{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TRINETTE PURNELL","gend":1,"add":"3308 GOLDEN OAK LN APT 104","city":"CHESAPEAKE","state":"VA","zip":"23321-9998","dob":"1973-01-27","age":"","mstatus":"","insh":"20075212*01","cliId":"","pno":7576064306,"cno":7576064306,"email":"","ename":"","eno":"","pphy":"WHITEHURST, CANDACE MD","ppno":7576228358,"pcpadd":"930 W 21ST ST STE 100,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23517-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours Ghent Station Medical Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576229662,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.1","NO DATA","M62.81","R26.81","M25.552","F33.2","Z23.","I10.","Z68.31","M79.89","G70.9","R74.8","E55.9","R16.0","I73.9","I70.213","Z76.0","Z68.28","F43.24","F41.9","G62.9","Z13.89","Z79.891","Z51.81","I70.90","T66.XXXA","R55.","F43.21","Z86.73","G73.7","F32.9","R20.2","G43.009","R41.3","M54.17","G60.9","I82.409","C78.7","C7A.00","F41.1","C53.9","M79.604","R22.41","N17.9","Z09.","E87.6","Z68.32","T82.856A","I74.5","G45.9","G43.909","K21.9","K52.9","R19.7","F33.8","R53.81","G72.9","Z11.59","R53.83","F32.1","C7A.8","C7B.8","M62.838","D86.0","R63.5","Z79.899","R26.89","I82.403","Z95.828","I95.9","E87.1","R11.2","D64.9","D3A.8","E86.0","E43.","Z68.30","E86.1","E83.39","G89.29","T82.868A","I74.3","I70.223","D49.0","Z91.040","Z92.3","Z79.890","Z79.82","Z87.891","Z90.710","Z79.02","Z85.41","Z88.8","Z12.31"],"date":["2022-10-28","2023-06-16","2023-04-06","2022-03-03","2022-03-03","2023-06-16","2022-10-20","2023-06-05","2023-02-06","2022-11-22","2023-04-06","2023-02-06","2023-06-05","2023-03-31","2023-06-06","2023-03-21","2022-11-22","2021-11-30","2022-07-29","2022-11-22","2023-06-06","2022-11-22","2022-11-22","2022-11-22","2022-12-21","2022-12-21","2023-03-31","2022-01-28","2023-06-06","2023-06-06","2023-06-06","2023-06-06","2023-06-06","2023-06-06","2022-10-11","2023-06-06","2022-10-13","2023-04-11","2023-04-26","2023-06-16","2023-02-01","2023-02-02","2023-06-05","2023-04-24","2023-04-06","2023-04-24","2023-01-03","2023-03-03","2023-03-03","2023-03-03","2023-03-03","2023-03-30","2023-03-31","2023-04-02","2021-08-27","2021-07-09","2021-07-09","2021-07-09","2021-07-09","2023-02-24","2023-03-29","2023-03-29","2022-07-21","2022-03-09","2022-03-09","2023-03-03","2022-07-21","2022-10-13","2023-03-21","2023-03-30","2023-03-30","2023-03-30","2023-04-11","2023-03-30","2023-03-30","2023-03-30","2023-03-30","2023-03-30","2023-03-30","2023-03-30","2023-03-03","2023-03-03","2023-03-03","2023-03-03","2023-03-03","2023-03-03","2023-03-03","2023-03-03","2023-03-03","2023-03-03","2023-03-03","2023-03-03","2023-03-03","2023-06-05"],"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":[["","00406051201","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","12","Select","Select",""],["","89634800252","","","30","Select","Select",""],["","49035091432","ASPIRIN EC","81 MG","90","Select","Select",""],["","00904598660","VITAMIN D","3 125 MCG","30","Select","Select",""],["","74312001380","VITAMIN B-","12 1000 MCG","30","Select","Select",""],["","65162010250","GABAPENTIN","300 MG","90","Select","Select",""],["","67877050651","COLESEVELAM HCL","625 MG","120","Select","Select",""],["","68382013814","TOPIRAMATE","25 MG","180","Select","Select",""],["","00172392660","DIAZEPAM","5 MG","60","Select","Select",""],["","00406055201","OXYCODONE HCL","5 MG","28","Select","Select",""],["","49035061287","ALLERGY RELIEF","10 MG","90","Select","Select",""],["","00713067831","NYSTATIN","100000\/G","60","Select","Select",""],["","69315011710","FUROSEMIDE","40 MG","90","Select","Select",""],["","29300041301","CYCLOBENZAPRINE HCL","5 MG","180","Select","Select",""],["","60258017101","MAGNESIUM OXIDE","400 MG","30","Select","Select",""],["","68001043804","LORATADINE","10 MG","30","Select","Select",""],["","68462039710","OMEPRAZOLE","40 MG","90","Select","Select",""],["","57237000511","FLUCONAZOLE","150 MG","1","Select","Select",""],["","59746017206","PREDNISONE","5 MG","180","Select","Select",""],["","68382004001","PROMETHAZINE HCL","12.5 MG","60","Select","Select",""],["","74312001670","B-","1 100 MG","90","Select","Select",""],["","67877084201","FAMOTIDINE","20 MG","60","Select","Select",""],["","13668001101","CITALOPRAM HBR","40 MG","30","Select","Select",""],["","50458058451","XARELTO","15 MG-20MG","51","Select","Select",""],["","67877019805","AMLODIPINE BESYLATE","5 MG","90","Select","Select",""],["","00832532411","POTASSIUM CHLORIDE","10 MEQ","60","Select","Select",""],["","68645059090","CLOPIDOGREL","75 MG","90","Select","Select",""],["","62332009830","ARIPIPRAZOLE","5 MG","30","Select","Select",""],["","45802081184","NALOXONE HCL","4 MG","2","Select","Select",""],["","31722070110","LOSARTAN POTASSIUM","50 MG","30","Select","Select",""],["","00046110281","PREMARIN","0.625 MG","15","Select","Select",""],["","31722070190","LOSARTAN POT","TAB 50MG","30","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","30","Select","Select",""],["","11523723701","CLARITIN","TAB 10MG","180","Select","Select",""],["","29300041319","CYCLOBENZAPR","TAB 5MG","130","Select","Select",""],["","68645051554","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","13668001101","CITALOPRAM","TAB 40MG","30","Select","Select",""],["","67877050651","COLESEVELAM","TAB 625MG","120","Select","Select",""],["","31722094201","HYDROCO\/APAP","TAB 7.5-325","120","Select","Select",""],["","60258017101","MAG OXIDE","TAB 400MG","30","Select","Select",""],["","68585000612","MAGNESIUM-OX","TAB 400MG","30","Select","Select",""],["","00832532411","POT CL MICRO","TAB 10MEQ ER","60","Select","Select",""],["","81131000720","D3","CAP 2000UNIT","30","Select","Select",""],["","49035061246","ALLERGY RELF","TAB 10MG","30","Select","Select",""],["","49035013606","EQ LIDOCAINE","PAD 0.04","30","Select","Select",""],["","10006070011","VITAMIN B1","TAB 100MG","90","Select","Select",""],["","00536468010","VITAMIN B-1","TAB 100MG","90","Select","Select",""],["","31604002621","VITAMIN D3","CAP 5000UNIT","30","Select","Select",""],["","78742000985","SV VIT B-12","TAB 1000 TR","30","Select","Select",""],["","69315031228","PROCTO-MED","CRE HC 2.5%","28","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","11845069305","VITAMIN B-12","TAB 1000MCG","30","Select","Select",""],["","13668021730","ARIPIPRAZOLE TAB","5MG","30","Select","Select",""],["","00046110291","PREMARIN TAB","0.625MG","15","Select","Select",""],["","29300041319","CYCLOBENZAPR TAB","5MG","130","Select","Select",""],["","68645051554","AMLODIPINE TAB","5MG","90","Select","Select",""],["","55111014512","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","00172392660","DIAZEPAM TAB","5MG","60","Select","Select",""],["","13668001101","CITALOPRAM TAB","40MG","30","Select","Select",""],["","11523723701","CLARITIN TAB","10MG","30","Select","Select",""],["","65862017160","TOPIRAMATE TAB","25MG","180","Select","Select",""],["","67877050651","COLESEVELAM TAB","625MG","120","Select","Select",""],["","31722070190","LOSARTAN POT TAB","50MG","30","Select","Select",""],["","68382004001","PROMETHAZINE TAB","12.5MG","30","Select","Select",""],["","31722094201","HYDROCO\/APAP TAB","7.5-325","120","Select","Select",""],["","68585000612","MAGNESIUM-OX TAB","400MG","30","Select","Select",""],["","16571082201","LORATADINE TAB","10MG","30","Select","Select",""],["","00832532411","POT CL MICRO TAB","10MEQ ER","60","Select","Select",""],["","00093216568","NALOXONE HCL SPR","","2","Select","Select",""],["","60258017101","MAG OXIDE TAB","400MG","30","Select","Select",""],["","49035061246","ALLERGY RELF TAB","10MG","30","Select","Select",""],["","55111064530","OMEPRAZOLE CAP","40MG","90","Select","Select",""],["","81131000720","D","3 CAP 2000UNIT","30","Select","Select",""],["","50228017910","GABAPENTIN CAP","100MG","180","Select","Select",""],["","49035013606","EQ LIDOCAINE PAD","4%","30","Select","Select",""],["","43547040211","FUROSEMIDE TAB","40MG","30","Select","Select",""],["","59746017210","PREDNISONE TAB","5MG","30","Select","Select",""],["","69315031228","PROCTO-MED CRE HC","2.5%","28","Select","Select",""],["","10006070011","VITAMIN B","1 TAB 100MG","30","Select","Select",""],["","65162047810","NITROFURANTN CAP","100MG","14","Select","Select",""],["","78742000985","SV VIT B-","12 TAB 1000 TR","30","Select","Select",""],["","13668059502","NYSTATIN CRE","100000","30","Select","Select",""],["","11534016501","FOLIC ACID","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":""}]}]}