{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEFFREY  T CHALK","gend":0,"add":"5201 RIVERWOOD RD","city":"NORFOLK","state":"VA","zip":"23502-9998","dob":"1969-04-01","age":"","mstatus":"","insh":"20075979*01","cliId":"","pno":7574660060,"cno":7574660060,"email":"","ename":"","eno":"","pphy":"HOWELL, CHRISTINE NP","ppno":7579552828,"pcpadd":"885 KEMPSVILLE RD STE 320,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23502-9998","pcpcounty":"","pcpid":"","pcpname":"Amelia Medical Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579552829,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","F41.9","K31.89","I85.11","G92.","R57.8","D62.","F11.23","E87.2","K76.6","K70.30","K72.90","Q53.212","Z79.01","Z80.9","Z86.718","K92.2","F11.10","I85.00","K92.0","F11.19","R10.84","B18.2","R18.8","L03.114","L03.113","F11.90","F17.210","Z88.6","Z88.8","M79.89","N50.819","N43.3","K70.31","T40.1X4A","R09.02","R11.0","B17.10","K74.60","M54.9","K21.9","F19.10","L03.119","B19.20","M54.5","G47.30","F10.20","E55.9","M79.605","I85.01","L03.818","K82.8","I82.90","R06.02","R06.89","Z13.31","I82.411","I26.99","Z68.23","L03.90","I10.","F32.2","S06.9X0S","K76.9","NO DATA","G99.0","Z68.25","U07.1","L03.116","Z72.0","F19.939","K40.90","Z87.898","F51.01","F41.8","E78.2","L03.115","F19.90","I82.511","M79.604","D69.6","R52.","Z00.00","Z20.822","F32.9","D64.9","Z79.899","Z90.49","N50.89","J90.","R74.9","Z86.010","I95.9","D72.819","R03.1","F10.239","F11.229","D61.818","F14.10","J45.909"],"date":["2023-06-19","2023-06-19","2021-08-31","2021-07-11","2021-07-11","2021-07-11","2021-07-17","2023-06-09","2021-07-11","2021-08-31","2023-06-11","2021-12-10","2021-07-11","2021-07-16","2021-07-11","2022-08-11","2021-07-17","2022-03-20","2023-05-10","2021-07-16","2022-11-22","2021-08-10","2023-05-10","2022-01-07","2022-08-11","2022-08-11","2022-08-11","2023-06-11","2022-08-11","2022-08-11","2022-08-11","2021-07-16","2021-07-16","2021-08-18","2021-09-06","2021-09-06","2021-09-06","2021-09-21","2023-06-09","2021-09-21","2023-06-09","2022-03-21","2022-08-11","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-09-20","2021-07-10","2021-07-13","2022-07-09","2021-07-13","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-09-24","2023-06-11","2022-12-06","2022-12-06","2022-12-06","2023-06-11","2022-12-06","2022-12-06","2021-07-09","2021-07-10","2021-07-10","2021-07-11","2021-08-09","2021-12-10","2021-12-10","2021-12-10","2021-12-10","2023-06-22","2022-06-05","2022-06-05","2022-06-06","2021-07-10","2021-08-09","2021-08-28","2021-08-28","2021-08-31","2023-06-11","2021-08-31","2021-08-31","2021-07-16","2021-08-24","2023-05-10","2023-05-10","2023-06-11","2023-06-11","2023-06-11","2023-06-15","2023-06-11","2023-06-09","2023-06-09","2023-06-09"],"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":[["","65649030302","XIFAXAN","550 MG","60","Select","Select",""],["","10006070021","VITAMIN B1","TAB 100MG","30","Select","Select",""],["","16729022701","SPIRONOLACT","TAB 100MG","90","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","15","Select","Select",""],["","12496120803","SUBOXONE","8 MG-2 MG","14","Select","Select",""],["","43598044770","NICOTINE TD","DIS 14MG\/24H","21","Select","Select",""],["","79854040050","MULTI-VIT\/","TAB MINERALS","30","Select","Select",""],["","00054429931","FUROSEMIDE","40 MG","30","Select","Select",""],["","00378235193","ESOMEPRA MAG","CAP 40MG DR","30","Select","Select",""],["","59651000305","OMEPRAZOLE","40 MG","30","Select","Select",""],["","29300014801","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","40","Select","Select",""],["","11534016501","FOLIC ACID","1 MG","30","Select","Select",""],["","10702002301","OXYCODONE","CAP 5MG","14","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","68180035309","SERTRALINE","TAB 100MG","30","Select","Select",""],["","65862086001","FAMOTIDINE","TAB 40MG","60","Select","Select",""],["","00527512570","LACTULOSE","10 G\/15 ML","1892","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","12","Select","Select",""],["","51672403401","WARFARIN","TAB 7.5MG","90","Select","Select",""],["","69097081507","GABAPENTIN","400 MG","90","Select","Select",""],["","80681009800","VITAMIN B-1","TAB 100MG","30","Select","Select",""],["","40985021151","B-1","TAB 100MG","90","Select","Select",""],["","37864000052","THERA-M","TAB ","90","Select","Select",""],["","50428048545","CVS B-1","TAB 100MG","30","Select","Select",""],["","00093216568","NALOXONE HCL","SPR 4MG","2","Select","Select",""],["","62135098505","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","47781035703","BUPRENORPHINE-NALOXONE","8 MG-2 MG","6","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","65162046650","IBUPROFEN","800 MG","30","Select","Select",""],["","29300014801","QUETIAPINE FUMARATE","50 MG","30","Select","Select",""],["","57237002801","AMOXICILLIN","500 MG","21","Select","Select",""],["","42806071401","BENZONATATE","100 MG","60","Select","Select",""],["","69097083512","SERTRALINE HCL","100 MG","90","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","90 MCG","18","Select","Select",""],["","11822046713","ACETAMINOPHEN","325 MG","30","Select","Select",""],["","16714008603","SPIRONOLACTONE","100 MG","30","Select","Select",""],["","11534016501","FOLIC ACID TAB","1MG","30","Select","Select",""],["","65649030302","XIFAXAN TAB","550MG","180","Select","Select",""],["","12496120803","SUBOXONE MIS","8-2MG","11","Select","Select",""],["","67877024201","QUETIAPINE TAB","25MG","30","Select","Select",""],["","00054429931","FUROSEMIDE TAB","40MG","30","Select","Select",""],["","16729022701","SPIRONOLACT TAB","100MG","30","Select","Select",""],["","55111064505","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","68180035309","SERTRALINE TAB","100MG","90","Select","Select",""],["","69097081507","GABAPENTIN CAP","400MG","270","Select","Select",""],["","47781035703","BUPREN\/NALOX MIS","8-2MG","12","Select","Select",""],["","00093216568","NALOXONE HCL SPR","4MG","2","Select","Select",""],["","69238110005","DOXYCYCL HYC CAP","100MG","20","Select","Select",""],["","67877021901","CEPHALEXIN CAP","500MG","28","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","00904052360","VITAMIN C","500 MG","14","Select","Select",""],["","72888001405","CYCLOBENZAPRINE HCL","10 MG","42","Select","Select",""],["","68462025401","ROPINIROLE HCL","0.5 MG","14","Select","Select",""],["","54629001171","THERATRUM COMPLETE","50 PLUS ","14","Select","Select",""],["","69367016504","FERROUS GLUCONATE","324(38)MG","14","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":""}]}]}