{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NORMAN GIVENS","gend":0,"add":"4007 WILLIAMSBURG DR","city":"HOPEWELL","state":"VA","zip":"23860-9998","dob":"1967-02-02","age":"","mstatus":"","insh":"2190726*01","cliId":"","pno":8047125909,"cno":8047125909,"email":"","ename":"","eno":"","pphy":"ALEXANDER, KYNDIS R NP","ppno":7578731009,"pcpadd":"739 THIMBLE SHOALS BLVD SUITE 801,","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606-9998","pcpcounty":"","pcpid":"","pcpname":"Eagle Harbor Primary Care","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7578737689,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["NO DATA","R60.1","R80.1","I10.","D50.9","N25.0","C18.7","G56.01","G56.02","C78.7","Z79.899","E11.22","R11.0","K52.1","T45.1X5A","I44.4","I82.210","D84.9","I13.0","I50.32","I87.1","E66.01","E11.40","Z68.41","Z95.828","E83.42","G47.33","E78.5","R59.0","R31.29","E11.3511","E11.3512","H33.42","G56.23","G56.03","M17.12","M79.602","M48.02","K65.4","N17.9","R91.1","D64.81","D69.59","R94.31","K74.60","G62.9","E86.0","I50.9","N18.9","R07.9","V58.89","E11.42","Z68.43","K21.9","Z85.038","Z90.49","Z92.21","Z79.84","Z79.891","M25.562","G89.29","M62.81","R26.89","C18.9","D69.6","R06.00","G47.10","R06.83","Z48.3","M54.12","R60.0","I50.23","M24.852","E11.3312","H04.123","H25.813","H43.393","H04.121","H04.122","H43.391","H43.392","Z08.","Z85.05","D64.9","G95.9","E11.9","I45.89","N28.9","Z79.01","Z79.82","M25.511","C80.1","M79.89","E66.9","Z91.14","M12.811","M54.2","E87.8","E55.9","M47.812","M75.121","Z92.3","M19.011","M75.111","R93.89","G56.11","G56.20","G95.20","G95.89","M75.101","Z12.11","M89.9","K63.89","G40.909","Z93.2","Z86.718","Z98.0"],"date":["2023-09-05","2021-03-31","2021-03-31","2022-09-04","2022-09-04","2021-03-31","2023-04-28","2022-05-24","2021-09-28","2023-08-24","2023-04-28","2023-08-24","2022-04-13","2022-06-23","2022-08-03","2022-08-03","2022-10-07","2022-09-04","2022-10-07","2023-08-24","2023-04-28","2023-08-24","2023-06-01","2023-08-24","2022-10-07","2022-10-18","2023-08-24","2022-10-07","2023-04-28","2022-09-04","2023-07-26","2023-07-26","2023-07-26","2021-09-20","2022-05-24","2021-04-13","2021-07-23","2023-06-26","2022-08-03","2022-09-02","2022-08-03","2022-08-03","2022-08-03","2022-08-24","2022-08-03","2023-01-26","2022-08-03","2022-09-05","2022-10-28","2022-09-05","2022-10-07","2022-10-07","2022-10-07","2023-08-24","2023-08-24","2023-08-24","2023-05-09","2022-10-18","2021-03-01","2021-05-03","2023-08-24","2021-05-03","2021-05-03","2023-02-02","2022-09-02","2022-09-05","2022-09-26","2022-09-26","2022-09-02","2023-06-26","2023-09-05","2022-10-28","2021-03-09","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-04-21","2021-04-21","2021-04-21","2021-04-21","2023-05-09","2023-05-09","2021-03-12","2022-05-24","2023-06-26","2022-08-16","2022-08-16","2022-09-13","2022-09-28","2023-06-22","2022-08-03","2022-09-01","2022-09-04","2023-01-31","2023-06-22","2023-03-31","2023-05-01","2023-09-05","2023-05-16","2023-05-16","2023-05-09","2023-05-19","2023-05-19","2023-05-19","2023-06-14","2023-06-14","2023-06-26","2023-06-26","2023-06-26","2023-08-24","2023-09-05","2023-08-24","2023-08-24","2023-08-24","2023-08-24","2023-08-24"],"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":[["","70010049105","METFORMIN","TAB 500MG ER","60","Select","Select",""],["","00054429931","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","120","Select","Select",""],["","00591024105","LORAZEPAM","TAB 1MG","2","Select","Select",""],["","00172392670","DIAZEPAM","5 MG","1","Select","Select",""],["","59676058015","JANSSEN VACC","INJ COVID-19","0","Select","Select",""],["","00093077198","PRAVASTATIN","TAB 10MG","30","Select","Select",""],["","69097068105","PREGABALIN","100 MG","60","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","70756081622","CAPECITABINE","500 MG","56","Select","Select",""],["","59746011506","PROCHLORPER","TAB 10MG","90","Select","Select",""],["","00406123601","DIPHEN\/ATROP","TAB 2.5MG","30","Select","Select",""],["","27241009803","DULOXETINE","CAP 30MG","30","Select","Select",""],["","50111091701","TORSEMIDE","20 MG","30","Select","Select",""],["","65862035705","CLOPIDOGREL","75 MG","30","Select","Select",""],["","53746036110","FOLIC ACID","1 MG","30","Select","Select",""],["","00536110301","ALCOHOL PREP","PAD 0.7","100","Select","Select",""],["","00406055262","OXYCODONE","TAB 5MG","28","Select","Select",""],["","53885004601","ONETOUCH","KIT ULTRA 2","1","Select","Select",""],["","11917021385","MAGNESIUM","CAP 400MG","30","Select","Select",""],["","53885001110","ONETOUCH DEL","MIS PLUS 30G","100","Select","Select",""],["","00781329969","ENOXAPARIN","INJ 150MG\/ML","24","Select","Select",""],["","00093077198","PRAVASTATIN SODIUM","10 MG","90","Select","Select",""],["","70010049105","METFORMIN HCL ER","500 MG","180","Select","Select",""],["","27241009803","DULOXETINE HCL","30 MG","30","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","10006073038","MAGNESIUM OXIDE","400 MG","30","Select","Select",""],["","11917021993",""," ","60","Select","Select",""],["","70010049105","METFORMIN TAB","500MG ER","60","Select","Select",""],["","59746011506","PROCHLORPER TAB","10MG","90","Select","Select",""],["","00093077198","PRAVASTATIN TAB","10MG","90","Select","Select",""],["","72205000792","CAPECITABINE TAB","500MG","112","Select","Select",""],["","27241009803","DULOXETINE CAP","30MG","90","Select","Select",""],["","00406123601","DIPHEN\/ATROP TAB","2.5MG","30","Select","Select",""],["","69097068105","PREGABALIN CAP","100MG","60","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","28","Select","Select",""],["","50111091701","TORSEMIDE TAB","20MG","30","Select","Select",""],["","11917021385","MAGNESIUM CAP","400MG","90","Select","Select",""],["","00536110301","ALCOHOL PREP PAD","70%","200","Select","Select",""],["","69315012710","FOLIC ACID TAB","1000MCG","30","Select","Select",""],["","53885024510","ONETOUCH TES ULTRA","","100","Select","Select",""],["","53885001110","ONETOUCH DEL MIS PLUS","30G","100","Select","Select",""],["","53885004601","ONETOUCH KIT ULTRA","2","1","Select","Select",""],["","65862035705","CLOPIDOGREL TAB","75MG","30","Select","Select",""],["","00781329969","ENOXAPARIN INJ","150MG\/ML","24","Select","Select",""],["","45802086802","POLYETHYLENE GLYCOL","3350 17 G\/DOSE","238","Select","Select",""],["","00363032706","GENTLE LAXATIVE","5 MG","2","Select","Select",""],["","53885014301","ONETOUCH DELICA","33 GAUGE","100","Select","Select",""],["","53885024450","ONETOUCH ULTRA TEST STRIP","","50","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","00093031101","LOPERAMIDE","2 MG","60","Select","Select",""],["","00574204230","LIDOCAINE-PRILOCAINE","2.5 %-2.5%","30","Select","Select",""],["","70954068910","PROCHLORPERAZINE MALEATE","10 MG","90","Select","Select",""],["","68462010630","ONDANSETRON HCL","8 MG","30","Select","Select",""],["","00054418425","DEXAMETHASONE","4 MG","60","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":""}]}]}