{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICKY D EVERETT","gend":0,"add":"526 W WASHINGTON ST","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1965-04-20","age":"","mstatus":"","insh":"2197645*01","cliId":"","pno":7574519509,"cno":7574519509,"email":"","ename":"","eno":"","pphy":"WILLIAMS, LINDSEY M PA","ppno":7579838650,"pcpadd":"2760 GODWIN BLVD STE 100,","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23434-9998","pcpcounty":"","pcpid":"","pcpname":"SMG - Sentara Family Medicine & Walk-In - Suffolk","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7579838673,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L03.115","M86.9","L97.519","E11.42","I73.9","Z89.421","D84.9","Z79.4","M54.16","E78.2","I10.","Z72.0","S42.291A","E11.9","Z85.9","Z85.72","F17.210","Z88.8","S49.91XA","S42.211A","V92.09XA","H25.12","H54.40","L03.031","R73.9","Z91.19","H54.50","S91.301A","L98.499","V54.11","X58.XXXD","E11.65","G89.29","M47.26","M51.16","Z00.00","H61.22","Z85.79","Z53.29","F19.10","M00.9","J30.9","Z12.5","F17.200","Z91.199","M25.511","C85.89","H57.12","M51.36","S42.201S","X58.XXXS","Z01.810","I44.4","E78.5","M25.50","Z71.6","E55.9","Z91.14","Z91.11","Z83.3","Z82.49","R63.1","Z87.2","L84.","R26.81","M20.41","M20.42","Z01.818","M54.17","E11.69","E11.59","I15.2","NO DATA","M51.26"],"date":["2021-08-23","2021-08-22","2021-11-03","2023-04-14","2021-09-13","2021-11-10","2021-10-04","2023-04-14","2022-05-26","2022-11-17","2022-11-17","2022-08-16","2021-11-10","2021-11-10","2021-11-10","2022-06-27","2022-06-27","2022-06-27","2021-11-10","2021-11-12","2021-11-12","2022-02-17","2021-08-26","2021-08-23","2021-08-23","2021-08-23","2021-08-26","2021-08-23","2021-08-23","2021-12-02","2021-11-17","2023-04-14","2022-04-05","2022-03-02","2022-04-05","2022-06-24","2022-06-24","2022-06-24","2022-06-24","2022-11-17","2022-06-24","2022-06-24","2022-11-17","2022-11-17","2022-11-17","2021-12-02","2022-07-13","2021-08-21","2021-08-26","2022-02-24","2022-02-24","2023-04-10","2023-04-10","2023-04-14","2021-08-22","2021-08-22","2021-08-22","2022-06-27","2022-06-27","2022-06-27","2022-06-27","2022-06-27","2021-12-13","2021-12-13","2021-12-13","2021-12-13","2021-12-13","2023-04-10","2023-04-10","2023-04-14","2023-04-14","2023-04-14","2023-04-06","2023-04-06"],"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":[["","00088221905","LANTUS SOLOS","INJ 100\/ML","3","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","54","Select","Select",""],["","24208091055","ERYTHROMYCIN","OIN 5MG\/GM","4","Select","Select",""],["","56151210401","PEN NEEDLES","MIS 32GX4MM","100","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","150","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","00406052301","OXYCOD\/APAP","TAB 10-325MG","20","Select","Select",""],["","68180098003","LISINOPRIL","10 MG","90","Select","Select",""],["","59267100002","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","00002822259","INSULIN LISP","INJ 100\/ML","54","Select","Select",""],["","65162062750","TRAMADOL HCL","50 MG","60","Select","Select",""],["","00378718505","METFORMIN","TAB 500MG","60","Select","Select",""],["","68180012201","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","49884072703","DOXYCYC MONO","CAP 100MG","20","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","40","Select","Select",""],["","24208079535","NEO\/POLY\/DEX","OIN 0.1% OP","4","Select","Select",""],["","61314063705","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","69315030802","CIPROFLOXACN","SOL 0.3% OP","2","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","60505100301","KETOROLAC","SOL 0.005","5","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","00955172805","INSULIN GLAR","INJ 100U\/ML","15","Select","Select",""],["","68462034690","LEVOCETIRIZI","TAB 5MG","30","Select","Select",""],["","11917014365","EAR WAX REMV","DRO 6.5% OT","15","Select","Select",""],["","49502025175","SEMGLEE","INJ 100U\/ML","3","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","8","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","200","Select","Select",""],["","55111012205","ATORVASTATIN","TAB 20MG","60","Select","Select",""],["","08627001601","DEXCOM G6","MIS TRANSMIT","1","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","11877001140","BINAXNOW COVID-","19 AG SELF TEST","8","Select","Select",""],["","43598083105","ATORVASTATIN CALCIUM","20 MG","90","Select","Select",""],["","08627009111","DEXCOM G","6 RECEIVER","1","Select","Select",""],["","70010049105","METFORMIN HCL ER","500 MG","180","Select","Select",""],["","65162062711","TRAMADOL HCL TAB","50MG","60","Select","Select",""],["","68180098103","LISINOPRIL TAB","20MG","30","Select","Select",""],["","60505100301","KETOROLAC SOL","0.5%","5","Select","Select",""],["","69315030802","CIPROFLOXACN SOL","0.3% OP","2","Select","Select",""],["","61314063705","PREDNISOLONE SUS","1% OP","5","Select","Select",""],["","68462019005","NAPROXEN TAB","500MG","60","Select","Select",""],["","52817033200","CYCLOBENZAPR TAB","10MG","60","Select","Select",""],["","65162010250","GABAPENTIN CAP","300MG","60","Select","Select",""],["","00378718505","METFORMIN TAB","500MG","60","Select","Select",""],["","68462034690","LEVOCETIRIZI TAB","5MG","30","Select","Select",""],["","53885027150","ONETOUCH TES VERIO","","150","Select","Select",""],["","00002879959","HUMALOG KWIK INJ","100\/ML","54","Select","Select",""],["","00002822259","INSULIN LISP INJ","100\/ML","54","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","3","Select","Select",""],["","49502025175","SEMGLEE INJ","100U\/ML","3","Select","Select",""],["","55111012205","ATORVASTATIN TAB","20MG","180","Select","Select",""],["","11917014365","EAR WAX REMV DRO","6.5% OT","15","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","200","Select","Select",""],["","53885013610","ONETOUCH MIS LANCETS","","200","Select","Select",""],["","00955172805","INSULIN GLAR INJ","100U\/ML","15","Select","Select",""],["","08290320122","BD PEN NEEDL MIS","32GX4MM","100","Select","Select",""],["","00172572860","FAMOTIDINE TAB","20MG","28","Select","Select",""],["","00406012305","HYDROCO\/APAP TAB","5-325MG","30","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","14","Select","Select",""],["","11877001140","BINAXNOW COV KIT HOME TES","","8","Select","Select",""],["","53885004401","ONE TOUCH KIT VERIO FL","","1","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":""}]}]}