{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SABRINA WILBER","gend":1,"add":"3801 BOWSPRIT CIR APT 204","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1966-02-02","age":"","mstatus":"","insh":"20071145*01","cliId":"","pno":7579493450,"cno":7579493450,"email":"","ename":"","eno":"","pphy":"ELLIOTT, JOY DO","ppno":7575943800,"pcpadd":"10510 JEFFERSON AVENUE STE A,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23601-9998","pcpcounty":"","pcpid":"","pcpname":"Riverside Brentwood Medical Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575943818,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R52.","R55.","S06.330A","I61.1","W18.30XA","Z79.02","Z95.0","F14.90","I25.10","I25.119","Z95.5","I10.","E78.5","Z95.810","Z95.818","S06.5X9A","G93.6","I50.22","J45.20","K59.00","D57.3","E11.9","E87.6","F14.10","F32.9","I11.0","T50.1X5A","I25.2","I25.5","R00.1","I61.0","I60.9","I50.9","I73.9","M25.561","G89.29","R07.9","R94.31","R31.29","R30.0","R19.8","R10.9","L20.84","L81.0","G57.62","M19.90","M79.672","M65.872","S06.6X9A","S06.349A","M17.11","Z47.89","I51.89","R06.02","I25.110","R91.1","F33.1","R20.2","L70.0","Z71.9","V58.89","I25.118","Z87.891","I11.9","R53.83","J01.90","G47.09","N17.9","S06.320A","G93.5","S06.369A","R51.9","I77.1","R31.0","D23.9","M54.2","R94.2","J84.9","R31.9","K29.60","N89.8","Z23.","Z71.85","L28.1","S06.5X0A","S06.2X0A","Z86.79","Z79.01","Z79.82","Z79.899","Z88.0","Z88.1","Z88.8","Z91.041","I51.7","I08.2","W19.XXXD","Z74.09","Z78.9","M25.551","M54.6","N64.89","R22.1","Z12.31","Z79.84","S39.012A","I49.3","R00.2","N30.00","L70.5"],"date":["2021-02-05","2021-02-06","2021-02-08","2021-02-08","2021-02-08","2021-12-14","2021-02-08","2021-02-08","2022-04-07","2023-06-15","2023-02-14","2023-07-31","2023-06-15","2023-06-20","2023-06-20","2021-02-26","2021-02-06","2023-06-15","2021-10-12","2021-02-05","2021-02-05","2023-09-01","2021-02-05","2021-02-06","2021-02-05","2023-06-15","2021-02-05","2022-04-07","2023-05-09","2021-02-05","2021-02-26","2021-02-08","2021-02-06","2023-06-28","2023-07-31","2023-08-09","2021-09-14","2021-09-14","2022-03-21","2023-06-28","2021-10-15","2021-10-15","2021-12-28","2021-12-28","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2021-02-07","2021-02-05","2023-08-09","2021-04-15","2021-07-07","2022-01-04","2022-11-02","2023-06-28","2023-06-28","2022-01-04","2022-03-14","2023-08-09","2021-03-03","2021-12-14","2022-12-16","2021-12-14","2022-08-09","2021-01-07","2021-01-14","2021-01-14","2021-02-05","2021-02-05","2021-02-07","2021-02-14","2021-06-07","2021-12-01","2021-12-01","2021-12-01","2021-12-01","2021-12-01","2022-01-20","2022-09-22","2022-08-09","2022-09-22","2022-09-22","2023-09-14","2021-02-14","2021-02-14","2021-05-11","2021-05-11","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-04-07","2021-02-07","2021-02-08","2021-02-08","2021-02-08","2023-02-14","2021-10-07","2021-10-07","2021-10-07","2021-10-07","2023-02-14","2023-04-21","2023-05-09","2023-05-09","2023-06-28","2023-08-09"],"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":[["","65162089603","ARIPIPRAZOLE","TAB 2MG","30","Select","Select",""],["","68382066001","SPIRONOLACT","TAB 25MG","15","Select","Select",""],["","43547040210","FUROSEMIDE","40 MG","60","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","90","Select","Select",""],["","00591352530","LIDOCAINE","5 %","30","Select","Select",""],["","45963070911","METOPROL SUC","TAB 25MG ER","30","Select","Select",""],["","72511076002","REPATHA SURE","INJ 140MG\/ML","2","Select","Select",""],["","00186077760","BRILINTA","90 MG","60","Select","Select",""],["","00904679480","ASPIRIN LOW","CHW 81MG","90","Select","Select",""],["","55111028050","LEVOFLOXACIN","TAB 500MG","10","Select","Select",""],["","00093005805","TRAMADOL HCL","TAB 50MG","20","Select","Select",""],["","71930001912","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","65162052111","PROMETHAZINE","TAB 25MG","28","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","59762005001","METHYLPRED","TAB 16MG","4","Select","Select",""],["","69097012715","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","27808015701","ROSUVASTATIN","TAB 20MG","60","Select","Select",""],["","68180037609","LOSARTAN POT","TAB 25MG","15","Select","Select",""],["","00378459710","METOPROLOL","TAB 100MG ER","90","Select","Select",""],["","67877049090","EZETIMIBE","10 MG","90","Select","Select",""],["","00904672080","ACETAMIN","TAB 500MG","30","Select","Select",""],["","00536113920","PAIN RELIEF","CRE 0.04","30","Select","Select",""],["","45802043321","DEXTROMETHOR","SUS 30MG\/5ML","89","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","00143980350","DOXYCYCL HYC","CAP 100MG","90","Select","Select",""],["","96295012836","MULTIVITAMIN","TAB ADULT","90","Select","Select",""],["","13668010401","ISOSORB MONO","TAB 30MG ER","60","Select","Select",""],["","76204020001","ALBUTEROL","NEB 0.00083","90","Select","Select",""],["","67877022210","GABAPENTIN","CAP 100MG","30","Select","Select",""],["","45802086803","POLYETH GLYC","POW 3350 NF","510","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","00168008031","HYDROCORT","CRE 0.025","30","Select","Select",""],["","00904555159","BANOPHEN","TAB 25MG","2","Select","Select",""],["","00009005602","MEDROL","TAB 4MG","16","Select","Select",""],["","00597015290","JARDIANCE","TAB 10MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","65862019301","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","00187510102","ELIDEL","CRE 0.01","60","Select","Select",""],["","00904679480","ASPIRIN","81 MG","30","Select","Select",""],["","70436020201","METOPROLOL SUCCINATE","25 MG","30","Select","Select",""],["","00024591502","DUPIXENT PEN","300 MG\/2ML","4","Select","Select",""],["","72511076002","REPATHA SURECLICK","140 MG\/ML","2","Select","Select",""],["","68382066001","SPIRONOLACTONE","25 MG","15","Select","Select",""],["","68180037609","LOSARTAN POTASSIUM","25 MG","15","Select","Select",""],["","27808015701","ROSUVASTATIN CALCIUM","20 MG","60","Select","Select",""],["","00904672080","ACETAMINOPHEN","500 MG","30","Select","Select",""],["","23155050101","HYDROXYZINE HCL","25 MG","120","Select","Select",""],["","69097015907","MELOXICAM","15 MG","30","Select","Select",""],["","45802016000","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","67877049090","EZETIMIBE TAB","10MG","90","Select","Select",""],["","43547040210","FUROSEMIDE TAB","40MG","60","Select","Select",""],["","45802043321","DEXTROMETHOR SUS","30MG\/5ML","89","Select","Select",""],["","27808015701","ROSUVASTATIN TAB","20MG","60","Select","Select",""],["","13668010401","ISOSORB MONO TAB","30MG ER","60","Select","Select",""],["","00186077760","BRILINTA TAB","90MG","60","Select","Select",""],["","76204020001","ALBUTEROL NEB","0.083%","90","Select","Select",""],["","67877022210","GABAPENTIN CAP","100MG","30","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","65862001205","SERTRALINE TAB","50MG","90","Select","Select",""],["","72511076002","REPATHA SURE INJ","140MG\/ML","2","Select","Select",""],["","59746001504","METHYLPRED TAB","32MG","2","Select","Select",""],["","68382066001","SPIRONOLACT TAB","25MG","15","Select","Select",""],["","00143980350","DOXYCYCL HYC CAP","100MG","30","Select","Select",""],["","00904672080","ACETAMIN TAB","500MG","30","Select","Select",""],["","00009005602","MEDROL TAB","4MG","16","Select","Select",""],["","00904555159","BANOPHEN TAB","25MG","2","Select","Select",""],["","00904530680","BANOPHEN CAP","25MG","2","Select","Select",""],["","00597015230","JARDIANCE TAB","10MG","30","Select","Select",""],["","65862019301","FLUOXETINE CAP","20MG","30","Select","Select",""],["","65862056090","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","65862020190","LOSARTAN POT TAB","25MG","15","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","43199004030","LIDOCAINE CRE","4%","30","Select","Select",""],["","51672300302","HYDROCORT CRE","2.5%","30","Select","Select",""],["","68462015713","ONDANSETRON TAB","4MG ODT","20","Select","Select",""],["","00536113920","PAIN RELIEF CRE","4%","30","Select","Select",""],["","00187510102","ELIDEL CRE","1%","60","Select","Select",""],["","47781030301","NITROFURANTN CAP","100MG","10","Select","Select",""],["","69097052444","DICLOFENAC GEL","1%","100","Select","Select",""],["","45963070911","METOPROL SUC TAB","25MG ER","30","Select","Select",""],["","47781030301","NITROFURANTOIN MONO-MACRO","100 MG","10","Select","Select",""],["","65862019301","FLUOXETINE HCL","20 MG","30","Select","Select",""],["","45802070002","TACROLIMUS","0.1 %","60","Select","Select",""],["","67877025145","TRIAMCINOLONE ACETONIDE","0.1 %","454","Select","Select",""],["","68382031818","MINOCYCLINE HCL","100 MG","60","Select","Select",""],["","53885027025","ONETOUCH VERIO TEST STRIP","","25","Select","Select",""],["","53885004401","ONETOUCH VERIO FLEX METER","","1","Select","Select",""],["","70000011201","ALCOHOL SWABS","","100","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","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":""}]}]}