{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RAYMOND O SIMPSON","gend":0,"add":"373 CIRCUIT LN UNIT B","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1959-04-09","age":"","mstatus":"","insh":"20073800*01","cliId":"","pno":7575509719,"cno":7575509719,"email":"","ename":"","eno":"","pphy":"HUSEN, SRIE D MD","ppno":7575941850,"pcpadd":"STE 100 11803 JEFFERSON AVE,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine Physicians - Port Warwick","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575941841,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M86.9","D72.829","I96.","Z89.411","L08.9","B95.5","B95.2","C61.","R97.20","I10.","E11.65","F17.209","N42.9","R39.81","N52.31","R97.21","I47.1","M86.8X7","E11.621","L97.529","E78.5","E83.42","Z79.4","Z72.0","Z89.429","M86.172","L02.612","B95.4","B96.5","B96.89","B95.61","I82.A12","H54.7","E11.9","H25.813","E11.628","S91.201A","M86.171","I82.B11","I82.621","I82.A11","E11.69","NO DATA","Z45.2","Z79.2","E11.42","F17.210","Z85.46","Z92.3","Z92.21","I82.A19","Z79.01","M79.89","A41.9","M86.471","M79.671","M84.675A","I95.9","D64.9","I82.611","E11.40","I44.0","E11.52","M80.071A","L03.031","Z79.899","Z01.810","M86.071","N39.3","Z12.11","Z86.79","Z98.890","B95.7","L76.82","Z89.422","Z86.31","T81.89XA","Z23.","Z89.412","L84.","H52.203","H52.4","E86.0","E11.36","Z86.718","Z79.818","R00.0","H52.213","R32.","N31.9","H25.13","I49.9","Z66.","N17.9","I50.32","I11.0","G47.8","Z89.421","Z87.891","Z79.82","I50.33","I50.9","R77.8","I45.81","I51.7","R94.31","R20.8","J81.0","I50.31","I50.30","Z79.84","I08.0","I50.22"],"date":["2022-12-12","2021-03-31","2021-04-08","2021-04-08","2021-04-08","2021-04-05","2021-04-08","2023-08-31","2022-11-28","2023-07-06","2023-07-06","2021-05-26","2023-06-07","2023-06-07","2021-11-04","2022-09-01","2023-09-01","2022-10-24","2023-06-03","2022-12-12","2023-08-30","2023-08-13","2023-08-24","2023-08-24","2023-01-30","2022-11-21","2022-10-22","2022-11-21","2022-11-03","2022-10-22","2022-11-21","2023-01-30","2023-05-01","2023-09-01","2023-06-14","2022-10-16","2021-04-01","2021-03-31","2022-11-14","2022-11-14","2022-11-14","2022-11-21","2023-08-11","2022-11-03","2022-11-21","2022-11-03","2023-08-11","2023-08-30","2023-08-30","2022-11-03","2022-11-14","2022-11-14","2022-11-14","2021-04-05","2021-04-07","2021-05-04","2022-10-16","2022-10-16","2022-10-24","2022-11-14","2022-10-16","2023-09-01","2021-04-02","2021-03-31","2021-03-31","2023-08-30","2021-03-31","2021-03-31","2022-02-09","2022-05-13","2022-10-20","2023-09-01","2022-10-21","2022-12-12","2023-08-30","2022-12-12","2022-12-12","2022-09-26","2021-04-02","2021-06-16","2022-03-08","2022-03-08","2023-07-06","2023-07-06","2023-08-30","2023-08-11","2023-07-06","2023-06-14","2023-07-25","2023-07-25","2023-06-26","2023-08-11","2023-08-30","2023-08-30","2023-08-30","2023-09-01","2023-08-30","2023-08-30","2023-08-30","2023-08-30","2023-08-31","2023-08-13","2023-08-13","2023-09-01","2023-08-31","2023-08-31","2023-09-01","2023-08-11","2023-08-11","2023-08-11","2023-08-11","2023-08-12","2023-09-01"],"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":[["","50228018010","GABAPENTIN","300 MG","90","Select","Select",""],["","68645057559","GLIPIZIDE","10 MG","90","Select","Select",""],["","68645055154","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","00093505998","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","00169220011","NOVOLOG MIX","70-30 70-30\/ML","10","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","50","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","00169220011","NOVOLOG RELI","INJ 70\/30","10","Select","Select",""],["","00002751001","HUMALOG","INJ 100\/ML","10","Select","Select",""],["","00006011254","JANUVIA","TAB 50MG","30","Select","Select",""],["","00088222033","LANTUS","100\/ML","10","Select","Select",""],["","08290328468","INSULIN SYRG","MIS 0.5\/31G","100","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","10","Select","Select",""],["","50458058451","XARELTO STAR","TAB 15\/20MG","51","Select","Select",""],["","00143924920","AMOX\/K CLAV","TAB 875-125","20","Select","Select",""],["","55111028130","LEVOFLOXACIN","TAB 750MG","10","Select","Select",""],["","00955172901","INSULIN GLAR","SOL 100U\/ML","10","Select","Select",""],["","69547035302","NARCAN","SPR 4MG","2","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","00093505798","ATORVASTATIN CALCIUM","80 MG","90","Select","Select",""],["","00002773701","INSULIN LISPRO","100\/ML","10","Select","Select",""],["","68645057559","GLIPIZIDE TAB","10MG","30","Select","Select",""],["","50228018010","GABAPENTIN CAP","300MG","90","Select","Select",""],["","68645055154","LISINOPRIL TAB","5MG","30","Select","Select",""],["","00169368512","NOVOLOG MIX INJ","70\/30","10","Select","Select",""],["","00093505998","ATORVASTATIN TAB","20MG","90","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","53885014301","ONETOUCH MIS LANCETS","","100","Select","Select",""],["","53885027150","ONETOUCH TES VERIO","","50","Select","Select",""],["","00088222033","LANTUS INJ","100\/ML","10","Select","Select",""],["","08290328468","INSULIN SYRG MIS","0.5\/31G","100","Select","Select",""],["","00955172901","INSULIN GLAR SOL","100U\/ML","10","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","10","Select","Select",""],["","00169220011","NOVOLOG RELI INJ","70\/30","10","Select","Select",""],["","00002751001","HUMALOG INJ","100\/ML","10","Select","Select",""],["","58160082311","SHINGRIX INJ","50\/0.5ML","1","Select","Select",""],["","50458058451","XARELTO STAR TAB","15\/20MG","51","Select","Select",""],["","59267030402","PFIZER BIVAL INJ BA","4\/BA5","0","Select","Select",""],["","00143924920","AMOX\/K CLAV TAB","875-125","20","Select","Select",""],["","55111028130","LEVOFLOXACIN TAB","750MG","10","Select","Select",""],["","00006011254","JANUVIA TAB","50MG","30","Select","Select",""],["","69547035302","NARCAN SPR","4MG","2","Select","Select",""],["","60758011910","PREDNISOLONE ACETATE","1 %","10","Select","Select",""],["","49035019502","NICOTINE PATCH","14MG\/24HR","42","Select","Select",""],["","53885027025","ONETOUCH VERIO TEST STRIP","","25","Select","Select",""],["","00310620530","FARXIGA","5 MG","90","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","100","Select","Select",""],["","73070020011","INSULIN ASPART PROT MIX","70-30 70-30\/ML","10","Select","Select",""],["","68382056410","METOPROLOL SUCCINATE","25 MG","90","Select","Select",""],["","00832141003","MOXIFLOXACIN","0.5 %","3","Select","Select",""],["","49502039380","INSULIN GLARGINE-YFGN","100\/ML","10","Select","Select",""],["","00955172901","INSULIN GLARGINE","100\/ML","10","Select","Select",""],["","60505100301","KETOROLAC TROMETHAMINE","0.5 %","5","Select","Select",""],["","08290328418","INSULIN SYRINGE","31 GX5\/16\"","100","Select","Select",""],["","69238149001","BUMETANIDE","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":""}]}]}