{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHIRLENE M LEWIS","gend":1,"add":"432 CLIFTON ST","city":"NORFOLK","state":"VA","zip":"23523-9998","dob":"1979-04-24","age":"","mstatus":"","insh":"2083934*01","cliId":"","pno":3183179094,"cno":3183179094,"email":"","ename":"","eno":"","pphy":"TORRY, CHE DO","ppno":7573106413,"pcpadd":"1030 LOFTIS BLVD STE 201,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606-9998","pcpcounty":"","pcpid":"","pcpname":"Depaul Medical Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7573106404,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R53.1","R20.2","M54.16","M54.2","Z01.818","Z68.38","M76.61","M19.071","Z68.37","K92.2","I10.","E87.6","E78.5","R10.9","N83.291","K21.9","NO DATA","M17.4","Z98.890","M17.11","S92.214A","Z23.","Z51.81","Z79.891","S92.331A","M20.21","M92.61","R42.","W19.XXXA","R41.3","J20.9","E11.42","Z68.39","G43.109","G31.84","M50.30","K64.9","R13.10","I11.0","I50.9","R19.7","G97.82","Z68.36","Z98.84","E78.00","R73.03","K58.9","Z11.59","R52.","M95.8","G47.00","G43.909","G56.03","R10.12","R10.32","K52.9","R10.84","R11.2","R11.0","R07.89","N83.201","E11.9","H52.13","H52.223","H52.4","K59.00","R10.31","R22.2","K80.50","M54.9","D57.3","E66.01","G47.30","M19.90","N32.81","K76.89","Z79.899","Z86.018","M51.36","M25.561","M25.571","Z86.39","Z13.31","M79.671","G89.29","Z68.41","S00.93XA","F32.9","R29.6","M62.81","N30.00","M67.88","K57.31","E43.","A07.2","E66.9","Z86.11","Z87.891","F41.9","K64.8","K57.91","E11.40","R51.9","R20.0","R47.89","R41.82","K56.41","Z87.442","Z87.19","E11.49","F33.1","M16.11","M25.551","M77.51","M65.28","G89.18","S90.01XA","Z20.822","S80.02XA","K08.89","A08.4","R07.9","R26.2","Z88.5","Z91.040","R32.","K04.7","R63.0","B37.3","G81.90","G56.01","M54.17","F32.0","K57.30","Z90.49","Z79.3","G89.4","M47.816","G62.9","S09.90XA","S86.911A","N64.4","N64.3","E61.1","B30.9","R10.13","D24.1","N64.52","Z79.4"],"date":["2022-04-28","2021-10-25","2023-02-13","2021-10-25","2022-02-02","2022-02-02","2022-08-30","2022-08-30","2022-02-07","2022-05-21","2023-08-24","2022-05-21","2022-05-21","2023-08-24","2022-11-06","2022-12-12","2023-08-11","2023-03-13","2023-04-14","2023-03-13","2021-01-04","2021-01-04","2022-08-01","2022-08-01","2021-01-27","2021-02-23","2021-02-23","2022-10-25","2021-03-23","2021-03-23","2022-12-01","2021-03-23","2021-09-05","2022-04-28","2022-04-28","2022-04-28","2022-07-17","2022-05-13","2023-08-31","2023-08-31","2022-11-07","2022-08-30","2022-12-12","2023-01-26","2023-06-22","2023-06-22","2022-12-01","2022-09-09","2022-09-09","2022-09-09","2022-12-01","2022-12-01","2022-09-09","2022-12-12","2021-05-03","2022-07-21","2023-09-03","2023-09-03","2022-11-04","2022-11-08","2022-12-12","2023-08-31","2021-05-26","2021-05-26","2021-05-26","2022-11-07","2022-10-25","2022-11-08","2022-11-08","2022-12-12","2023-06-22","2022-12-12","2023-08-31","2023-08-31","2022-12-12","2022-12-12","2022-12-12","2022-12-12","2023-02-13","2023-04-14","2023-02-13","2023-02-13","2023-02-13","2023-04-14","2023-06-22","2021-01-19","2021-03-16","2021-03-15","2021-03-15","2021-09-05","2021-09-05","2021-12-21","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2022-05-11","2022-10-29","2022-05-11","2022-05-11","2022-05-11","2021-03-14","2023-08-06","2021-03-14","2021-03-14","2021-03-14","2022-10-25","2022-10-25","2022-10-25","2023-01-24","2021-04-13","2021-09-16","2023-04-14","2022-02-10","2022-02-10","2022-02-10","2023-03-14","2023-03-14","2023-03-14","2023-03-14","2023-03-14","2023-08-06","2021-09-05","2021-09-05","2021-09-05","2021-09-05","2023-08-06","2022-03-21","2022-03-21","2022-04-28","2022-04-28","2022-04-28","2022-04-28","2022-10-29","2022-10-29","2022-10-29","2023-08-18","2023-08-18","2023-08-18","2023-04-14","2023-04-14","2023-08-23","2023-06-22","2023-06-22","2023-08-24","2023-08-06","2023-08-31","2023-08-31","2023-08-31"],"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":[["","72888001405","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","300","Select","Select",""],["","65162079108","LIDOCAINE","5 %","30","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","90","Select","Select",""],["","57237001830","DULOXETINE","CAP 30MG","30","Select","Select",""],["","64380078706","BUSPIRONE","TAB 7.5MG","60","Select","Select",""],["","57237002901","AMOXICILLIN","875 MG","20","Select","Select",""],["","64380073706","VITAMIN D","CAP 50000UNT","12","Select","Select",""],["","31722058901","METOPROL SUC","TAB 25MG ER","90","Select","Select",""],["","16729017401","AMITRIPTYLIN","TAB 75MG","30","Select","Select",""],["","69097012403","TOPIRAMATE","TAB 100MG","60","Select","Select",""],["","68180098001","LISINOPRIL","10 MG","90","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00781106101","ALPRAZOLAM","TAB 0.25MG","12","Select","Select",""],["","50228018001","GABAPENTIN","300 MG","90","Select","Select",""],["","00591079401","DICYCLOMINE","CAP 10MG","90","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","62559015710","POLYETH GLYC","POW 3350 NF","10","Select","Select",""],["","50458058030","XARELTO","TAB 10MG","30","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","120","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","69367024324","HYDROCORT AC","SUP 25MG","2","Select","Select",""],["","42192033901","HYOSCYAMINE","SUB 0.125MG","15","Select","Select",""],["","00713050312","ANUCORT-HC","SUP 25MG","2","Select","Select",""],["","59762045001","COLESTIPOL","TAB 1GM","60","Select","Select",""],["","53746074501","PROMETHAZINE","TAB 12.5MG","180","Select","Select",""],["","11822332470","RA ANTACID","SUS ANTI-GAS","355","Select","Select",""],["","11822393550","RA LAXATIVE","POW ","238","Select","Select",""],["","00254101196","SUCRALFATE","1 G\/10 ML","1200","Select","Select",""],["","24385046678","FIBER THERAP","TAB 500MG","120","Select","Select",""],["","00132030140","FLEET OIL","ENE ","13","Select","Select",""],["","10135011130","DOCUSATE SOD","CAP 100MG","60","Select","Select",""],["","11822316500","RA COL-RITE","CAP 100MG","60","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","8","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","10","Select","Select",""],["","55111018015","TIZANIDINE HCL","4 MG","120","Select","Select",""],["","31722016930","DULOXETINE HCL","30 MG","30","Select","Select",""],["","72516003001","METOPROLOL SUCCINATE","25 MG","90","Select","Select",""],["","00832605211","DICYCLOMINE HCL","20 MG","56","Select","Select",""],["","29300042201","AMITRIPTYLINE HCL","75 MG","30","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","65862018730","ONDANSETRON HCL","4 MG","30","Select","Select",""],["","65162083366","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","00904672080","ACETAMINOPHEN","500 MG","60","Select","Select",""],["","31722071310","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","59011075104","BUTRANS","10 MCG\/HR","4","Select","Select",""],["","69238120302","BUPRENORPHINE","10 MCG\/HR","4","Select","Select",""],["","59385002160","BELBUCA","75 MCG","60","Select","Select",""],["","11822001780","COL-RITE","100 MG","60","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","00904723760","BANOPHEN","25 MG","30","Select","Select",""],["","43547035310","LISINOPRIL TAB","10MG","90","Select","Select",""],["","67877059001","METOPROL SUC TAB","25MG ER","90","Select","Select",""],["","31722016930","DULOXETINE CAP","30MG","30","Select","Select",""],["","16729017401","AMITRIPTYLIN TAB","75MG","30","Select","Select",""],["","00406051201","OXYCOD\/APAP TAB","5-325MG","8","Select","Select",""],["","65162079108","LIDOCAINE PAD","5%","90","Select","Select",""],["","55111018015","TIZANIDINE TAB","4MG","120","Select","Select",""],["","67877021901","CEPHALEXIN CAP","500MG","28","Select","Select",""],["","50458058030","XARELTO TAB","10MG","30","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","12","Select","Select",""],["","62559015710","POLYETH GLYC POW","3350 NF","10","Select","Select",""],["","69097012403","TOPIRAMATE TAB","100MG","60","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","42192033901","HYOSCYAMINE SUB","0.125MG","15","Select","Select",""],["","00713050312","ANUCORT-HC SUP","25MG","2","Select","Select",""],["","50228018001","GABAPENTIN CAP","300MG","30","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","57237002901","AMOXICILLIN TAB","875MG","20","Select","Select",""],["","69367024324","HYDROCORT AC SUP","25MG","2","Select","Select",""],["","68462011944","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","59762045001","COLESTIPOL TAB","1GM","60","Select","Select",""],["","31722071390","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","53746074501","PROMETHAZINE TAB","12.5MG","180","Select","Select",""],["","00527058601","DICYCLOMINE CAP","10MG","90","Select","Select",""],["","65162083366","DICLOFENAC GEL","1%","300","Select","Select",""],["","11822332470","RA ANTACID SUS ANTI-GAS","","355","Select","Select",""],["","00254101196","SUCRALFATE SUS","1GM\/10ML","1200","Select","Select",""],["","10135011130","DOCUSATE SOD CAP","100MG","60","Select","Select",""],["","72888000215","TIZANIDINE CAP","4MG","90","Select","Select",""],["","11822316500","RA COL-RITE CAP","100MG","60","Select","Select",""],["","00132030140","FLEET OIL ENE","","13","Select","Select",""],["","00406055201","OXYCODONE TAB","5MG","8","Select","Select",""],["","11822393550","RA LAXATIVE POW","","238","Select","Select",""],["","24385046678","FIBER THERAP TAB","500MG","120","Select","Select",""],["","57896020110","PAIN RELIEF","500 MG","60","Select","Select",""],["","00093117401","PENICILLIN V POTASSIUM","500 MG","40","Select","Select",""],["","24510005010","NUCYNTA","50 MG","90","Select","Select",""],["","00574402435","ERYTHROMYCIN","5 MG\/GRAM","3.5","Select","Select",""],["","00406012301","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","18","Select","Select",""],["","68382004101","PROMETHAZINE HCL","25 MG","15","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":""}]}]}