{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SIERRA MCPEEK","gend":1,"add":"2261 SPECKLED ROCK LN","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1997-05-16","age":"","mstatus":"","insh":"2151247*01","cliId":"","pno":7576333460,"cno":7576333460,"email":"","ename":"","eno":"","pphy":"WARSOF, STEVEN L MD","ppno":7574467900,"pcpadd":"SUITE 310 825 FAIRFAX AVE,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23507-9998","pcpcounty":"","pcpid":"","pcpname":"EVMS Maternal & Fetal Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576242254,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J96.01","R65.21","J18.9","I26.90","B95.62","N10.","G93.41","F11.20","I33.9","I33.0","F11.10","R78.81","R00.0","D69.6","A41.2","I26.99","A41.9","G47.33","A41.02","Z53.21","F90.2","F41.1","F31.81","R07.9","O44.41","O20.9","Z3A.11","I07.9","F90.0","F31.70","Z34.92","I76.","Z33.1","B95.61","F19.10","O99.322","L03.221","Z3A.25","O34.211","I38.","R53.1","Z86.16","I07.1","F11.90","I10.","F90.9","F41.9","F12.90","E66.01","Z68.30","Z86.14","Z87.891","Z91.02","R11.0","F17.200","G47.00","F43.0","F39.","U07.1","NO DATA","J02.9","R05.","R19.7","Z20.822","Z86.79","R68.89","O99.320","O99.281","E07.9","F14.10","Z13.89","Z51.81","O98.812","Z3A.19","Z3A.24","Z34.93","Z39.1","Z34.82","Z34.83","F11.21","Z3A.01","R10.2","F11.23","Z3A.16","N30.00","E87.6","J81.1","O23.12","O12.02","O99.212","O99.282","O99.342","F31.9","O34.219","E83.42","F11.93","I36.1","Z72.0","V23.9","Z3A.35","M54.30","I50.33","I36.8","R60.0","I51.7","Z3A.39","Z37.0","I31.3","J96.00","R94.5","B96.89","R79.89","O26.892","I50.9","Z3A.20","O26.93","O99.42","O41.1230","O75.2","O99.334","Z3A.38","Z82.3","Z81.8","Z80.3","Z82.49","Z83.438","Z86.711","G89.18","I28.8","Z59.0","F17.210","O46.90","Z3A.00","O99.321","R68.83","R52.","M79.609","Z45.2","F14.20","J15.212","J90.","R10.10","F60.3","Z65.8","F19.94","O88.312","O99.112","O99.412","O16.2","R04.2","Z3A.18","Z3A.17","Z3A.21","O99.012","E43.","R07.89","F22.","O99.712","O98.512","O98.412","O46.92","R21.","K59.00","R10.9","F17.290","R11.10"],"date":["2021-02-11","2021-02-11","2021-02-01","2021-12-23","2021-11-24","2021-01-13","2021-02-05","2023-09-18","2021-12-01","2022-04-26","2021-06-18","2021-12-02","2021-02-11","2021-02-11","2021-01-29","2021-01-29","2021-12-08","2021-02-11","2021-11-24","2021-04-24","2021-10-11","2022-01-27","2021-10-11","2022-08-01","2021-10-12","2021-12-14","2021-10-12","2022-01-20","2021-11-15","2022-08-01","2022-01-04","2022-01-14","2022-05-03","2022-01-05","2022-01-20","2022-01-20","2022-01-20","2022-01-20","2022-04-26","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2022-08-01","2023-09-18","2023-09-18","2023-09-18","2021-02-03","2022-01-20","2021-12-06","2021-07-07","2021-07-07","2021-07-07","2021-07-07","2021-11-24","2021-10-15","2022-03-24","2021-10-15","2021-10-15","2022-02-26","2022-02-26","2022-02-26","2022-01-14","2021-11-30","2022-01-16","2022-01-20","2022-03-31","2022-03-31","2022-03-31","2021-08-31","2021-08-31","2021-08-31","2021-11-24","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2021-11-24","2022-01-14","2021-11-15","2022-03-24","2021-11-15","2021-11-19","2022-01-14","2022-02-26","2022-03-24","2022-03-24","2022-06-03","2021-01-02","2021-10-13","2021-04-12","2021-12-19","2022-04-26","2022-04-26","2021-02-09","2021-01-04","2021-01-06","2021-01-09","2021-01-21","2021-11-14","2021-11-14","2021-12-14","2022-02-08","2022-04-26","2022-04-26","2022-04-26","2022-04-26","2022-04-26","2022-04-26","2022-04-26","2022-04-26","2022-04-26","2022-04-26","2022-04-26","2022-04-27","2021-02-05","2021-04-12","2021-04-12","2021-08-31","2021-08-31","2021-10-12","2021-10-14","2021-10-14","2021-11-26","2022-01-17","2022-01-27","2021-01-03","2021-01-03","2021-01-04","2022-01-14","2021-04-28","2021-04-28","2021-11-24","2021-11-24","2022-01-14","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2021-12-23","2021-12-23","2021-01-21","2021-06-18","2022-01-14","2022-01-14","2022-01-14","2022-01-14","2022-01-14","2022-01-14","2023-08-28","2023-08-28","2023-08-28","2023-08-28"],"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":[["","67877019905","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","14","Select","Select",""],["","13668033101","TRAZODONE","TAB 100MG","30","Select","Select",""],["","57237010299","METOPROL TAR","TAB 100MG","60","Select","Select",""],["","10702025301","BUT\/APAP\/CAF","TAB ","16","Select","Select",""],["","08290236712","LACTINEX","GRA ","90","Select","Select",""],["","31722070290","LOSARTAN POT","TAB 100MG","30","Select","Select",""],["","00093506101","HYDROXYZ HCL","TAB 25MG","90","Select","Select",""],["","43547028910","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","51645087510","THERA-M","TAB ","30","Select","Select",""],["","12496120803","SUBOXONE","8 MG-2 MG","14","Select","Select",""],["","43598058230","BUPREN\/NALOX","MIS 8-2MG","14","Select","Select",""],["","11822619080","ALLERGY\/CONG","TAB 5-120MG","20","Select","Select",""],["","31722095801","BENZONATATE","CAP 200MG","30","Select","Select",""],["","27808008601","HYD POL\/CPM","SUS 10-8\/5ML","50","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","67877021660","CEFUROXIME","TAB 500MG","10","Select","Select",""],["","00904625549","SORE THROAT","LOZ 15-3.6MG","18","Select","Select",""],["","63044015005","PRENATAL VIT","TAB LOW IRON","30","Select","Select",""],["","00115180301","HYDROXYZ PAM","CAP 25MG","180","Select","Select",""],["","00904699880","DOCUSATE SOD","CAP 100MG","30","Select","Select",""],["","00574200802","NYSTOP","POW 100000","60","Select","Select",""],["","80681013800","CALCIUM\/D3","TAB 600MG","60","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","12496030001","SUBLOCADE","300 MG\/1.5","1.5","Select","Select",""],["","00093406701","PRAZOSIN HCL","1 MG","14","Select","Select",""],["","47781035703","BUPRENORPHINE-NALOXONE","8 MG-2 MG","14","Select","Select",""],["","13107008001","TRAZODONE HCL","100 MG","28","Select","Select",""],["","45802086803","POLYETHYLENE GLYCOL","3350 17 G\/DOSE","510","Select","Select",""],["","00093216568","NALOXONE HCL","4 MG","2","Select","Select",""],["","00904625549","SORE THROAT LOZ","15-3.6MG","18","Select","Select",""],["","00093506101","HYDROXYZ HCL TAB","25MG","90","Select","Select",""],["","43598058230","BUPREN\/NALOX MIS","8-2MG","14","Select","Select",""],["","12496120803","SUBOXONE MIS","8-2MG","54","Select","Select",""],["","63044015005","PRENATAL VIT TAB LOW IRON","","30","Select","Select",""],["","00904699880","DOCUSATE SOD CAP","100MG","30","Select","Select",""],["","00115180301","HYDROXYZ PAM CAP","25MG","180","Select","Select",""],["","00054429731","FUROSEMIDE TAB","20MG","14","Select","Select",""],["","00574200802","NYSTOP POW","100000","60","Select","Select",""],["","00904759080","FEROSUL TAB","325MG","30","Select","Select",""],["","80681013800","CALCIUM\/D","3 TAB 600MG","60","Select","Select",""],["","65162046650","IBUPROFEN TAB","800MG","30","Select","Select",""],["","00299492045","DIFFERIN","0.1 %","45","Select","Select",""],["","21922002705","CLINDAMYCIN PHOSPHATE","1 %","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":""}]}]}