{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JEFFREY LANE","gend":0,"add":"940 PORTSMOUTH BLVD LOT 13","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1964-06-11","age":"","mstatus":"","insh":"2149596*01","cliId":"","pno":7576636765,"cno":7576636765,"email":"","ename":"","eno":"","pphy":"SEREM, MAUREEN C MD","ppno":7576061656,"pcpadd":"3235 BRIDGE RD STE 15,","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23435-9998","pcpcounty":"","pcpid":"","pcpname":"North Suffolk Family Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576061657,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.10","F15.10","F11.20","F17.200","F12.10","B35.1","M79.674","J44.9","R06.02","M79.604","T40.604A","J43.9","I10.","F17.210","Z88.5","R45.1","K40.91","M17.11","R06.00","NO DATA","D64.9","M54.2","F17.290","Z79.01","R05.9","R11.2","F41.9","Z53.21","G47.00","R60.0","T79.A21A","Z48.1","I48.0","I77.810","S06.309A","S06.6X9A","T14.90XA","I61.5","T79.A0XA","S06.9X9A","S02.2XXA","S12.9XXA","S82.131A","T07.XXXA","G89.18","S93.314A","I60.9","Z98.890","Z87.81","V87.7XXA","I82.401","V54.16","V54.17","F32.9","M21.061","M25.561","G89.29","S01.21XA","I45.6","R29.6","L03.115","M25.061","K59.00","K40.20","I82.4Z1","S09.90XA","F07.81","G44.309","M79.89","R52.","R09.02","R60.9","W19.XXXA","I82.4Y1","M25.512","Z86.718","Z79.899","R11.11","R53.81","A41.9","R07.9","I95.9","R07.89","M25.571","F10.10","M25.461","N17.9","R10.9","I82.503","S00.93XA","T50.916A","Z91.128","Z63.9","Z20.822","Z01.812","Z01.818","S82.201A","S82.401A","S82.141A","K40.21","R29.898","R53.1","S89.91XA","R51.9","M40.209","S20.212A","S80.921A","S90.922A","Z91.81","Z91.51","V89.2XXD","R03.0","E87.6","M25.522","R68.89","I82.5Z1","M79.606","I48.91","G47.9","R29.818","I25.10","J32.0","J32.1","J32.2","J32.3","Z47.2","G44.89","V89.2XXA","Z79.82","D68.32","T45.515A","Z71.6","Z82.49","K40.30","F14.10","Z13.89","Z51.81","R10.31","Z79.891","Z76.0","F14.20","R53.83","I72.3","F43.12","F33.1","I87.8","K40.90","Z23.","R06.9","R11.0","V58.89","Z91.19","I70.0","F29.","R44.2","J35.01","R49.0","J37.0","R59.0","R19.03","F33.9","J35.8","R10.84","S27.321A","S12.000A","S12.100A","S12.400A","S22.42XA","D62.","I44.1","I80.8","S93.04XA","S82.831A","S92.211A","S92.131A","S92.001A","Z29.9","V54.19","S01.81XA","Z86.79","G89.4","M79.609","F12.90","S22.49XA","S27.329A","T79.A22A","M25.469","L03.90","M79.661","J43.2","R41.82","Z09.","K40.31","Z79.51","I82.4Y9","R42.","Z71.51","J06.9","R09.81","R06.89","R06.2","T40.2X1A","J98.01","T65.891A","R00.0","Z12.11","K57.30","K64.0","K63.5","K46.9","M25.569","Z87.820","R10.30","R19.09","J30.9","M75.102","S46.219A","E86.0","G47.30","R07.81","Z77.098","J01.90","S06.6X0A","S06.360A","S12.091A","S12.191A","G93.1","R59.9","M62.81","L98.9","E16.1","E16.2","J44.1","T84.398A","V62.84","I89.0","F32.2","F41.1","G47.09","F11.120","R06.81","R45.7","I11.0","I50.9","Z79.52","I82.509","F11.90","F11.23","R57.1","R94.31","A41.89","R65.21","J10.1","Z91.148","R00.1","N43.3","I86.1","R50.9","R11.10","N50.819","T88.7XXA","F43.10","Z53.29","F99.","T50.7X5A"],"date":["2022-12-28","2022-12-01","2023-09-20","2022-12-01","2022-12-01","2022-12-01","2022-12-01","2023-05-03","2023-02-24","2023-04-30","2023-01-11","2023-07-19","2023-07-19","2023-08-06","2023-06-18","2023-01-11","2023-07-19","2023-02-20","2023-05-03","2023-08-06","2023-07-19","2023-02-25","2023-08-06","2023-07-19","2023-02-25","2022-08-21","2023-06-18","2022-09-05","2023-06-18","2023-06-25","2021-10-03","2021-07-11","2023-07-19","2021-09-21","2021-08-04","2021-08-04","2021-10-03","2021-07-28","2021-07-31","2021-08-01","2021-07-28","2021-10-08","2021-08-01","2021-07-27","2021-07-27","2021-10-03","2021-09-23","2022-02-24","2022-02-21","2021-08-01","2022-07-23","2023-02-16","2021-09-28","2022-12-28","2021-09-28","2023-04-29","2023-02-15","2021-09-24","2022-09-05","2022-09-04","2023-04-30","2021-09-28","2021-09-28","2021-11-04","2021-10-25","2022-08-26","2021-10-08","2021-10-08","2023-08-21","2022-09-05","2022-08-21","2023-02-21","2022-02-15","2022-01-25","2022-10-13","2023-07-19","2023-04-30","2023-04-16","2022-04-29","2023-06-20","2023-06-17","2022-07-19","2023-06-29","2023-04-30","2023-06-02","2022-11-03","2023-06-18","2022-08-26","2022-07-20","2022-09-04","2022-09-04","2022-09-04","2022-09-05","2023-06-18","2021-07-06","2022-07-15","2021-07-24","2021-07-24","2021-10-03","2021-09-05","2021-09-09","2022-08-20","2021-09-24","2021-09-24","2021-09-24","2021-09-29","2021-09-29","2021-09-29","2021-09-29","2023-08-06","2021-11-04","2022-08-21","2023-06-18","2022-03-24","2022-05-08","2022-06-25","2022-07-13","2023-06-29","2023-08-06","2022-08-21","2022-09-12","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-07-22","2021-08-07","2021-09-06","2023-04-30","2021-09-09","2021-09-09","2021-09-09","2023-01-01","2021-10-28","2022-03-02","2022-03-02","2022-03-02","2023-02-15","2023-07-19","2022-05-16","2023-09-20","2023-01-19","2023-02-03","2023-09-21","2023-09-21","2023-02-21","2023-07-19","2022-09-29","2023-08-06","2023-04-16","2022-02-24","2022-02-24","2022-03-29","2022-09-05","2022-09-05","2022-11-22","2022-11-22","2022-11-22","2022-11-22","2023-02-04","2021-06-16","2022-03-12","2022-12-09","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-08-02","2021-08-12","2021-09-24","2021-10-28","2021-11-09","2022-01-18","2022-03-02","2021-07-11","2021-07-08","2021-07-09","2021-09-09","2021-09-09","2022-10-02","2023-01-08","2023-01-08","2021-09-22","2023-07-19","2022-01-16","2022-08-20","2022-09-03","2022-10-13","2023-01-01","2023-08-06","2023-01-01","2023-04-22","2023-01-11","2023-02-02","2023-02-02","2023-06-17","2021-04-09","2021-04-09","2021-04-09","2021-04-09","2021-09-07","2021-09-07","2023-08-06","2021-10-28","2022-01-25","2022-04-18","2022-04-18","2022-04-18","2023-06-23","2022-08-21","2023-01-21","2023-02-01","2021-06-26","2021-07-08","2021-07-08","2021-07-08","2021-07-08","2021-08-07","2021-08-07","2021-08-07","2021-09-17","2022-01-18","2022-01-18","2023-04-22","2022-11-03","2023-01-01","2021-06-16","2023-05-18","2023-05-18","2023-05-18","2023-05-18","2023-04-16","2023-04-16","2023-06-18","2023-06-18","2023-04-30","2023-04-29","2023-05-16","2023-08-21","2023-06-20","2023-06-25","2023-06-18","2023-06-18","2023-06-18","2023-06-25","2023-06-17","2023-06-18","2023-06-18","2023-06-18","2023-06-23","2023-06-29","2023-08-21","2023-08-06","2023-08-06","2023-08-06","2023-08-21"],"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":[["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","11822333000","MAG CITRATE","SOL LEMON","296","Select","Select",""],["","57896044101","BISACODYL","TAB 5MG EC","2","Select","Select",""],["","00378363701","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","16714047802","AMOX\/K CLAV","TAB 875-125","10","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","20","Select","Select",""],["","11845051801","VITAMIN C","CHW 250MG","90","Select","Select",""],["","11822300230","ACETAMIN","TAB 500MG","42","Select","Select",""],["","49483048112","ASPIRIN LOW","TAB 81MG EC","30","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","90","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","70954006020","PREDNISONE","20 MG","12","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","20","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","8","Select","Select",""],["","45802086803","POLYETH GLYC","POW 3350 NF","510","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","00536124810","STIMULANT","TAB 8.6-50MG","60","Select","Select",""],["","00054429731","FUROSEMIDE","20 MG","60","Select","Select",""],["","00003089421","ELIQUIS","5 MG","60","Select","Select",""],["","57664037708","TRAMADOL HCL","TAB 50MG","10","Select","Select",""],["","29300035916","AMIODARONE","TAB 200MG","90","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","8","Select","Select",""],["","31722072250","LEVOFLOXACIN","TAB 500MG","14","Select","Select",""],["","11534016503","FOLIC ACID","1 MG","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","16714001610","ENOXAPARIN","INJ 40\/0.4ML","17","Select","Select",""],["","10006070021","VITAMIN B1","TAB 100MG","90","Select","Select",""],["","50228018001","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","41167005840","ASPERCREME","PAD LIDO 4%","14","Select","Select",""],["","57896030401","STOOL SOFTNR","TAB 8.6-50MG","60","Select","Select",""],["","65862006299","METOPROL TAR","TAB 25MG","180","Select","Select",""],["","72888001405","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","11822316910","RA ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","69618002601","FERROUS SULF","TAB 325MG","90","Select","Select",""],["","11822010233","PAIN RELIEF","TAB 500MG","42","Select","Select",""],["","12496120803","SUBOXONE","8 MG-2 MG","11","Select","Select",""],["","51645087513","THERA-M","TAB ","31","Select","Select",""],["","59267100003","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","8","Select","Select",""],["","46581083006","SALONPAS GEL","PAD 0.04","6","Select","Select",""],["","49348008110","V-R VIT C","CHW 250MG","90","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","20","Select","Select",""],["","10006070047","C-250","CHW ","90","Select","Select",""],["","11822228090","RA MELATONIN","TAB 3MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","76204020030","ALBUTEROL","NEB 0.00083","360","Select","Select",""],["","00172392660","DIAZEPAM","TAB 5MG","1","Select","Select",""],["","65162024709","CHLORTHALID","TAB 25MG","30","Select","Select",""],["","65162046550","IBUPROFEN","600 MG","30","Select","Select",""],["","00093506105","HYDROXYZ HCL","TAB 25MG","30","Select","Select",""],["","60505476606","APO-VARENICL","TAB 1MG","56","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","69238106901","POT CHLORIDE","TAB 20MEQ ER","5","Select","Select",""],["","67877021905","CEPHALEXIN","500 MG","28","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","49884015676","VARENICLINE","TAB 1MG","34","Select","Select",""],["","46122012078","ESSENTL ONE","TAB DAILY","30","Select","Select",""],["","00185067401","HYDROXYZ PAM","CAP 25MG","10","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","11917014664","ESSENT ONE","TAB DAILY","30","Select","Select",""],["","59267030402","PFIZER BIVAL","INJ BA4\/BA5","0","Select","Select",""],["","00363058714","ASPIRIN 81","TAB 81MG EC","30","Select","Select",""],["","80681002000","MULTIVITAMIN","","30","Select","Select",""],["","45802014167","CICLOPIROX","SOL 0.08","7","Select","Select",""],["","00363645014","ASPIRIN EC","81 MG","30","Select","Select",""],["","00781808926","AZITHROMYCIN","250 MG","6","Select","Select",""],["","00143928501","AMOXICILLIN","875 MG","20","Select","Select",""],["","65862006299","METOPROLOL TARTRATE","25 MG","180","Select","Select",""],["","52817033200","CYCLOBENZAPRINE HCL","10 MG","30","Select","Select",""],["","00591352530","LIDOCAINE","5 %","30","Select","Select",""],["","43598058230","BUPRENORPHINE-NALOXONE","8 MG-2 MG","7","Select","Select",""],["","23155050105","HYDROXYZINE HCL","25 MG","30","Select","Select",""],["","29300039710","AMLODIPINE BESYLATE","5 MG","30","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","00406051201","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","15","Select","Select",""],["","68180044701","QUETIAPINE FUMARATE","100 MG","30","Select","Select",""],["","24689012001","BUPROPION HCL","100 MG","30","Select","Select",""],["","60505265301","TRAZODONE HCL","50 MG","90","Select","Select",""],["","65862006299","METOPROL TAR TAB","25MG","180","Select","Select",""],["","11822316910","RA ASPIRIN TAB","81MG EC","30","Select","Select",""],["","11534016503","FOLIC ACID TAB","1MG","30","Select","Select",""],["","12496120803","SUBOXONE MIS","8-2MG","14","Select","Select",""],["","51645087513","THERA-M TAB","","31","Select","Select",""],["","00003089421","ELIQUIS TAB","5MG","60","Select","Select",""],["","64380073706","VITAMIN D CAP","50000UNT","12","Select","Select",""],["","65162024709","CHLORTHALID TAB","25MG","90","Select","Select",""],["","60505265301","TRAZODONE TAB","50MG","90","Select","Select",""],["","00172392660","DIAZEPAM TAB","5MG","1","Select","Select",""],["","11822228090","RA MELATONIN TAB","3MG","30","Select","Select",""],["","65162046510","IBUPROFEN TAB","600MG","30","Select","Select",""],["","65162004710","OXYCODONE TAB","5MG","8","Select","Select",""],["","42858010201","OXYCOD\/APAP TAB","5-325MG","20","Select","Select",""],["","68180012201","CEPHALEXIN CAP","500MG","28","Select","Select",""],["","00093506105","HYDROXYZ HCL TAB","25MG","30","Select","Select",""],["","60505476606","APO-VARENICL TAB","1MG","56","Select","Select",""],["","69238106901","POT CHLORIDE TAB","20MEQ ER","5","Select","Select",""],["","00093216568","NALOXONE HCL SPR","4MG","2","Select","Select",""],["","00093005301","BUSPIRONE TAB","5MG","90","Select","Select",""],["","11822300230","ACETAMIN TAB","500MG","42","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","11822010233","PAIN RELIEF TAB","500MG","42","Select","Select",""],["","00536123441","ASPIRIN LOW TAB","81MG EC","30","Select","Select",""],["","00054001925","PREDNISONE TAB","50MG","5","Select","Select",""],["","47335070349","ALBUTEROL NEB","0.083%","360","Select","Select",""],["","60432026415","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","49884015676","VARENICLINE TAB","1MG","34","Select","Select",""],["","72888001405","CYCLOBENZAPR TAB","10MG","30","Select","Select",""],["","46122012078","ESSENTL ONE TAB DAILY","","30","Select","Select",""],["","57664037708","TRAMADOL HCL TAB","50MG","10","Select","Select",""],["","16714047802","AMOX\/K CLAV TAB","875-125","10","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","10","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","43598058230","BUPREN\/NALOX MIS","8-2MG","10","Select","Select",""],["","00054429731","FUROSEMIDE TAB","20MG","5","Select","Select",""],["","68180072003","AMLODIPINE TAB","5MG","30","Select","Select",""],["","00185067401","HYDROXYZ PAM CAP","25MG","10","Select","Select",""],["","59267030402","PFIZER BIVAL INJ BA","4\/BA5","0","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","80681002000","MULTIVITAMIN TAB","","30","Select","Select",""],["","00363058714","ASPIRIN","81 TAB 81MG EC","30","Select","Select",""],["","11917014664","ESSENT ONE TAB DAILY","","30","Select","Select",""],["","45802014167","CICLOPIROX SOL","8%","7","Select","Select",""],["","57237007710","ONDANSETRON ODT","4 MG","12","Select","Select",""],["","00904728060","DOCUSATE SODIUM","100 MG","30","Select","Select",""],["","00228315303","BUPRENORPHINE HCL","8 MG","6","Select","Select",""],["","29300024401","BUSPIRONE HCL","5 MG","90","Select","Select",""],["","00054327099","FLUTICASONE PROPIONATE","50 MCG","16","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":""}]}]}