","32GX 5\/32\"","100","Select","Select",""],["","00003089421","ELIQUIS","5 MG","60","Select","Select",""],["","00555087302","MEDROXYPROGESTERONE ACETATE","5 MG","7","Select","Select",""],["","00406051201","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","10","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":""}]}]}