{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHAWNTA BOONE","gend":1,"add":"1708 SPRATLEY ST","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1977-10-29","age":"","mstatus":"","insh":"20075540*01","cliId":"","pno":7573869924,"cno":7573869924,"email":"","ename":"","eno":"","pphy":"TAYLOR, ANDREA NP","ppno":7577381600,"pcpadd":"2613 TAYLOR RD STE 201,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23321-9998","pcpcounty":"","pcpid":"","pcpname":"Bon Secours Western Branch Primary Care","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574658616,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["C50.919","C50.812","Z17.0","Z51.11","L02.31","K92.2","C50.912","C78.7","K74.60","E66.01","J45.20","M19.90","K21.9","Z68.41","F32.9","D63.0","G43.909","R13.10","I51.7","C79.51","K61.1","E09.9","T38.0X5A","Z79.899","Z51.12","Z90.12","R00.2","I10.","Z68.42","K61.0","Z68.39","A41.50","E55.9","L02.412","R73.9","D72.829","N17.9","T38.0X5S","R17.","F41.9","Z48.00","Z09.","R00.0","J45.909","Z85.3","Z79.4","L92.8","E72.9","C79.31","A41.9","M10.30","J45.41","N17.0","G44.40","V58.89","F43.10","Z13.228","R53.1","R42.","R06.02","R07.9","M17.0","M23.203","M23.307","M17.12","M17.11","M25.762","M25.761","K92.1","M62.81","R94.31","K61.2","E87.2","K62.89","M10.9","M54.2","Z20.822","T81.89XA","E11.9","Z86.16","Z92.21","Z79.51","Z79.84","Z88.5","T82.9XXA","D05.12","M25.561","M25.562","I44.4","M23.51","NO DATA","R19.7","E11.65","E66.9","Z92.3","R06.89","R11.0","R11.2","T45.1X5A","C15.9","N30.00","G89.29"],"date":["2023-01-24","2023-06-15","2023-06-15","2023-05-31","2022-09-26","2021-07-12","2023-04-12","2023-03-27","2022-03-29","2023-04-12","2021-08-17","2022-03-31","2023-04-12","2023-04-14","2021-07-12","2021-08-17","2022-03-29","2021-08-17","2023-03-13","2023-03-02","2023-03-27","2022-12-06","2022-01-28","2023-04-17","2023-06-13","2022-11-11","2022-11-04","2023-04-14","2022-11-04","2021-08-17","2021-12-25","2021-08-03","2022-07-13","2022-11-11","2022-12-06","2022-12-08","2022-12-08","2022-12-06","2021-06-11","2021-06-11","2021-08-17","2021-08-09","2023-04-12","2023-04-12","2023-04-14","2023-04-12","2022-05-26","2022-12-08","2023-04-14","2021-08-17","2021-08-17","2021-08-17","2022-03-29","2021-08-17","2021-08-17","2021-08-30","2021-12-23","2022-03-31","2022-03-31","2023-04-12","2022-05-06","2023-04-19","2022-11-21","2022-11-21","2022-12-05","2023-04-19","2022-12-05","2022-12-05","2021-06-01","2021-06-11","2023-04-12","2022-03-14","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2021-08-30","2022-03-31","2023-04-12","2023-04-12","2022-03-31","2023-04-12","2023-04-12","2022-11-11","2021-09-08","2022-03-29","2023-04-19","2022-10-11","2023-04-13","2023-03-22","2023-04-14","2023-04-14","2023-04-18","2023-04-14","2023-04-14","2023-04-12","2023-04-12","2023-04-18","2023-04-18","2023-04-14","2023-04-12","2023-04-19"],"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":[["","50111033402","METRONIDAZOL","TAB 500MG","36","Select","Select",""],["","00456120230","LINZESS","CAP 290MCG","30","Select","Select",""],["","00406851001","OXYCODONE","TAB 10MG","60","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","10","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","51862094205","DIAZEPAM","TAB 5MG","9","Select","Select",""],["","00378668977","PANTOPRAZOLE","TAB 40MG","180","Select","Select",""],["","04142000024","FLORASTOR","CAP 250MG","28","Select","Select",""],["","64380073706","VITAMIN D","2 1250 MCG","8","Select","Select",""],["","00121087316","LACTULOSE","SOL 10GM\/15","1800","Select","Select",""],["","00093342601","LORAZEPAM","1 MG","120","Select","Select",""],["","67877041920","LINEZOLID","TAB 600MG","20","Select","Select",""],["","48102004701","DEXAMETHASON","TAB 4MG","40","Select","Select",""],["","65862009620","CEFPODOXIME","TAB 200MG","28","Select","Select",""],["","59267100001","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","8","Select","Select",""],["","51991000590","EXEMESTANE","25 MG","30","Select","Select",""],["","64980028001","GLIPIZIDE ER","5 MG","90","Select","Select",""],["","56151147002","TRUE METRIX","KIT METER","1","Select","Select",""],["","83490031065","VIOS","MIS SYSTEM","1","Select","Select",""],["","11523091901","LOTRIMIN AF","POW 0.02","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","59762054001","GLIPIZIDE XL","TAB 2.5MG","30","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","3","Select","Select",""],["","00002822259","INSULIN LISP","INJ 100\/ML","15","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","53885024450","ONETOUCH","TES ULTRA","50","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","08290320883","BD PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","16714033001","GABAPENTIN","600 MG","60","Select","Select",""],["","00173069700","ADVAIR DISKU","AER 500\/50","60","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","75","Select","Select",""],["","00378932232","WIXELA INHUB","AER 500\/50","60","Select","Select",""],["","00781809003","AZITHROMYCIN","TAB 500MG","3","Select","Select",""],["","57599080000","FREESTY LIBR","KIT 2 SENSOR","2","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","00781214501","AMPICILLIN","CAP 500MG","20","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","90","Select","Select",""],["","68180071909","AMLODIPINE","TAB 2.5MG","90","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","76385011050","CARVEDILOL","TAB 3.125MG","60","Select","Select",""],["","70010006310","METFORMIN","TAB 500MG","120","Select","Select",""],["","16571069809","LANSOPRAZOLE","30 MG","30","Select","Select",""],["","50111056001","TRAZODONE HCL","50 MG","90","Select","Select",""],["","57599081800","FREESTYLE LIBRE","3 SENSOR ","2","Select","Select",""],["","00002751001","HUMALOG","100\/ML","20","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","70010006505","METFORMIN HCL","1000 MG","180","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","Select","Select",""],["","68180071909","AMLODIPINE BESYLATE","2.5 MG","90","Select","Select",""],["","63304082790","ATORVASTATIN CALCIUM","10 MG","90","Select","Select",""],["","16729003410","LETROZOLE","2.5 MG","30","Select","Select",""],["","69097083412","SERTRALINE HCL","50 MG","90","Select","Select",""],["","08489831510","DROPLET PEN NEEDLE","32GX 5\/32\"","100","Select","Select",""],["","65862018830","ONDANSETRON HCL","8 MG","30","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","70954040310","DEXAMETHASONE","4 MG","30","Select","Select",""],["","55111016330","OLANZAPINE","2.5 MG","30","Select","Select",""],["","68382004101","PROMETHAZINE HCL","25 MG","180","Select","Select",""],["","69315091001","DIPHENOXYLATE-ATROPINE","2.5-.025MG","30","Select","Select",""],["","16714043901","NITROFURANTOIN MONO-MACRO","100 MG","14","Select","Select",""],["","29033000301","SUCRALFATE","1 G","30","Select","Select",""],["","00002879959","HUMALOG KWIKPEN U-","100 100\/ML","5","Select","Select",""],["","70436015301","POTASSIUM CHLORIDE","20 MEQ","5","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","20","Select","Select",""],["","00002773701","INSULIN LISPRO","100\/ML","2","Select","Select",""],["","08560940003","V-GO","20 ","30","Select","Select",""],["","65162062710","TRAMADOL HCL","50 MG","40","Select","Select",""],["","08333358601","TEGADERM","3.5\"X4\"","100","Select","Select",""],["","00781185220","AMOX\/K CLAV TAB","875-125","14","Select","Select",""],["","50228018001","GABAPENTIN CAP","300MG","90","Select","Select",""],["","53885024450","ONETOUCH TES ULTRA","","50","Select","Select",""],["","59651026830","GLIPIZIDE ER TAB","2.5MG","30","Select","Select",""],["","42806071401","BENZONATATE CAP","100MG","30","Select","Select",""],["","00781809003","AZITHROMYCIN TAB","500MG","3","Select","Select",""],["","57599080000","FREESTY LIBR KIT","2 SENSOR","2","Select","Select",""],["","57599080300","FREESTY LIBR MIS","2 READER","1","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","00406851001","OXYCODONE TAB","10MG","60","Select","Select",""],["","64380073706","VITAMIN D CAP","50000UNT","24","Select","Select",""],["","00406051205","OXYCOD\/APAP TAB","5-325MG","8","Select","Select",""],["","51991000590","EXEMESTANE TAB","25MG","30","Select","Select",""],["","00781214501","AMPICILLIN CAP","500MG","20","Select","Select",""],["","68180071909","AMLODIPINE TAB","2.5MG","90","Select","Select",""],["","00143992801","CIPROFLOXACN TAB","500MG","10","Select","Select",""],["","60505265301","TRAZODONE TAB","50MG","90","Select","Select",""],["","00093342505","LORAZEPAM TAB","0.5MG","180","Select","Select",""],["","76385011050","CARVEDILOL TAB","3.125MG","60","Select","Select",""],["","16714033001","GABAPENTIN TAB","600MG","60","Select","Select",""],["","69238110005","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","70010006310","METFORMIN TAB","500MG","120","Select","Select",""],["","00093506101","HYDROXYZINE HCL","25 MG","180","Select","Select",""],["","67877084301","FAMOTIDINE","40 MG","90","Select","Select",""],["","51660093901","CETIRIZINE HCL","10 MG","180","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":""}]}]}