{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"STEPHINE D HINES","gend":1,"add":"5466 GREENPLAIN RD APT 208","city":"NORFOLK","state":"VA","zip":"23502-9998","dob":"1970-08-14","age":"","mstatus":"","insh":"20083011*01","cliId":"","pno":7572027046,"cno":7572027046,"email":"","ename":"","eno":"","pphy":"TUCKER, MICHAEL MD","ppno":7576253777,"pcpadd":"110 KINGSLEY LANE SUITE 411,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23505-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576257411,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K12.1","R13.19","L10.0","Z99.81","R12.","K59.00","E66.9","J44.9","R09.02","J20.9","F31.62","F43.10","M25.431","J43.2","M25.432","R32.","R10.11","Z87.01","J84.10","J38.4","I10.","F31.9","Z87.891","J12.81","F41.9","F48.9","F43.20","M62.81","Z01.419","J43.9","E78.5","Z79.899","Z88.0","Z88.8","Z00.00","K12.0","I16.0","F33.2","R91.1","E78.2","E55.9","N89.8","R30.0","N95.1","K64.9","K58.9","K21.9"],"date":["2022-11-22","2022-11-22","2022-11-22","2022-11-22","2022-11-28","2023-09-12","2022-11-28","2023-08-03","2023-04-25","2022-12-09","2023-08-10","2023-08-10","2022-05-04","2022-05-04","2022-05-04","2022-10-19","2022-11-06","2023-01-23","2023-01-23","2022-11-14","2023-09-18","2023-09-12","2022-11-06","2022-08-22","2022-12-13","2023-02-17","2022-10-31","2023-01-19","2022-10-19","2022-11-06","2022-11-06","2022-11-06","2022-11-06","2022-11-06","2023-09-18","2022-11-11","2022-11-11","2022-12-01","2023-04-25","2023-05-17","2023-05-17","2023-05-22","2023-05-22","2023-05-22","2023-09-12","2023-09-12","2023-09-12"],"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":[["","00310461612","BREZTRI AERO","AER SPHERE","32","Select","Select",""],["","00363049860","MUCUS RELIEF","TAB 600MG ER","10","Select","Select",""],["","00597010061","SPIRIVA","SPR 2.5MCG","4","Select","Select",""],["","68645055854","LISINOP\/HCTZ","TAB 20-25MG","30","Select","Select",""],["","00591544210","PREDNISONE","10 MG","20","Select","Select",""],["","00115175701","CYPROHEPTAD","TAB 4MG","90","Select","Select",""],["","00173071920","FLOVENT HFA","AER 110MCG","12","Select","Select",""],["","68180047903","SIMVASTATIN","20 MG","30","Select","Select",""],["","00121077516","GG\/CODEINE","SOL 100-10\/5","237","Select","Select",""],["","00597015561","STIOLTO","AER 2.5-2.5","4","Select","Select",""],["","57664047758","METOPROL TAR","TAB 50MG","90","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","40","Select","Select",""],["","00093342605","LORAZEPAM","1 MG","30","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","55111017915","TIZANIDINE","TAB 2MG","60","Select","Select",""],["","57237000630","FLUCONAZOLE","200 MG","2","Select","Select",""],["","00173071720","ADVAIR HFA","230-21MCG","36","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","31","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","58657050016","CODEINE\/GG","SOL 10-100\/5","240","Select","Select",""],["","59651036205","IBUPROFEN","800 MG","90","Select","Select",""],["","69543025116","VIRTUSSIN AC","LIQ 100-10\/5","240","Select","Select",""],["","00781707787","METRONIDAZOL","GEL 0.75%VAG","70","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","00005200010","PREVNAR 20","INJ ","0","Select","Select",""],["","43547028110","ESCITALOPRAM","TAB 10MG","15","Select","Select",""],["","65862022701","LAMOTRIGINE","25 MG","60","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","23155005101","NYSTATIN","TAB 500000","30","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","400","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","33332032203","AFLURIA QUAD","INJ 2022-23","0","Select","Select",""],["","63824000832","MUCINEX","600 MG","60","Select","Select",""],["","31722072320","LEVOFLOXACIN","TAB 750MG","7","Select","Select",""],["","76204020060","ALBUTEROL","NEB 0.00083","360","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","69367027216","CODEINE-GUAIFENESIN","10-100MG\/5","240","Select","Select",""],["","65862037405","ESCITALOPRAM OXALATE","10 MG","30","Select","Select",""],["","51672128202","TRIAMCINOLONE ACETONIDE","0.1 %","30","Select","Select",""],["","55111017915","TIZANIDINE HCL","2 MG","60","Select","Select",""],["","45802013970","METRONIDAZOLE","0.75 %","70","Select","Select",""],["","00115175701","CYPROHEPTADINE HCL","4 MG","15","Select","Select",""],["","00254302802","LUBIPROSTONE","8 MCG","60","Select","Select",""],["","00310461612","BREZTRI AEROSPHERE","160-9-4.8","10.7","Select","Select",""],["","00143992801","CIPROFLOXACIN HCL","500 MG","20","Select","Select",""],["","00832105415","BACLOFEN","10 MG","60","Select","Select",""],["","64764008060","AMITIZA","8 MCG","60","Select","Select",""],["","00121077516","GUAIFENESIN-CODEINE","10-100MG\/5","240","Select","Select",""],["","57664047758","METOPROLOL TARTRATE","50 MG","60","Select","Select",""],["","00597010061","SPIRIVA RESPIMAT","2.5 MCG","12","Select","Select",""],["","51224012250","AZITHROMYCIN","500 MG","10","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","69097014260","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","00310461612","BREZTRI AERO AER SPHERE","","11","Select","Select",""],["","68645056354","IBUPROFEN TAB","800MG","90","Select","Select",""],["","00115175701","CYPROHEPTAD TAB","4MG","90","Select","Select",""],["","00093342705","LORAZEPAM TAB","2MG","45","Select","Select",""],["","00597010061","SPIRIVA SPR","2.5MCG","4","Select","Select",""],["","00054001925","PREDNISONE TAB","50MG","5","Select","Select",""],["","16729000517","SIMVASTATIN TAB","20MG","30","Select","Select",""],["","00173071920","FLOVENT HFA AER","110MCG","12","Select","Select",""],["","68645055854","LISINOP\/HCTZ TAB","20-25MG","30","Select","Select",""],["","57664047758","METOPROL TAR TAB","50MG","90","Select","Select",""],["","00121077516","GG\/CODEINE SOL","100-10\/5","237","Select","Select",""],["","16571020150","DICLOFENAC TAB","75MG DR","40","Select","Select",""],["","00597015561","STIOLTO AER","2.5-2.5","4","Select","Select",""],["","00185012201","NITROFURANTN CAP","100MG","10","Select","Select",""],["","55111017915","TIZANIDINE TAB","2MG","60","Select","Select",""],["","00363049860","MUCUS RELIEF TAB","600MG ER","10","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","10","Select","Select",""],["","59651031477","TIZANIDINE CAP","2MG","60","Select","Select",""],["","00173071720","ADVAIR HFA AER","230\/21","12","Select","Select",""],["","69543025116","VIRTUSSIN AC LIQ","100-10\/5","240","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","20","Select","Select",""],["","00781707787","METRONIDAZOL GEL","0.75%VAG","70","Select","Select",""],["","62559099330","FLUCONAZOLE TAB","200MG","2","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","43547028110","ESCITALOPRAM TAB","10MG","30","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","12","Select","Select",""],["","58657050016","CODEINE\/GG SOL","10-100\/5","240","Select","Select",""],["","62332003731","LAMOTRIGINE TAB","25MG","28","Select","Select",""],["","68382050010","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","00456120130","LINZESS CAP","145MCG","30","Select","Select",""],["","65162006205","SUCRALFATE SUS","1GM\/10ML","200","Select","Select",""],["","00406012305","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","33332032203","AFLURIA QUAD INJ","2022-23","0","Select","Select",""],["","00005200010","PREVNAR","20 INJ","0","Select","Select",""],["","42806040021","METHYLPRED TAB","4MG","21","Select","Select",""],["","50111033402","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","23155005101","NYSTATIN TAB","500000","30","Select","Select",""],["","63824000832","MUCINEX TAB","600MG ER","60","Select","Select",""],["","76204020060","ALBUTEROL NEB","0.083%","360","Select","Select",""],["","31722072320","LEVOFLOXACIN TAB","750MG","7","Select","Select",""],["","00713050324","ANUCORT-HC","25 MG","10","Select","Select",""],["","65649041112","ANUSOL-HC","25 MG","10","Select","Select",""],["","00172572960","FAMOTIDINE","40 MG","30","Select","Select",""],["","69339014919","GUAIFENESIN-DEXTROMETHORPHAN","100-10MG\/5","240","Select","Select",""],["","65862001605","AMOXICILLIN","250 MG","21","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":""}]}]}