{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ANGELA N DECKER","gend":1,"add":"2904 GUTHER PL","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1984-05-21","age":"","mstatus":"","insh":"2325466*01","cliId":"","pno":7577514865,"cno":7577514865,"email":"","ename":"","eno":"","pphy":"PATEL, JITENDRA M MD","ppno":7573904540,"pcpadd":"2088 S INDEPENDENCE BLVD STE 101,","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23453-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7573902646,"pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J30.1","K58.1","Z20.828","A08.4","E87.6","N30.00","M79.7","Z86.718","Z86.711","D80.1","Z98.51","L40.50","I89.0","E78.2","N18.2","M54.9","A69.20","Z90.710","J30.89","H93.13","H93.293","R42.","E66.9","Z79.899","Z82.49","M54.2","NO DATA","M25.521","M54.6","G43.109","G60.9","G31.84","M51.17","F51.04","G47.33","F41.1","F33.0","K58.9","K59.00","Z87.19","H18.221","H20.031","H40.013","H16.223","D31.32","D35.2","E22.1","M47.812","N32.89","R89.9","G89.29","M54.16","Z01.419","N83.209","Z12.72","L40.0","B37.3","M51.36","H81.393","M17.0","S70.01XA","S59.901A","S99.911A","S39.92XA","M43.6","K21.9","Z68.33","Z87.891","Z88.5","Z88.0","Z88.2","M47.816","M48.04","N95.1","R10.2","H02.831","H02.834","R89.1","K59.02","H16.391","M54.12","G35.","G43.009","M54.17","G60.3","K31.84","R11.0","Z01.810","K04.7","Q82.0","R94.31","R00.2","R06.02","R07.89","R05.9","M50.30","M51.34","M47.814","M12.9","Z98.1","M79.2","M62.838","E55.9","R79.89","R33.9","R10.10","H20.9","H40.023","R20.2","M35.01","Z51.81","N30.10","R10.30","R30.0","N39.46","U07.1","M47.815","L40.9","Z86.19","R20.0","R60.0","I87.2","M79.662","N64.4","I26.99","H15.011","K59.09","R11.2","R10.32","R10.31","R51.9","M43.26","I10.","Z90.49","Z98.890","Z68.32","H02.839","H57.11","M27.3","R68.84","F41.9","N80.8","N73.6","M25.561","M25.562","E78.5","Z00.00","R35.0","R35.1","N39.0","R07.9","J32.2","F33.1","Z88.1","Z91.041","N83.8","L40.8","H40.1111","H40.1121","H40.1131","H16.042","H20.042","I78.1","R60.9","I80.8"],"date":["2023-09-22","2021-08-06","2022-05-26","2021-09-09","2023-08-26","2021-10-12","2023-02-02","2022-11-08","2022-11-08","2022-11-08","2021-12-13","2023-08-02","2023-09-11","2023-04-05","2022-05-27","2022-02-05","2022-11-08","2022-02-05","2023-01-18","2023-01-18","2023-01-18","2023-01-18","2023-03-30","2023-08-30","2022-03-22","2023-03-30","2023-06-19","2022-04-21","2023-03-30","2023-06-19","2023-06-19","2023-06-19","2023-06-19","2023-06-19","2023-07-17","2023-08-30","2023-08-30","2022-11-22","2023-08-26","2022-12-06","2023-02-21","2023-02-21","2023-02-22","2023-08-22","2023-02-22","2023-03-20","2023-03-20","2022-07-05","2022-11-08","2022-11-08","2022-02-05","2021-02-26","2022-08-10","2021-06-09","2021-06-09","2023-02-02","2021-07-14","2022-07-11","2021-12-29","2022-10-17","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-04-12","2022-11-08","2022-04-12","2022-11-08","2022-11-08","2022-11-08","2022-11-08","2022-05-17","2022-05-17","2022-08-10","2022-10-03","2022-08-23","2022-08-23","2022-09-15","2022-10-25","2023-06-19","2021-03-04","2021-03-04","2021-09-02","2021-09-02","2021-09-02","2022-02-05","2022-02-05","2022-04-27","2021-12-16","2022-03-03","2022-04-27","2023-09-14","2022-04-27","2023-09-14","2022-05-26","2023-03-30","2023-03-30","2023-03-30","2023-03-30","2023-03-30","2023-03-30","2023-03-30","2023-04-05","2022-11-10","2022-11-10","2022-11-10","2023-01-10","2023-01-10","2021-06-03","2021-08-11","2023-02-02","2021-11-24","2022-09-12","2021-11-24","2021-11-30","2022-01-05","2022-03-12","2023-08-02","2022-03-12","2022-03-12","2022-03-03","2022-03-03","2022-03-03","2022-06-14","2022-07-29","2022-08-05","2022-11-08","2022-09-12","2022-02-05","2022-02-05","2022-02-05","2022-02-05","2022-02-05","2022-02-05","2022-02-05","2022-02-05","2022-09-16","2023-02-17","2023-03-16","2023-03-16","2022-07-26","2022-10-03","2022-10-03","2022-10-17","2022-10-17","2021-06-01","2022-05-27","2021-11-12","2021-11-12","2021-11-12","2022-02-09","2022-02-24","2022-09-20","2022-11-08","2023-09-14","2023-04-05","2023-06-20","2023-05-02","2023-05-09","2023-08-22","2023-07-20","2023-07-20","2023-09-11","2023-09-11","2023-09-11"],"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":[["","00536106229","STOOL SOFTNR","CAP 100MG","68","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","29300012501","MELOXICAM","TAB 15MG","30","Select","Select",""],["","27505009060","ZELNORM","6 MG","180","Select","Select",""],["","00904674860","BISACODYL","5 MG","45","Select","Select",""],["","65862017360","TOPIRAMATE","100 MG","120","Select","Select",""],["","00078063941","COSENTYX PEN","INJ 300DOSE","1","Select","Select",""],["","00172208380","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","55111029398","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","67877046390","PREGABALIN","CAP 50MG","60","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","70710122601","AMITRIPTYLIN","TAB 25MG","60","Select","Select",""],["","57894006103","STELARA","INJ 90MG\/ML","1","Select","Select",""],["","16571040210","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","50111056003","TRAZODONE","TAB 50MG","60","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","90","Select","Select",""],["","68462015813","ONDANSETRON","TAB 8MG ODT","60","Select","Select",""],["","62175061743","PANTOPRAZOLE","TAB 40MG","90","Select","Select",""],["","59746017210","PREDNISONE","5 MG","40","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","62332025130","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","4","Select","Select",""],["","00904699860","DOCUSATE SOD","CAP 100MG","60","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","11527070442","SOD FLUORIDE","GEL 1.1-5%","100","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","65162062750","TRAMADOL HCL","TAB 50MG","20","Select","Select",""],["","59267100003","PFIZER VACC","INJ COVID-19","0","Select","Select",""],["","42571025201","CLINDAMYCIN","CAP 300MG","15","Select","Select",""],["","13668000701","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","65162068210","PHENAZOPYRID","TAB 200MG","6","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","6","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","66993087861","CALCIPOTRIEN","OIN 0.00005","120","Select","Select",""],["","63304007601","POT CHLORIDE","TAB 10MEQ ER","10","Select","Select",""],["","00093598627","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00093506110","HYDROXYZ HCL","TAB 25MG","60","Select","Select",""],["","69238115403","EZETIMIBE","10 MG","30","Select","Select",""],["","49281072110","FLUBLOK QUAD","INJ 2021-22","0","Select","Select",""],["","00591530710","PROMETHAZINE","TAB 25MG","12","Select","Select",""],["","00069108530","PAXLOVID","TAB ","30","Select","Select",""],["","45802058084","SCOPOLAMINE","DIS 1MG\/3DAY","6","Select","Select",""],["","00536117201","ACETAMIN","TAB 500MG","24","Select","Select",""],["","00603371834","FROVATRIPTAN","TAB 2.5MG","9","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","15","Select","Select",""],["","00245531911","KLOR-CON M20","TAB 20MEQ ER","5","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","Select","Select",""],["","30768017965","ALPHA LIPOIC","CAP 600MG","60","Select","Select",""],["","60505015701","BUPROPION","TAB 100MG","30","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","2","Select","Select",""],["","00406048501","APAP\/CODEINE","TAB 300-60MG","10","Select","Select",""],["","42806001101","SULINDAC","TAB 200MG","60","Select","Select",""],["","61314063705","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","23155013525","DOXYCYC MONO","TAB 100MG","42","Select","Select",""],["","00093542088","CABERGOLINE","0.5 MG","8","Select","Select",""],["","00781183120","AMOX\/K CLAV","TAB 500-125","10","Select","Select",""],["","42806066201","BUSPIRONE","TAB 5MG","30","Select","Select",""],["","69097034135","DIFLUPREDNAT","EMU 0.0005","5","Select","Select",""],["","57237008663","RIZATRIPTAN","TAB 10MG ODT","9","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","1","Select","Select",""],["","00904530760","BANOPHEN","CAP 50MG","30","Select","Select",""],["","00574402435","ERYTHROMYCIN","5 MG\/GRAM","3.5","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","00115164501","NITROFUR MAC","CAP 100MG","14","Select","Select",""],["","00093356026","PEG\/NASUL\/C\/","SOL NACL\/POT","1","Select","Select",""],["","00527512570","LACTULOSE","SOL 10GM\/15","2700","Select","Select",""],["","69097083305","SERTRALINE","TAB 25MG","30","Select","Select",""],["","51672401801","ETODOLAC","400 MG","69","Select","Select",""],["","00093005301","BUSPIRONE HCL","5 MG","60","Select","Select",""],["","60505015701","BUPROPION HCL","100 MG","60","Select","Select",""],["","00093220401","METOCLOPRAMIDE HCL","5 MG","90","Select","Select",""],["","70069042101","LATANOPROST","0.005 %","2.5","Select","Select",""],["","24208029905","LOTEMAX","0.5 %","5","Select","Select",""],["","00904699880","DOCUSATE SODIUM","100 MG","60","Select","Select",""],["","16714062101","ZOLPIDEM TARTRATE","5 MG","30","Select","Select",""],["","49035032712","GENTLE LAXATIVE","5 MG","135","Select","Select",""],["","65862044930","VALACYCLOVIR","1000 MG","30","Select","Select",""],["","49035007860","STOOL SOFTENER","100 MG","60","Select","Select",""],["","11845017228","ALPHA LIPOIC ACID","600 MG","90","Select","Select",""],["","49035045875","ALLERGY RELIEF","10 MG","90","Select","Select",""],["","50383026505","LOTEPREDNOL ETABONATE","0.5 %","5","Select","Select",""],["","61314065605","CIPROFLOXACIN HCL","0.3 %","5","Select","Select",""],["","00832532511","POTASSIUM CHLORIDE","20 MEQ","5","Select","Select",""],["","47781064090","LEVOTHYROXINE SODIUM","25 MCG","90","Select","Select",""],["","00116200116","CHLORHEXIDINE GLUCONATE","0.12 %","473","Select","Select",""],["","50228017505","BUPROPION HCL SR","150 MG","60","Select","Select",""],["","42858010201","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","20","Select","Select",""],["","68645051054","HYDROCHLOROTHIAZIDE","25 MG","90","Select","Select",""],["","17478071310","OFLOXACIN","0.3 %","10","Select","Select",""],["","60758011910","PREDNISOLONE ACETATE","1 %","10","Select","Select",""],["","60758088005","FLUOROMETHOLONE","0.1 %","5","Select","Select",""],["","63304069301","CLINDAMYCIN HCL","300 MG","30","Select","Select",""],["","00093505698","ATORVASTATIN CALCIUM","10 MG","30","Select","Select",""],["","16714079904","CETIRIZINE HCL","10 MG","90","Select","Select",""],["","60505100301","KETOROLAC TROMETHAMINE","0.5 %","5","Select","Select",""],["","00069108530","PAXLOVID TAB","","30","Select","Select",""],["","13668000701","ZOLPIDEM TAB","5MG","30","Select","Select",""],["","45802058084","SCOPOLAMINE DIS","1MG\/3DAY","6","Select","Select",""],["","68382013905","TOPIRAMATE TAB","50MG","30","Select","Select",""],["","16729043315","EZETIMIBE TAB","10MG","30","Select","Select",""],["","00093220401","METOCLOPRAM TAB","5MG","90","Select","Select",""],["","52817033200","CYCLOBENZAPR TAB","10MG","90","Select","Select",""],["","00525097160","ZELNORM TAB","6MG","60","Select","Select",""],["","68462015813","ONDANSETRON TAB","8MG ODT","60","Select","Select",""],["","00904674860","BISACODYL TAB","5MG EC","45","Select","Select",""],["","00536117201","ACETAMIN TAB","500MG","24","Select","Select",""],["","21922000909","DICLOFENAC GEL","1%","100","Select","Select",""],["","00904699860","DOCUSATE SOD CAP","100MG","60","Select","Select",""],["","00143122701","DICYCLOMINE TAB","20MG","30","Select","Select",""],["","55111029398","SUMATRIPTAN TAB","100MG","9","Select","Select",""],["","00172208380","HYDROCHLOROT TAB","25MG","90","Select","Select",""],["","00406051201","OXYCOD\/APAP TAB","5-325MG","30","Select","Select",""],["","00603371834","FROVATRIPTAN TAB","2.5MG","9","Select","Select",""],["","62332025130","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","00245531911","KLOR-CON M","20 TAB 20MEQ ER","5","Select","Select",""],["","42806054701","VITAMIN D CAP","1.25MG","4","Select","Select",""],["","30768017965","ALPHA LIPOIC CAP","600MG","60","Select","Select",""],["","42806071401","BENZONATATE CAP","100MG","15","Select","Select",""],["","70954006110","PREDNISONE TAB","50MG","3","Select","Select",""],["","59762444002","METHYLPRED TAB","4MG","21","Select","Select",""],["","63304007601","POT CHLORIDE TAB","10MEQ ER","10","Select","Select",""],["","65162046650","IBUPROFEN TAB","800MG","90","Select","Select",""],["","60505015701","BUPROPION TAB","100MG","60","Select","Select",""],["","42806001101","SULINDAC TAB","200MG","60","Select","Select",""],["","23155013525","DOXYCYC MONO TAB","100MG","42","Select","Select",""],["","61314063705","PREDNISOLONE SUS","1% OP","5","Select","Select",""],["","69097034135","DIFLUPREDNAT EMU","0.05%","5","Select","Select",""],["","00781183120","AMOX\/K CLAV TAB","500-125","10","Select","Select",""],["","00406048501","APAP\/CODEINE TAB","300-60MG","10","Select","Select",""],["","42571025201","CLINDAMYCIN CAP","300MG","15","Select","Select",""],["","50742011808","CABERGOLINE TAB","0.5MG","8","Select","Select",""],["","42806066201","BUSPIRONE TAB","5MG","60","Select","Select",""],["","00574402435","ERYTHROMYCIN OIN","5MG\/GM","4","Select","Select",""],["","57237008663","RIZATRIPTAN TAB","10MG ODT","9","Select","Select",""],["","70461032203","FLUCLVX QUAD INJ","2022-23","0","Select","Select",""],["","00172392670","DIAZEPAM TAB","5MG","2","Select","Select",""],["","00093356026","PEG\/NASUL\/C\/ SOL NACL\/POT","","1","Select","Select",""],["","00115164501","NITROFUR MAC CAP","100MG","14","Select","Select",""],["","00002143611","EMGALITY INJ","120MG\/ML","1","Select","Select",""],["","60505004101","ETODOLAC TAB","400MG","60","Select","Select",""],["","00527512570","LACTULOSE SOL","10GM\/15","2700","Select","Select",""],["","69097083305","SERTRALINE TAB","25MG","30","Select","Select",""],["","65162068210","PHENAZOPYRID TAB","200MG","6","Select","Select",""],["","00904530760","BANOPHEN CAP","50MG","30","Select","Select",""],["","72618300002","NURTEC ODT","75 MG","16","Select","Select",""],["","65862039110","ONDANSETRON ODT","8 MG","90","Select","Select",""],["","29300041519","CYCLOBENZAPRINE HCL","10 MG","90","Select","Select",""],["","00074709430","QULIPTA","60 MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE SODIUM","40 MG","90","Select","Select",""],["","65649000330","TRULANCE","3 MG","90","Select","Select",""],["","00069050130","XELJANZ XR","11 MG","30","Select","Select",""],["","61314063136","NEOMYCIN-POLYMYXIN-DEXAMETH","3.5-10K-.1","3.5","Select","Select",""],["","00832141003","MOXIFLOXACIN","0.5 %","3","Select","Select",""],["","16571086203","BUPROPION XL","150 MG","60","Select","Select",""],["","65862014836","SUMATRIPTAN SUCCINATE","100 MG","9","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":""}]}]}