{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WALLACE W EBERLY","gend":0,"add":"195 MERRIMAC TRL APT 6","city":"WILLIAMSBURG","state":"VA","zip":"23185-9998","dob":"1977-05-08","age":"","mstatus":"","insh":"2322283*01","cliId":"","pno":7572794697,"cno":7572794697,"email":"","ename":"","eno":"","pphy":"MAIGI, KIMBERLY D NP","ppno":7573450011,"pcpadd":"7364 RICHMOND ROAD,","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":"23188-9998","pcpcounty":"","pcpid":"","pcpname":"Riverside Primary Care Norge","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7573450381,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R06.2","R13.10","R11.0","R10.9","D72.829","K63.5","K92.1","R19.5","D64.9","R05.9","J45.40","J98.59","R73.9","R73.03","S20.212A","S80.812A","R29.818","D50.9","NO DATA","R65.10","I12.9","K21.9","E11.22","G47.33","R42.","Z98.890","D63.1","E78.5","G25.81","G47.30","Z86.73","Z87.440","Z87.442","Z90.49","F17.290","T81.9XXA","E55.9","R19.7","R63.5","Z91.09","Z79.899","Z51.81","M54.42","G89.29","Z86.2","R56.9","I10.","M54.14","M54.17","R41.841","R41.3","R26.2","K27.9","T78.40XA","E21.3","E66.01","Z68.41","R34.","R29.898","R45.89","W19.XXXA","R47.81","G40.909","E83.51","N17.9","T39.091A","N18.2","E87.2","E87.0","R41.82","E87.6","R89.2","G43.819","R51.9","J45.20","Z48.89","L91.8","S41.101A","K92.2","K29.80","K29.70","K64.9","K25.9","Z87.19","K26.9","Z86.16","D62.","K25.4","G43.019","T82.49XA","R22.1","I12.0","N18.6","Z99.2","Z87.891","S10.93XA","J20.9","R09.82","M79.662","M79.89","R68.81","G93.40","M62.82","R74.01","E83.39","R06.02","Z99.89","R79.89","B00.1","R10.13","K59.00","T85.192A","M48.04","S20.219A","Z86.69","Z79.51","Z04.3","R07.89","S46.912A","W10.8XXA","T39.011A","E87.1","I24.8","T39.1X1A","E86.9","H91.90","J32.0","J32.2","Z01.818","R09.89","N28.89","U07.1","R22.2","K76.0","R50.9","R11.2","H69.83","Z20.822","G89.18","R11.10","M54.9","R10.84","R20.0","R20.2","R25.2","R07.9","Z09.","Z87.898","A41.9","R53.1","I49.9","J02.9","J32.8","J34.2","J34.3","E83.41","H93.13","R10.33","E78.2","M54.6","I67.89","R94.31","R29.90"],"date":["2021-02-16","2021-02-16","2022-05-05","2022-02-07","2021-02-16","2021-03-29","2022-07-06","2021-03-29","2022-06-21","2022-01-18","2022-07-27","2022-03-03","2022-07-07","2022-04-12","2022-04-24","2022-04-24","2022-07-03","2022-08-16","2022-08-04","2022-07-15","2022-08-04","2022-08-04","2022-07-15","2022-08-02","2022-08-04","2022-08-04","2022-08-04","2022-08-04","2022-08-04","2022-08-04","2022-08-04","2022-08-04","2022-08-04","2022-08-04","2022-08-04","2022-08-04","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-10-25","2022-07-04","2022-01-31","2022-05-04","2022-05-04","2021-12-07","2022-04-12","2021-12-07","2022-01-31","2022-01-31","2022-04-12","2022-07-08","2022-07-08","2022-07-27","2022-05-04","2022-05-04","2022-05-04","2022-06-23","2022-07-13","2022-07-01","2022-07-04","2022-07-04","2022-07-04","2022-07-01","2022-07-04","2022-07-04","2022-07-04","2022-07-03","2022-08-02","2022-08-02","2022-08-02","2022-08-04","2021-11-09","2021-11-22","2022-02-07","2022-03-02","2022-01-31","2022-04-28","2022-01-31","2022-01-31","2022-01-31","2022-08-16","2022-01-31","2022-05-05","2022-08-16","2022-07-07","2022-07-07","2022-07-24","2022-07-07","2022-07-07","2022-07-07","2022-07-07","2021-12-09","2021-12-09","2022-01-10","2022-01-10","2022-05-05","2022-07-04","2022-07-04","2022-07-02","2022-07-04","2022-07-27","2022-07-20","2022-07-27","2022-07-27","2022-07-27","2022-07-27","2021-03-23","2021-03-23","2022-04-24","2022-04-24","2022-04-24","2022-04-24","2022-04-28","2022-04-28","2022-04-28","2022-07-01","2022-07-01","2022-07-01","2022-07-01","2022-07-01","2022-07-13","2021-02-01","2021-02-01","2021-02-01","2021-02-18","2021-02-18","2022-01-25","2022-01-25","2022-01-25","2022-01-25","2022-06-29","2022-06-21","2022-07-13","2022-07-07","2022-07-13","2022-07-13","2022-07-24","2022-01-04","2022-01-04","2022-01-04","2022-01-25","2022-07-07","2022-07-07","2022-07-13","2022-07-13","2022-07-18","2022-07-20","2021-02-03","2021-02-03","2021-02-03","2022-04-12","2022-06-29","2022-07-24","2022-08-16","2022-08-16","2023-08-16","2023-08-16","2023-08-16"],"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":[["","65862085901","FAMOTIDINE","TAB 20MG","10","Select","Select",""],["","11822033209","ALLERGY REL","CAP 25MG","10","Select","Select",""],["","11822305800","RA NIGHTTIME","TAB 25MG","20","Select","Select",""],["","11822511120","RA MELATONIN","TAB 5MG","30","Select","Select",""],["","42385095512","LEVETIRACETA","TAB 500MG","120","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","68180063709","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","59746017306","PREDNISONE","TAB 10MG","42","Select","Select",""],["","11822334950","ALLERGY MED","CAP 25MG","10","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","90","Select","Select",""],["","00904530660","BANOPHEN","CAP 25MG","10","Select","Select",""],["","00131247735","VIMPAT","50 MG","60","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","00378932232","WIXELA INHUB","AER 500\/50","60","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","80681013100","VITAMIN D3","CAP 5000UNIT","90","Select","Select",""],["","50228018001","GABAPENTIN","300 MG","120","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","16571020110","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","69238110005","DOXYCYCL HYC","CAP 100MG","56","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","30","Select","Select",""],["","10006073043","VITAMIN B-12","TAB 1000MCG","30","Select","Select",""],["","65162027210","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","21","Select","Select",""],["","51660093901","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","62332025118","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","29300034301","BACLOFEN","TAB 10MG","30","Select","Select",""],["","11822511120","MELATONIN","5 MG","30","Select","Select",""],["","71143037501","XHANCE","MIS 93MCG","16","Select","Select",""],["","70436015542","PROMETHAZINE","SOL DM","120","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","57896010105","ACETAMINOPHE","TAB 325MG","30","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","100","Select","Select",""],["","53885027150","ONETOUCH","TES VERIO","100","Select","Select",""],["","53885039310","ONETOUCH US","MIS LANCETS","100","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","20","Select","Select",""],["","00173069700","ADVAIR DISKU","AER 500\/50","180","Select","Select",""],["","66993058697","FLUTIC\/SALME","AER 500\/50","180","Select","Select",""],["","29033000301","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","00904759080","FEROSUL","325(65) MG","30","Select","Select",""],["","11534016501","FOLIC ACID","1 MG","30","Select","Select",""],["","31722017030","DULOXETINE","CAP 60MG","90","Select","Select",""],["","51991034806","LACOSAMIDE","50 MG","60","Select","Select",""],["","72647033101","METHYLPRED","TAB 4MG","21","Select","Select",""],["","43386031214","GAVILAX","POW ","510","Select","Select",""],["","00536105227","PEG3350","POW ","510","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","12","Select","Select",""],["","11822015796","RA VIT B-1","TAB 100MG","100","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","80681000500","CALCIUM","TAB 600MG","30","Select","Select",""],["","31722077701","ACYCLOVIR","TAB 400MG","25","Select","Select",""],["","80681009800","VITAMIN B-1","TAB 100MG","30","Select","Select",""],["","69452034672","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","11822511150","RA VIT B-12","TAB 1000 TR","30","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","57896089601","VITAMIN B-","12 1000 MCG","30","Select","Select",""],["","42385095512","LEVETIRACETAM","500 MG","120","Select","Select",""],["","80681013100","VITAMIN D","3 125 MCG","90","Select","Select",""],["","00406051201","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","90","Select","Select",""],["","50383070016","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","63304082990","ATORVASTATIN CALCIUM","40 MG","30","Select","Select",""],["","69452034672","SUMATRIPTAN SUCCINATE","100 MG","9","Select","Select",""],["","27241009903","DULOXETINE HCL","60 MG","30","Select","Select",""],["","29300022019","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","68180096301","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","82607066026","FLOWFLEX COVID-","19 AG HOME TEST","8","Select","Select",""],["","16571020110","DICLOFENAC TAB","75MG DR","60","Select","Select",""],["","59310057922","PROAIR HFA AER","","8","Select","Select",""],["","30768015745","MELATONIN TAB","5MG","30","Select","Select",""],["","00406051201","OXYCOD\/APAP TAB","5-325MG","90","Select","Select",""],["","00131247735","VIMPAT TAB","50MG","60","Select","Select",""],["","50228018001","GABAPENTIN CAP","300MG","120","Select","Select",""],["","31722057447","LEVETIRACETA SOL","100MG\/ML","600","Select","Select",""],["","31722071390","PANTOPRAZOLE TAB","40MG","60","Select","Select",""],["","42806071401","BENZONATATE CAP","100MG","21","Select","Select",""],["","72647033104","METHYLPRED TAB","4MG","21","Select","Select",""],["","53885014301","ONETOUCH MIS LANCETS","","100","Select","Select",""],["","53885027150","ONETOUCH TES VERIO","","50","Select","Select",""],["","53885004401","ONE TOUCH KIT VERIO FL","","1","Select","Select",""],["","53885065701","ONETOUCH KIT VERIO","","1","Select","Select",""],["","53885039310","ONETOUCH US MIS LANCETS","","100","Select","Select",""],["","65862018730","ONDANSETRON TAB","4MG","20","Select","Select",""],["","29300022019","MONTELUKAST TAB","10MG","30","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","66993058697","FLUTIC\/SALME AER","500\/50","180","Select","Select",""],["","00173069700","ADVAIR DISKU AER","500\/50","180","Select","Select",""],["","00904759080","FEROSUL TAB","325MG","30","Select","Select",""],["","11534016501","FOLIC ACID TAB","1MG","30","Select","Select",""],["","57896010105","ACETAMINOPHE TAB","325MG","30","Select","Select",""],["","00591079501","DICYCLOMINE TAB","20MG","20","Select","Select",""],["","68180063709","ATORVASTATIN TAB","40MG","90","Select","Select",""],["","68180096301","ALBUTEROL AER HFA","","8","Select","Select",""],["","11822511120","RA MELATONIN TAB","5MG","30","Select","Select",""],["","00093031401","KETOROLAC TAB","10MG","12","Select","Select",""],["","68462067860","LACOSAMIDE TAB","50MG","60","Select","Select",""],["","29033000301","SUCRALFATE TAB","1GM","120","Select","Select",""],["","51660093901","CETIRIZINE TAB","10MG","30","Select","Select",""],["","31722017030","DULOXETINE CAP","60MG","34","Select","Select",""],["","00093598627","EPINEPHRINE INJ","0.3MG","2","Select","Select",""],["","80681000500","CALCIUM TAB","600MG","30","Select","Select",""],["","11822511150","RA VIT B-","12 TAB 1000 TR","30","Select","Select",""],["","59746017306","PREDNISONE TAB","10MG","42","Select","Select",""],["","43386031214","GAVILAX POW","","510","Select","Select",""],["","00536105227","PEG","3350 POW","510","Select","Select",""],["","31722077701","ACYCLOVIR TAB","400MG","25","Select","Select",""],["","42385095512","LEVETIRACETA TAB","500MG","120","Select","Select",""],["","69452034672","SUMATRIPTAN TAB","100MG","9","Select","Select",""],["","50383070016","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","69097012203","TOPIRAMATE","25 MG","30","Select","Select",""],["","10702025301","BUTALBITAL-ACETAMINOPHEN-CAFFE","50-325-40","20","Select","Select",""],["","00536123441","ASPIRIN EC","81 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":""}]}]}