{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MICHELLE CORLEY","gend":1,"add":"3230 ROSEGATE CT LOT 180","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1974-11-19","age":"","mstatus":"","insh":"2182275*01","cliId":"","pno":7579491690,"cno":7579491690,"email":"","ename":"","eno":"","pphy":"ANYIWO, JOEL O MD","ppno":7576898430,"pcpadd":"1925 GLENN MITCHELL DR STE 100,","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23456-9998","pcpcounty":"","pcpid":"","pcpname":"Princess Anne Medical Associates","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7576898435,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","K43.0","I26.99","R10.9","R11.2","NO DATA","A41.9","T81.41XA","L03.311","Z68.42","L02.211","E87.1","J44.9","E66.01","K21.9","H54.7","R73.03","M12.9","G43.909","Z98.51","Z91.018","Z88.0","Z98.890","T81.40XA","L03.90","T81.9XXA","Z45.2","R00.0","Z46.82","T81.43XA","T80.219A","E66.9","V58.89","M47.817","M43.17","Z79.1","Z87.440","Z87.891","J45.909","R30.0","R73.9","D50.0","K27.9","K59.09","Z86.010","S99.922A","Z88.6","Z91.02","Z88.8","R26.9","J30.9","S90.30XA","M79.672","K43.6","N12.","R31.9","J06.9","Z20.828","T85.79XA","Z20.822","Z90.49","K59.00","T81.89XA","R19.7","N10.","K56.7","E86.0","D50.9","A49.02","T81.40XD","R53.1","R07.9","R50.9","Z68.43","S31.109A","R10.30","U07.1","R52.","R06.02","Z48.03","K44.9","B99.9","Z88.5","R10.84","T80.212A","Z79.2","Z79.891","J02.9","Z91.09","N39.0","R35.0","R39.15","L03.211","J32.9","J30.1","T78.1XXA","J45.998","J45.20","J30.89","Z68.41","K52.9","R51.9","K40.90"],"date":["2023-03-14","2022-04-01","2022-04-04","2023-08-23","2022-06-02","2022-08-01","2022-05-31","2022-05-01","2022-08-01","2023-03-14","2022-08-01","2022-05-01","2022-08-10","2023-03-14","2023-07-27","2022-08-10","2022-05-19","2022-08-01","2022-08-10","2022-05-01","2022-06-02","2022-06-02","2022-05-24","2022-05-08","2022-06-03","2022-06-03","2022-05-31","2022-04-07","2022-04-08","2022-05-12","2022-05-31","2023-07-27","2022-08-10","2022-08-10","2022-08-10","2023-07-27","2022-08-10","2023-08-23","2023-09-18","2023-03-14","2023-03-14","2023-07-27","2021-03-03","2023-07-27","2023-07-27","2022-02-13","2022-06-02","2022-02-13","2022-05-24","2022-02-13","2021-11-24","2022-02-24","2022-02-24","2022-03-22","2023-03-14","2023-03-14","2021-08-10","2021-08-10","2022-05-24","2022-05-12","2022-05-24","2022-05-12","2022-07-01","2022-06-02","2023-03-14","2022-03-22","2023-08-23","2022-03-22","2022-05-16","2022-05-16","2022-05-24","2022-05-24","2022-05-24","2022-05-24","2022-06-02","2022-06-02","2021-08-10","2021-08-10","2021-08-10","2022-05-02","2022-05-02","2022-05-02","2022-06-02","2022-03-26","2022-08-01","2022-08-01","2022-08-01","2023-04-11","2023-09-18","2023-08-08","2023-05-03","2023-05-03","2022-05-13","2023-06-08","2023-06-28","2023-06-28","2023-06-08","2023-06-28","2023-06-28","2023-07-27","2023-08-23","2023-08-23","2023-08-23"],"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":[["","00603548421","PROPRANOLOL","TAB 40MG","60","Select","Select",""],["","55111064505","OMEPRAZOLE","40 MG","60","Select","Select",""],["","51660093901","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","11822003960","RA COL-RITE","CAP 100MG","30","Select","Select",""],["","64764008060","AMITIZA","CAP 8MCG","60","Select","Select",""],["","68382005105","MELOXICAM","15 MG","30","Select","Select",""],["","72888001405","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00254302802","LUBIPROSTONE","CAP 8MCG","60","Select","Select",""],["","00904759080","FEROSUL","325(65) MG","30","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","3","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00121077504","GG\/CODEINE","SOL 100-10\/5","180","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00186037220","SYMBICORT","80-4.5 MCG","10.2","Select","Select",""],["","29300039705","AMLODIPINE","TAB 5MG","90","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","57664037708","TRAMADOL HCL","TAB 50MG","20","Select","Select",""],["","11822070538","ALLERGY REL","TAB 10MG","30","Select","Select",""],["","16714020030","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","00456120330","LINZESS","CAP 72MCG","30","Select","Select",""],["","00574705012","BISACODYL","SUP 10MG","30","Select","Select",""],["","51079030630","POLYETH GLYC","POW 3350 NF","10","Select","Select",""],["","50458057990","XARELTO","TAB 20MG","30","Select","Select",""],["","67877056105","METFORMIN","TAB 500MG","60","Select","Select",""],["","11822306500","LAX\/STL SOFT","TAB 8.6-50MG","30","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","00904052360","VITAMIN C","TAB 500MG","30","Select","Select",""],["","80681000300","THEREMS","TAB MULTIVIT","30","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","18","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","28","Select","Select",""],["","80681013500","ZINC","CAP 220MG","7","Select","Select",""],["","00904699860","DOCUSATE SOD","CAP 100MG","30","Select","Select",""],["","47335070349","ALBUTEROL SULFATE","2.5 MG\/3ML","225","Select","Select",""],["","00054074287","ALBUTEROL SULFATE HFA","90 MCG","6.7","Select","Select",""],["","00603548421","PROPRANOLOL HCL","40 MG","180","Select","Select",""],["","59746017506","PREDNISONE","20 MG","10","Select","Select",""],["","65862007701","CIPROFLOXACIN HCL","500 MG","14","Select","Select",""],["","72888001405","CYCLOBENZAPRINE HCL","10 MG","30","Select","Select",""],["","11822031650","COL-RITE","100 MG","30","Select","Select",""],["","00904759161","FERROUS SULFATE","325(65) MG","90","Select","Select",""],["","00310737220","BUDESONIDE-FORMOTEROL FUMARATE","80-4.5 MCG","10.2","Select","Select",""],["","51660093901","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","68382055901","NITROFURANTOIN","50 MG","30","Select","Select",""],["","11822070538","ALLERGY RELIEF","10 MG","90","Select","Select",""],["","70010049101","METFORMIN HCL ER","500 MG","180","Select","Select",""],["","72888001405","CYCLOBENZAPR TAB","10MG","30","Select","Select",""],["","68382005101","MELOXICAM TAB","15MG","30","Select","Select",""],["","29300022019","MONTELUKAST TAB","10MG","30","Select","Select",""],["","29300039705","AMLODIPINE TAB","5MG","90","Select","Select",""],["","55111064501","OMEPRAZOLE CAP","40MG","60","Select","Select",""],["","00186037220","SYMBICORT AER","80-4.5","10","Select","Select",""],["","51660093901","CETIRIZINE TAB","10MG","30","Select","Select",""],["","00603548421","PROPRANOLOL TAB","40MG","60","Select","Select",""],["","00904759080","FEROSUL TAB","325MG","30","Select","Select",""],["","57664037708","TRAMADOL HCL TAB","50MG","20","Select","Select",""],["","00310737220","BUDES\/FORMOT AER","80-4.5","10","Select","Select",""],["","11822031650","RA COL-RITE CAP","100MG","30","Select","Select",""],["","51079030630","POLYETH GLYC POW","3350 NF","10","Select","Select",""],["","50458057990","XARELTO TAB","20MG","30","Select","Select",""],["","31722099601","HYDROCO\/APAP TAB","5-325MG","12","Select","Select",""],["","16714020030","ONDANSETRON TAB","4MG ODT","15","Select","Select",""],["","11822306500","LAX\/STL SOFT TAB","8.6-50MG","30","Select","Select",""],["","00003089421","ELIQUIS TAB","5MG","60","Select","Select",""],["","80681013500","ZINC CAP","220MG","7","Select","Select",""],["","00456120330","LINZESS CAP","72MCG","30","Select","Select",""],["","67877056105","METFORMIN TAB","500MG","60","Select","Select",""],["","00904699860","DOCUSATE SOD CAP","100MG","30","Select","Select",""],["","11822070538","ALLERGY REL TAB","10MG","30","Select","Select",""],["","00904052360","VITAMIN C TAB","500MG","30","Select","Select",""],["","80681000300","THEREMS TAB MULTIVIT","","30","Select","Select",""],["","00574705012","BISACODYL SUP","10MG","30","Select","Select",""],["","00406324301","HYDROMORPHON TAB","2MG","28","Select","Select",""],["","69238110005","DOXYCYCL HYC CAP","100MG","18","Select","Select",""],["","67877054360","CEFDINIR","300 MG","28","Select","Select",""],["","29300039705","AMLODIPINE BESYLATE","5 MG","90","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","30","Select","Select",""],["","70710116201","MECLIZINE HCL","25 MG","30","Select","Select",""],["","00832605211","DICYCLOMINE HCL","20 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":""}]}]}