{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISA LONG","gend":1,"add":"2342 MEADOWS LNDG","city":"CHESAPEAKE","state":"VA","zip":"23321-9998","dob":"1972-09-08","age":"","mstatus":"","insh":"2040902*01","cliId":"","pno":7576182534,"cno":7576182534,"email":"","ename":"","eno":"","pphy":"FRANK, JANINE M MD","ppno":"","pcpadd":"4124 CHESAPEAKE SQUARE BLVD STE 103,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23321-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family & Internal Medicine Physicians - Chesapeake Square","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576738291,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I51.89","L82.0","L60.3","L81.4","Z71.9","F31.70","G47.33","G47.00","G47.50","R35.1","F90.2","F41.1","F31.12","E86.0","N30.00","I42.9","F17.210","R03.1","R42.","I50.22","NO DATA","I48.91","I50.42","R06.00","R00.2","I49.8","I44.0","R94.31","H93.25","I48.0","N32.81","F41.9","I42.0","N32.9","F42.9","I42.8","N18.2","K21.9","F31.9","Z95.810","Z88.1","Z79.899","Z88.8","Z88.5","Z91.040","R55.","N30.01","D75.1","K44.9","N32.89","R30.0","R33.9","R39.16","R14.0","I95.9","R53.81","R53.83","Z91.09","Z79.01","Z87.891","R35.0","I50.9","I10.","E78.2","R73.9","F98.8","L57.8","L82.1","L70.9","L91.8","N35.021","M62.89","Z20.828","U07.1","Z03.818","E11.59","G47.30","Z98.890","Z86.79","H69.93","R07.9","R00.0","I50.20","Z82.49","A60.09","F10.21","Z20.822","K59.00","M25.552","N81.10","J43.2","F31.60","G89.29","N81.6","I50.31","Z01.419","K58.9","R15.0","K64.9","F90.0","N91.2","G62.9","Z12.11","M25.559","Z53.21","I51.7","R53.1","M70.62","F51.01","E55.9","R20.2","H90.0","S92.414A","S99.921A","S92.411A","V54.16","Z00.00","D50.8","E53.8","M54.2","R53.82","I13.0","J90."],"date":["2021-03-31","2021-08-25","2021-04-08","2021-08-25","2021-04-08","2022-04-26","2023-03-29","2023-02-03","2023-02-03","2023-02-03","2022-03-28","2022-03-28","2022-03-28","2021-07-18","2021-09-28","2021-10-12","2022-03-28","2021-07-19","2022-10-11","2023-08-11","2023-07-25","2023-08-11","2021-09-29","2021-09-29","2023-04-05","2021-11-11","2021-11-11","2021-11-11","2022-02-18","2023-07-28","2023-07-25","2023-01-25","2023-07-28","2023-01-05","2022-03-28","2021-09-28","2023-08-11","2022-12-28","2023-08-11","2023-07-28","2022-07-14","2023-08-11","2023-08-11","2022-10-11","2022-10-11","2021-09-27","2021-09-30","2021-09-30","2021-09-30","2023-04-04","2021-10-07","2022-12-28","2021-10-07","2022-05-19","2022-12-28","2022-07-14","2022-07-14","2022-07-14","2023-08-11","2023-08-11","2022-12-02","2023-01-05","2021-01-05","2021-01-05","2021-01-05","2021-09-28","2021-01-28","2021-08-25","2021-08-25","2021-08-25","2023-01-05","2023-04-11","2021-04-17","2021-04-17","2021-04-23","2021-10-11","2021-10-11","2023-01-31","2023-01-31","2022-02-18","2022-10-11","2022-10-11","2022-10-11","2022-10-11","2021-09-28","2021-09-28","2021-04-23","2021-10-05","2023-01-25","2023-01-25","2023-01-25","2023-01-25","2023-07-25","2023-01-25","2021-08-31","2022-04-05","2022-05-19","2022-05-19","2022-05-19","2022-07-25","2022-07-25","2022-07-25","2023-07-25","2023-04-11","2021-07-19","2022-05-12","2022-12-28","2022-12-28","2022-12-28","2023-07-25","2022-12-28","2022-12-28","2023-05-16","2023-05-03","2023-05-03","2023-09-05","2023-07-25","2023-07-25","2023-07-25","2023-07-25","2023-07-25","2023-08-11","2023-08-11"],"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":[["","00456120230","LINZESS","290 MCG","30","Select","Select",""],["","65862085999","FAMOTIDINE","TAB 20MG","124","Select","Select",""],["","80681009800","VITAMIN B-1","TAB 100MG","90","Select","Select",""],["","00555097402","AMPHET\/DEXTR","TAB 30MG","30","Select","Select",""],["","69367026230","VALACYCLOVIR","500 MG","90","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","13107008405","LORAZEPAM","1 MG","60","Select","Select",""],["","65862023060","LAMOTRIGINE","200 MG","90","Select","Select",""],["","11534016503","FOLIC ACID","1 MG","30","Select","Select",""],["","31722071310","PANTOPRAZOLE","TAB 40MG","180","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","29300032813","SOLIFENACIN","TAB 5MG","30","Select","Select",""],["","68462016505","CARVEDILOL","25 MG","180","Select","Select",""],["","53746051105","SPIRONOLACT","TAB 25MG","90","Select","Select",""],["","45802056202","CLINDAMYCIN","SOL 0.01","60","Select","Select",""],["","65162075710","DIVALPROEX","TAB 500MG ER","30","Select","Select",""],["","62332004490","VALSARTAN","TAB 40MG","90","Select","Select",""],["","00536589688","NICOTINE TD","DIS 21MG\/24H","28","Select","Select",""],["","00135019602","NICODERM CQ","DIS 7MG\/24HR","14","Select","Select",""],["","00078065967","ENTRESTO","TAB 24-26MG","60","Select","Select",""],["","54092038301","ADDERALL XR","CAP 10MG","30","Select","Select",""],["","63402030230","LATUDA","TAB 20MG","30","Select","Select",""],["","65649000330","TRULANCE","TAB 3MG","30","Select","Select",""],["","65862073260","AMIODARONE","TAB 200MG","60","Select","Select",""],["","00003089421","ELIQUIS","5 MG","180","Select","Select",""],["","00781214501","AMPICILLIN","CAP 500MG","27","Select","Select",""],["","00178074001","URIBEL","CAP 118MG","28","Select","Select",""],["","68382013510","LOSARTAN POT","TAB 25MG","30","Select","Select",""],["","00527512570","LACTULOSE","SOL 10GM\/15","237","Select","Select",""],["","42799012001","BUMETANIDE","1 MG","90","Select","Select",""],["","45802014464","HC PRAMOXINE","CRE 1-1%","30","Select","Select",""],["","57237000511","FLUCONAZOLE","150 MG","14","Select","Select",""],["","00116200116","CHLORHEX GLU","SOL 0.0012","473","Select","Select",""],["","00168008031","HYDROCORT","CRE 0.025","30","Select","Select",""],["","55111046805","METOPROL SUC","TAB 100MG ER","30","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","8","Select","Select",""],["","00126028766","PREVIDENT","CRE 5000 PLS","51","Select","Select",""],["","54766079904","ANALPRAM HC","CRE 2.5-1%","30","Select","Select",""],["","13668000701","ZOLPIDEM","TAB 5MG","1","Select","Select",""],["","49281072210","FLUBLOK QUAD","INJ 2022-23","0","Select","Select",""],["","62559043130","HYDROCORTISO","CRE 0.025","30","Select","Select",""],["","00555097402","DEXTROAMPHETAMINE-AMPHETAMINE","30 MG","60","Select","Select",""],["","45963067711","METOPROLOL SUCCINATE","100 MG","90","Select","Select",""],["","80681009800","VITAMIN B-","1 100 MG","90","Select","Select",""],["","54766071604","PRAMOSONE","1 %-1 %","28.4","Select","Select",""],["","00378668977","PANTOPRAZOLE SODIUM","40 MG","180","Select","Select",""],["","53746051105","SPIRONOLACTONE","25 MG","90","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","69315012710","FOLIC ACID TAB","1000MCG","30","Select","Select",""],["","31722070490","VALACYCLOVIR TAB","500MG","73","Select","Select",""],["","31722071310","PANTOPRAZOLE TAB","40MG","180","Select","Select",""],["","62332004490","VALSARTAN TAB","40MG","90","Select","Select",""],["","16729022517","SPIRONOLACT TAB","25MG","90","Select","Select",""],["","65862014505","CARVEDILOL TAB","25MG","180","Select","Select",""],["","00121087316","LACTULOSE SOL","10GM\/15","474","Select","Select",""],["","62332004060","LAMOTRIGINE TAB","200MG","90","Select","Select",""],["","00456120230","LINZESS CAP","290MCG","30","Select","Select",""],["","00116200116","CHLORHEX GLU SOL","0.12%","473","Select","Select",""],["","00093342605","LORAZEPAM TAB","1MG","60","Select","Select",""],["","00003089421","ELIQUIS TAB","5MG","60","Select","Select",""],["","60505082901","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","54092038301","ADDERALL XR CAP","10MG","30","Select","Select",""],["","00406895201","AMPHET\/DEXTR CAP","10MG ER","30","Select","Select",""],["","60505470203","SOLIFENACIN TAB","5MG","60","Select","Select",""],["","00185012901","BUMETANIDE TAB","1MG","30","Select","Select",""],["","47781018001","AMPHET\/DEXTR TAB","30MG","30","Select","Select",""],["","45802014464","HC PRAMOXINE CRE","1-1%","30","Select","Select",""],["","68462011944","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","00078065967","ENTRESTO TAB","24-26MG","60","Select","Select",""],["","55111046805","METOPROL SUC TAB","100MG ER","30","Select","Select",""],["","00168008031","HYDROCORT CRE","2.5%","30","Select","Select",""],["","13668000701","ZOLPIDEM TAB","5MG","1","Select","Select",""],["","11877001140","BINAXNOW COV KIT HOME TES","","8","Select","Select",""],["","00126028766","PREVIDENT CRE","5000 PLS","51","Select","Select",""],["","45802056202","CLINDAMYCIN SOL","1%","60","Select","Select",""],["","54766079904","ANALPRAM HC CRE","2.5-1%","30","Select","Select",""],["","49281072210","FLUBLOK QUAD INJ","2022-23","0","Select","Select",""],["","62559043130","HYDROCORTISO CRE","2.5%","30","Select","Select",""],["","00310621030","FARXIGA","10 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":""}]}]}