{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TERRI  D CHAMBERS","gend":1,"add":"5548 TAYLORS WALKE LN APT 306","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1989-12-28","age":"","mstatus":"","insh":"2372613*01","cliId":"","pno":2164130371,"cno":2164130371,"email":"","ename":"","eno":"","pphy":"RHODES, SHARON NP","ppno":7573337625,"pcpadd":"4421 VIRGINIA BEACH BLVD STE 112,","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23462-9998","pcpcounty":"","pcpid":"","pcpname":"COASTAL ENDOCRINOLOGY","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7573337639,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["O35.9XX0","O26.20","O26.893","R10.11","Z3A.31","O36.5930","O24.013","V23.9","Z3A.34","U07.1","E10.10","G93.41","E87.5","N17.9","Z79.4","M54.6","N30.00","J02.9","Z32.01","O09.93","Z3A.32","Z3A.36","Z37.0","E10.11","A41.9","R65.20","E10.9","E03.9","E83.39","O24.019","O23.599","B96.89","E89.0","Z3A.00","R10.31","O00.101","O24.011","K31.84","E10.43","V23.1","Z3A.01","Z88.5","O26.859","O00.90","O24.012","Z71.3","Z3A.23","Z3A.33","Z3A.35","B37.2","O26.90","O26.899","V23.87","E10.649","O99.891","R00.0","R93.89","O46.90","Z53.29","N93.9","O20.9","Z87.59","O20.8","M50.120","O26.892","R10.2","R12.","Z3A.27","O42.92","O76.","O24.02","O60.14X0","F33.3","O35.8XX0","O69.81X0","Z20.822","O26.23","O99.344","O99.62","K59.09","O99.284","A41.89","NO DATA","E86.0","Z87.891","Z79.899","R41.82","Z39.1","R13.10","Z79.890","Z87.440","Z87.448","E10.65","E05.00","E78.2","E10.29","R80.9"],"date":["2021-07-15","2021-03-10","2021-06-23","2021-06-23","2021-06-23","2021-07-30","2021-07-30","2021-07-29","2021-07-22","2022-01-25","2022-01-22","2022-01-22","2022-01-20","2022-01-22","2022-09-19","2022-01-25","2022-01-25","2022-01-25","2021-03-25","2021-07-15","2021-07-12","2021-07-30","2021-07-30","2022-01-20","2022-01-20","2022-01-20","2023-03-26","2022-11-17","2022-01-22","2022-09-19","2022-08-29","2022-08-29","2023-02-15","2022-09-19","2022-08-29","2022-08-31","2022-08-31","2022-09-19","2022-09-19","2022-08-31","2022-09-19","2022-09-19","2022-08-31","2022-09-19","2021-05-04","2021-07-12","2021-05-04","2021-07-19","2021-07-29","2021-11-05","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-09-19","2022-09-19","2022-09-19","2022-09-19","2022-08-29","2023-03-26","2021-05-30","2021-05-30","2021-05-30","2021-05-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2021-07-30","2022-01-19","2022-01-19","2022-01-19","2022-01-19","2022-01-19","2022-01-19","2021-08-16","2022-01-25","2022-01-25","2022-01-25","2022-01-25","2023-02-15","2023-02-15","2023-02-15","2023-02-15","2023-02-15"],"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":[["","11917007492","CALCIUM 600","","60","Select","Select",""],["","31604001870","VITAMIN D","TAB 1000UNIT","60","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","8","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","200","Select","Select",""],["","73070010315","INSULIN ASPA","INJ FLEXPEN","9","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","12","Select","Select",""],["","08290320550","BD PEN NEEDL","MIS 32GX5\/32","200","Select","Select",""],["","42192033101","NP THYROID","TAB 90MG","30","Select","Select",""],["","80681013800","CALCIUM\/D3","TAB 600MG","60","Select","Select",""],["","00456046001","ARMOUR THYRO","TAB 90MG","30","Select","Select",""],["","57599080000","FREESTY LIBR","KIT 2 SENSOR","2","Select","Select",""],["","00955172901","INSULIN GLAR","SOL 100U\/ML","10","Select","Select",""],["","11917004918","ACETAMIN","TAB 500MG","20","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","15","Select","Select",""],["","00378113401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","69751010012","PHEXXI","GEL ","60","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","10","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","00430042014","LO LOESTRIN","TAB 40188","84","Select","Select",""],["","00456046001","ARMOUR THYROID","90 MG","10","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","100","Select","Select",""],["","73070010315","INSULIN ASPART FLEXPEN","100\/ML (3)","15","Select","Select",""],["","00002614511","BAQSIMI","3 MG","1","Select","Select",""],["","08627005303","DEXCOM G","6 SENSOR ","3","Select","Select",""],["","16571020211","DICLOFENAC SODIUM","50 MG","14","Select","Select",""],["","57599080000","FREESTYLE LIBRE","2 SENSOR ","1","Select","Select",""],["","69584061150","METHOCARBAMOL","500 MG","40","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","12","Select","Select",""],["","49999028260","THYROID","180 MG","30","Select","Select",""],["","00955172805","INSULIN GLARGINE SOLOSTAR","100\/ML (3)","9","Select","Select",""],["","00955172901","INSULIN GLARGINE","100\/ML","10","Select","Select",""],["","31604001870","VITAMIN D TAB","1000UNIT","60","Select","Select",""],["","11917007492","CALCIUM","600 TAB +D","60","Select","Select",""],["","00093314705","CEPHALEXIN CAP","500MG","14","Select","Select",""],["","68462019005","NAPROXEN TAB","500MG","8","Select","Select",""],["","08290320550","BD PEN NEEDL MIS","32GX5\/32","200","Select","Select",""],["","73070010315","INSULIN ASPA INJ FLEXPEN","","9","Select","Select",""],["","53885024510","ONETOUCH TES ULTRA","","200","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","12","Select","Select",""],["","42192033101","NP THYROID TAB","90MG","30","Select","Select",""],["","00456046001","ARMOUR THYRO TAB","90MG","30","Select","Select",""],["","80681013800","CALCIUM\/D","3 TAB 600MG","60","Select","Select",""],["","57599080000","FREESTY LIBR KIT","2 SENSOR","2","Select","Select",""],["","00955172901","INSULIN GLAR SOL","100U\/ML","10","Select","Select",""],["","00955172805","INSULIN GLAR INJ","100U\/ML","15","Select","Select",""],["","68462010530","ONDANSETRON TAB","4MG","30","Select","Select",""],["","11917004918","ACETAMIN TAB","500MG","20","Select","Select",""],["","69751010012","PHEXXI GEL","","60","Select","Select",""],["","64380080707","IBUPROFEN TAB","800MG","90","Select","Select",""],["","00406055201","OXYCODONE TAB","5MG","10","Select","Select",""],["","00378113401","KETOROLAC TAB","10MG","30","Select","Select",""],["","00430042014","LO LOESTRIN TAB","1-10-10","84","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":""}]}]}