{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARCIA  R WAGUK","gend":1,"add":"673 HARPERSVILLE ROAD","city":"NEWPORT NEWS","state":"VA","zip":"23601-9998","dob":"1975-08-21","age":"","mstatus":"","insh":"20075443*01","cliId":"","pno":7572691632,"cno":7572691632,"email":"","ename":"","eno":"","pphy":"FULLER, SHEILA M NP","ppno":7573165050,"pcpadd":"209 VILLAGE AVE STE P,","pcpcity":"YORKTOWN","pcpstate":"VA","pcpzip":"23693-9998","pcpcounty":"","pcpid":"","pcpname":"Riverside Primary Care Kiln Creek","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7573692999,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z20.822","E43.","N18.6","I12.0","E11.22","R78.81","T82.590A","R20.0","Z99.2","R20.2","I31.3","I33.0","I63.40","I76.","T80.211A","E87.2","I47.2","E87.1","H53.122","I48.92","I42.5","N25.81","I31.4","R29.705","R41.82","M25.562","M00.9","Z86.79","Z98.890","S01.312A","D61.818","E78.00","Z86.73","Z89.412","Z79.899","H92.22","T82.898A","T82.7XXA","A41.02","T82.9XXA","Z79.4","T82.838A","B95.61","I13.2","D63.1","R53.1","E78.5","I10.","E87.5","R79.89","H54.7","R41.0","R06.9","I95.9","E88.09","M89.9","M54.9","Z01.812","NO DATA","D62.","L97.419","Z88.0","I72.1","E11.65","Z90.710","A41.9","A41.01","H54.61","M89.8X9","I50.9","I95.3","D69.6","H43.10","E11.36","N25.0","D72.829","H54.62","R51.9","R65.10","R53.83","R07.9","T78.40XA","I44.0","I45.81","I51.7","R50.9","I95.89","K59.00","I08.8","D64.9","I08.1","Z95.828","R07.89","Z74.09","Z99.11","I34.0","M25.462","E11.9","E87.6","E83.42","E83.39","R06.00","E83.51","I63.9","R19.7","T67.5XXA","J81.1","E86.0","Z45.2","G93.89","R52.","N17.9","V58.89","E11.29","A49.8","Z16.29","A41.2","H54.40","T85.71XA","E87.8","J90.","B96.89","E11.628","L08.9","Z88.1","M65.9","B95.7","E11.621","L97.519","S91.301A","M65.871","E11.610","M14.671","E11.43","T82.49XA","I13.10","E03.9","B95.1","A40.1","D84.9","E11.42","E11.319","T82.41XA"],"date":["2022-07-01","2023-06-03","2023-06-30","2023-05-24","2023-05-24","2023-05-24","2021-10-03","2022-04-25","2023-06-30","2022-04-25","2022-07-01","2022-07-27","2022-06-04","2022-06-04","2022-06-04","2022-06-11","2022-07-01","2023-05-24","2022-06-04","2023-05-16","2022-06-04","2023-05-21","2022-06-07","2022-06-04","2022-07-03","2022-07-02","2022-07-27","2022-09-13","2022-09-13","2022-09-29","2022-09-29","2022-09-29","2022-09-29","2022-09-29","2022-09-29","2022-09-29","2021-09-24","2021-09-27","2021-10-02","2022-05-05","2022-06-30","2022-05-05","2022-07-27","2022-05-29","2023-05-24","2022-07-01","2023-05-24","2022-06-11","2022-06-11","2022-06-11","2022-06-07","2022-06-07","2022-06-05","2022-07-01","2022-06-09","2022-06-09","2022-06-09","2021-08-10","2023-05-24","2021-09-24","2021-09-24","2022-05-24","2021-09-24","2021-09-28","2021-09-24","2023-05-20","2022-05-28","2022-05-20","2022-05-20","2022-05-20","2022-05-20","2022-05-29","2022-05-20","2022-05-20","2022-05-20","2023-05-24","2022-05-29","2022-05-29","2022-05-29","2022-06-04","2023-05-24","2022-06-28","2022-06-29","2022-06-29","2023-05-16","2023-05-24","2022-06-30","2022-06-30","2022-10-04","2022-07-01","2023-05-17","2022-05-24","2023-05-16","2022-06-04","2022-06-05","2022-06-11","2022-07-01","2022-06-30","2022-07-03","2022-07-01","2023-05-24","2022-07-01","2022-07-01","2022-07-01","2022-07-02","2022-07-01","2022-07-01","2022-07-01","2022-05-21","2022-06-07","2022-09-29","2021-09-24","2023-05-24","2021-09-28","2021-09-28","2021-09-28","2022-05-23","2022-06-10","2022-06-10","2022-05-25","2022-06-04","2023-05-24","2023-05-24","2023-05-24","2023-05-24","2023-05-24","2023-05-24","2023-06-27","2023-06-27","2023-05-24","2023-05-19","2023-05-19","2023-05-24","2023-05-24","2023-05-24","2023-05-24","2023-05-24","2023-05-23","2023-05-16","2023-05-16","2023-05-16","2023-05-16","2023-05-16"],"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":[["","53746010905","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","68462044718","SEVELAMER","TAB 800MG","270","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","12","Select","Select",""],["","65862083130","CINACALCET","TAB 30MG","30","Select","Select",""],["","31722052101","HYDRALAZINE","TAB 50MG","90","Select","Select",""],["","00904552987","HEARTBURN","TAB RELIEF","30","Select","Select",""],["","00363020765","ACID CONTROL","TAB 10MG","30","Select","Select",""],["","00406123601","DIPHEN\/ATROP","TAB 2.5MG","10","Select","Select",""],["","00187526801","NEPHROCAPS","CAP ","30","Select","Select",""],["","58602070584","ACID REDUCER","TAB 10MG","30","Select","Select",""],["","69543026010","VIRT-CAPS","CAP ","30","Select","Select",""],["","63044062201","RENO","CAP ","30","Select","Select",""],["","00363031734","ANTACID","CHW 500MG","60","Select","Select",""],["","57896076315","CALCIUM CARB","CHW 500MG","60","Select","Select",""],["","64980051505","OFLOXACIN","0.3 %","5","Select","Select",""],["","29300039810","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","31722052101","HYDRALAZINE HCL","50 MG","90","Select","Select",""],["","65862083130","CINACALCET HCL","30 MG","90","Select","Select",""],["","69097096793","SEVELAMER CARBONATE","800 MG","50","Select","Select",""],["","49483034001","ACETAMINOPHEN","325 MG","30","Select","Select",""],["","65862083130","CINACALCET TAB","30MG","30","Select","Select",""],["","65862092127","SEVELAMER TAB","800MG","300","Select","Select",""],["","68180072103","AMLODIPINE TAB","10MG","90","Select","Select",""],["","31722052101","HYDRALAZINE TAB","50MG","90","Select","Select",""],["","58602070584","ACID REDUCER TAB","10MG","30","Select","Select",""],["","00363031734","ANTACID CHW","500MG","60","Select","Select",""],["","00363020765","ACID CONTROL TAB","10MG","30","Select","Select",""],["","53746010905","HYDROCO\/APAP TAB","5-325MG","28","Select","Select",""],["","69543026010","VIRT-CAPS CAP","","30","Select","Select",""],["","63044062201","RENO CAP","","30","Select","Select",""],["","00187526801","NEPHROCAPS CAP","","30","Select","Select",""],["","00904552987","HEARTBURN TAB RELIEF","","30","Select","Select",""],["","57896076315","CALCIUM CARB CHW","500MG","60","Select","Select",""],["","00406123601","DIPHEN\/ATROP TAB","2.5MG","10","Select","Select",""],["","60505036301","OFLOXACIN DRO","0.3%OTIC","5","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","3","Select","Select",""],["","08290320109","ULTRA-FINE SHORT PEN NEEDLE","31 GX5\/16\"","100","Select","Select",""],["","65162003416","OMEGA-","3 ACID ETHYL ESTERS 1 G","120","Select","Select",""],["","73070010315","INSULIN ASPART FLEXPEN","100\/ML (3)","3","Select","Select",""],["","00574402435","ERYTHROMYCIN","5 MG\/GRAM","3.5","Select","Select",""],["","00023031204","REFRESH LACRI-LUBE","42.5-56.8%","3.5","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":""}]}]}