{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STACEY L SPIRES","gend":1,"add":"220 CHOWAN DR APT D","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1975-11-11","age":"","mstatus":"","insh":"20067095*01","cliId":"","pno":7576294605,"cno":7576294605,"email":"","ename":"","eno":"","pphy":"STRONG, WILLIAM P MD","ppno":7574883333,"pcpadd":"3925 PORTSMOUTH BLVD,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23321-9998","pcpcounty":"","pcpid":"","pcpname":"Family Medicine Healthcare, PLLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574880007,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M15.9","M79.7","M54.89","R32.","H81.10","M54.5","R31.9","H25.13","H16.223","F41.1","F33.1","F51.01","M54.41","G89.29","R55.","S99.919A","S82.842A","U07.1","F25.9","E11.9","E55.9","E66.01","E78.5","E87.5","F31.30","F41.9","G40.909","K59.00","I10.","K21.9","N28.9","E87.6","S82.892A","S90.512A","Z68.39","S90.522A","Z91.19","V54.16","Z74.09","Z78.9","Z68.41","R41.82","R53.83","Z20.822","G47.30","Z87.891","Z79.01","Z79.899","R44.0","S92.502A","Z98.890","S99.912A","E66.9","Z88.2","Z88.6","Z88.8","Z91.013","M25.472","M79.89","M79.606","T88.7XXA","R06.9","M79.609","M13.0","M62.40","F32.9","M25.562","M54.9","R35.0","G56.21","R42.","Z23.","NO DATA","M25.572","F31.5","S82.402A","F31.4","Z68.38","K92.2","S82.843B","F31.9","G47.00","G43.909","F17.210","F10.21","F31.2","F31.10","F51.11","Z01.810","R07.89","M94.0","R40.4","Z68.42","Z68.43","G40.209","V62.84","F43.10","G89.4","Z82.49","Z83.3","Z86.16","Z87.11","Z90.49","Z90.710","M25.561","Z91.14","R06.02","R56.9","R52.","Z51.81","M51.36","J02.9","R07.9","W19.XXXD","R44.3","F20.9","F99.","I95.9","T50.901A","R10.9","R73.01","R10.84","G89.18","M47.816","M85.80","I89.0","R41.0","Z03.818","Z71.89","M51.37","M17.0","I51.7","R41.9","Z87.898","Z86.59","M79.672","R60.0","R79.1","R73.03","R94.31","L73.9","T48.1X1A","G47.33","Z01.419","Z12.72","N76.0","M25.579","M19.072","M23.91","M23.92","R41.3","M79.661","M79.662","M13.161","M13.162","Z79.84","M13.861","M13.862","R00.0","Z03.89","M79.604","M76.62","R06.00","F51.3"],"date":["2021-03-04","2023-07-03","2021-03-04","2021-03-29","2021-03-08","2021-09-20","2021-03-08","2021-04-23","2021-04-23","2023-09-21","2021-07-08","2021-07-08","2021-09-28","2023-08-08","2022-05-29","2022-05-29","2022-07-08","2022-08-03","2022-12-22","2023-04-23","2022-08-03","2023-04-17","2022-12-20","2022-06-08","2022-06-08","2023-08-08","2023-04-23","2022-08-03","2023-08-08","2023-01-27","2022-06-08","2022-06-08","2022-06-08","2022-06-08","2022-06-09","2022-06-10","2022-06-08","2022-11-14","2022-07-15","2022-07-15","2022-09-25","2023-01-17","2022-08-16","2023-01-15","2023-04-23","2023-04-23","2022-11-04","2023-04-23","2022-08-16","2022-08-24","2022-09-25","2022-09-25","2023-01-17","2022-09-25","2022-09-25","2022-09-25","2022-09-25","2022-09-25","2023-08-22","2022-10-29","2021-01-03","2021-01-03","2022-05-24","2022-05-24","2021-02-01","2022-07-01","2023-07-07","2022-12-20","2021-09-20","2021-08-09","2022-08-17","2021-09-20","2023-07-03","2023-02-01","2022-06-30","2022-06-23","2022-10-25","2022-06-23","2022-06-29","2022-07-15","2022-08-17","2023-09-21","2022-08-03","2022-08-03","2022-08-03","2023-09-21","2021-01-22","2021-01-22","2022-06-09","2023-04-23","2022-08-02","2022-12-20","2023-01-17","2023-04-17","2023-04-21","2022-12-20","2022-12-20","2022-12-20","2022-12-20","2022-12-20","2022-12-20","2022-12-20","2022-12-20","2022-12-20","2023-02-21","2022-08-16","2023-08-08","2022-12-20","2022-12-20","2023-04-21","2023-02-21","2022-03-23","2023-06-20","2022-07-02","2022-08-17","2022-08-17","2022-08-17","2023-01-17","2023-01-17","2021-07-16","2021-07-16","2023-01-15","2022-06-10","2023-02-21","2022-11-14","2022-11-14","2022-12-20","2022-12-20","2023-01-27","2021-02-19","2023-04-17","2021-07-18","2023-04-21","2021-11-16","2021-11-16","2023-08-08","2023-08-22","2023-07-19","2022-11-12","2021-03-19","2022-03-01","2023-01-17","2023-08-30","2021-12-14","2021-12-14","2021-12-14","2023-02-16","2023-02-16","2023-04-17","2023-04-17","2023-04-21","2023-01-05","2023-01-05","2023-01-05","2023-01-05","2023-04-23","2023-07-03","2023-07-03","2023-07-19","2023-08-23","2023-08-22","2023-08-28","2023-08-30","2023-08-30"],"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":[["","65862059501","DIVALPROEX","TAB 500MG ER","60","Select","Select",""],["","00781107905","ALPRAZOLAM","1 MG","120","Select","Select",""],["","16571066101","MECLIZINE","TAB 25MG","30","Select","Select",""],["","61874016030","VRAYLAR","CAP 6MG","30","Select","Select",""],["","70436005801","BUPROPION","TAB 100MG SR","60","Select","Select",""],["","43598029390","PREGABALIN","75 MG","60","Select","Select",""],["","57237016199","OMEPRAZOLE","20 MG","30","Select","Select",""],["","13668019030","TOLTERODINE","CAP 4MG ER","30","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","30","Select","Select",""],["","60505025103","TIZANIDINE","TAB 2MG","15","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","68180078001","ZOLPIDEM ER","TAB 12.5MG","30","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","9","Select","Select",""],["","69097094605","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","42806016105","HYDROXYZ HCL","TAB 50MG","120","Select","Select",""],["","68382025601","OXYBUTYNIN","TAB 10MG ER","30","Select","Select",""],["","68180071909","AMLODIPINE","TAB 2.5MG","30","Select","Select",""],["","43598043501","NITROGLYCERN","SUB 0.3MG","100","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","14","Select","Select",""],["","52536068210","CARISOPRODOL","TAB 250MG","40","Select","Select",""],["","00143312601","DICYCLOMINE","CAP 10MG","90","Select","Select",""],["","70954002010","PRAZOSIN HCL","2 MG","180","Select","Select",""],["","00172392570","DIAZEPAM","TAB 2MG","15","Select","Select",""],["","80681017401","VITAMIN D","3 CAP 1.25MG","4","Select","Select",""],["","00093031101","LOPERAMIDE","CAP 2MG","180","Select","Select",""],["","00555032402","HYDROXYZ PAM","CAP 100MG","60","Select","Select",""],["","00603188016","LIDOCAINE","5 %","30","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","24658031205","DOXYCYCL HYC","TAB 100MG","14","Select","Select",""],["","27241009809","DULOXETINE","CAP 30MG","60","Select","Select",""],["","43547030703","ARIPIPRAZOLE","30 MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","45802048678","DOCUSATE SOD","CAP 100MG","90","Select","Select",""],["","80681017401","VITAMIN D3","CAP 1.25MG","4","Select","Select",""],["","59779067613","CVS C-LAX","TAB 5MG","30","Select","Select",""],["","40093010164","MELATONIN","TAB 5MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","21","Select","Select",""],["","70710134403","RAMELTEON","TAB 8MG","30","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","12","Select","Select",""],["","50458058030","XARELTO","TAB 10MG","30","Select","Select",""],["","59651017501","DOXEPIN HCL","50 MG","30","Select","Select",""],["","00006000530","BELSOMRA","TAB 5MG","30","Select","Select",""],["","57664050658","METOPROL TAR","TAB 25MG","60","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","10","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","14","Select","Select",""],["","76385012450","METHOCARBAM","TAB 750MG","14","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","64980056210","FUROSEMIDE","20 MG","30","Select","Select",""],["","59148003713","REXULTI","TAB 1MG","30","Select","Select",""],["","43547022215","LEVETIRACETA","TAB 500MG","60","Select","Select",""],["","00456120130","LINZESS","145 MCG","30","Select","Select",""],["","45802048678","DOCUSATE SODIUM","100 MG","90","Select","Select",""],["","33342007007","OLANZAPINE","10 MG","30","Select","Select",""],["","47335030888","ZOLPIDEM TARTRATE ER","12.5 MG","30","Select","Select",""],["","27241009809","DULOXETINE HCL","30 MG","60","Select","Select",""],["","47781030301","NITROFURANTOIN MONO-MACRO","100 MG","14","Select","Select",""],["","55111018015","TIZANIDINE HCL","4 MG","60","Select","Select",""],["","70954000520","OXYBUTYNIN CHLORIDE","5 MG","180","Select","Select",""],["","00597015337","JARDIANCE","25 MG","30","Select","Select",""],["","60505016601","FLUVOXAMINE MALEATE","100 MG","30","Select","Select",""],["","31722053812","LEVETIRACETAM","750 MG","60","Select","Select",""],["","70377002911","ATORVASTATIN CALCIUM","40 MG","30","Select","Select",""],["","50428038612","ACETAMINOPHEN","500 MG","60","Select","Select",""],["","57664050658","METOPROLOL TARTRATE","25 MG","30","Select","Select",""],["","00469260130","MYRBETRIQ","25 MG","90","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","300","Select","Select",""],["","60505265501","TRAZODONE HCL","150 MG","30","Select","Select",""],["","70710116201","MECLIZINE HCL","25 MG","90","Select","Select",""],["","65862059505","DIVALPROEX SODIUM ER","500 MG","60","Select","Select",""],["","69097015907","MELOXICAM","15 MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","500 MG","14","Select","Select",""],["","43598043611","NITROGLYCERIN","0.4 MG","25","Select","Select",""],["","70710122501","AMITRIPTYLINE HCL","10 MG","30","Select","Select",""],["","59779060027","ASPIRIN EC","81 MG","30","Select","Select",""],["","70954002010","PRAZOSIN HCL CAP","2MG","30","Select","Select",""],["","00093007301","ZOLPIDEM TAB","5MG","5","Select","Select",""],["","00781107905","ALPRAZOLAM TAB","1MG","120","Select","Select",""],["","57237016199","OMEPRAZOLE CAP","20MG","30","Select","Select",""],["","00555032402","HYDROXYZ PAM CAP","100MG","60","Select","Select",""],["","60505025103","TIZANIDINE TAB","2MG","15","Select","Select",""],["","42806016105","HYDROXYZ HCL TAB","50MG","60","Select","Select",""],["","61874016030","VRAYLAR CAP","6MG","30","Select","Select",""],["","43598029290","PREGABALIN CAP","50MG","60","Select","Select",""],["","70377002911","ATORVASTATIN TAB","40MG","30","Select","Select",""],["","65862059501","DIVALPROEX TAB","500MG ER","120","Select","Select",""],["","68180078001","ZOLPIDEM ER TAB","12.5MG","30","Select","Select",""],["","68382025601","OXYBUTYNIN TAB","10MG ER","30","Select","Select",""],["","16571066101","MECLIZINE TAB","25MG","30","Select","Select",""],["","70436005801","BUPROPION TAB","100MG SR","60","Select","Select",""],["","27241009809","DULOXETINE CAP","30MG","60","Select","Select",""],["","43547030703","ARIPIPRAZOLE TAB","30MG","30","Select","Select",""],["","59779067613","CVS C-LAX TAB","5MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP TAB","5-325MG","12","Select","Select",""],["","45802048678","DOCUSATE SOD CAP","100MG","90","Select","Select",""],["","65162004710","OXYCODONE TAB","5MG","12","Select","Select",""],["","70710134403","RAMELTEON TAB","8MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","6","Select","Select",""],["","59651017501","DOXEPIN HCL CAP","50MG","30","Select","Select",""],["","76385012450","METHOCARBAM TAB","750MG","14","Select","Select",""],["","00603188016","LIDOCAINE PAD","5%","14","Select","Select",""],["","07610015540","MELATONIN TAB","5MG","30","Select","Select",""],["","68462010530","ONDANSETRON TAB","4MG","14","Select","Select",""],["","57664050658","METOPROL TAR TAB","25MG","60","Select","Select",""],["","00006000530","BELSOMRA TAB","5MG","30","Select","Select",""],["","50458058030","XARELTO TAB","10MG","30","Select","Select",""],["","69097081312","GABAPENTIN CAP","100MG","10","Select","Select",""],["","43547040211","FUROSEMIDE TAB","40MG","5","Select","Select",""],["","69097052444","DICLOFENAC GEL","1%","100","Select","Select",""],["","59148003713","REXULTI TAB","1MG","30","Select","Select",""],["","43547022215","LEVETIRACETA TAB","500MG","60","Select","Select",""],["","29300046810","CLONIDINE HCL","0.1 MG","30","Select","Select",""],["","65862016001","ZOLPIDEM TARTRATE","10 MG","30","Select","Select",""],["","00093342210","CYCLOBENZAPRINE HCL","10 MG","15","Select","Select",""],["","53746010901","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","10","Select","Select",""],["","00406051205","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","10","Select","Select",""],["","68382025501","OXYBUTYNIN CHLORIDE ER","5 MG","15","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","17","Select","Select",""],["","00781802801","TRIFLUOPERAZINE HCL","1 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":""}]}]}