{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CELLIA D WILSON","gend":1,"add":"1042 BRYCE LN APT 2","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1976-02-27","age":"","mstatus":"","insh":"3201732*01","cliId":"","pno":7573831055,"cno":7573831055,"email":"","ename":"","eno":"","pphy":"MUSSELMANI, ZATTAM MD","ppno":7575433557,"pcpadd":"1422 POINDEXTER ST,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23324-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7575430053,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K92.0","D50.9","K92.2","G60.9","G47.33","E11.43","K31.84","F41.9","D64.9","I10.","E11.42","Z79.4","R10.9","U07.1","R11.2","R10.11","R19.7","R53.1","R00.0","K92.1","H16.142","E87.70","F51.04","E11.3593","H35.373","H35.033","D62.","K44.9","NO DATA","M79.89","I50.9","K31.89","Z86.39","K52.1","U09.9","J18.9","H33.41","H35.371","E11.3591","H33.22","J06.9","F43.20","N39.0","Z20.822","N17.9","E11.21","I11.0","E78.5","E11.9","F17.200","I37.1","I07.1","I50.30","H33.42","R77.8","E78.2","N92.1","E66.9","E11.65","N76.0","E11.22","E08.3541","E08.3543","E08.3542","E10.8","Z01.818","R06.00","Z86.16","E10.9","Z79.899","R06.02","R60.0","M79.605","M79.604","E11.3511","Z01.411","R31.9","Z12.4","Z01.419","N93.9","E11.3312","K22.11","K25.4","N92.0","I12.9","L85.3","R07.89","N64.4","Z12.31","Z09.","E10.21","E04.9","H69.83","L03.116","M77.42","M79.671","L97.522","R82.998","N83.209","B35.3","E04.0","R25.2","E83.42","R51.9","D50.0","I95.9","R42.","E04.2","R11.12","I95.1","E86.0","F32.9","J30.1","Z01.810","Z80.3","Z83.3","Z88.5","Z88.8","L70.0","M25.512","G89.4","E55.9","J34.3","K21.9","E04.1","R13.10","J34.89","N83.202","D25.9","N73.6","R10.2"],"date":["2021-02-23","2023-08-30","2021-02-23","2021-08-10","2021-08-10","2022-01-07","2022-01-07","2023-05-10","2023-08-30","2023-08-30","2023-05-10","2023-08-30","2022-01-04","2022-07-06","2023-04-28","2022-01-07","2022-01-07","2022-11-07","2022-01-07","2022-01-07","2021-02-02","2021-07-15","2021-08-10","2023-03-30","2022-10-18","2023-03-30","2023-04-30","2021-02-22","2023-08-30","2021-03-17","2021-05-25","2022-01-01","2022-01-01","2022-01-07","2022-03-08","2022-03-08","2022-05-31","2023-03-30","2022-05-31","2022-11-17","2023-02-13","2021-01-26","2021-09-16","2021-02-18","2023-05-30","2021-07-08","2021-07-14","2021-07-14","2023-08-30","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2022-11-17","2021-02-18","2021-02-18","2021-02-18","2023-06-06","2021-02-18","2022-08-16","2023-06-06","2022-05-05","2022-05-05","2023-06-06","2022-05-05","2023-08-15","2022-05-05","2022-05-05","2022-05-27","2023-08-30","2021-03-05","2021-03-05","2021-03-17","2021-03-17","2021-03-25","2022-08-16","2022-08-16","2022-08-16","2022-08-16","2023-04-28","2021-02-05","2021-02-18","2021-02-18","2023-05-22","2023-04-28","2021-03-16","2022-01-04","2022-11-01","2022-11-01","2022-12-29","2023-02-15","2023-02-15","2023-07-24","2023-04-21","2023-04-07","2023-04-07","2023-04-21","2023-04-14","2023-08-25","2023-04-21","2023-05-04","2023-04-30","2023-04-30","2023-05-30","2023-04-28","2023-04-25","2023-04-25","2023-05-31","2023-05-10","2023-04-28","2023-04-28","2023-04-28","2023-09-12","2023-08-25","2023-08-30","2023-08-30","2023-08-30","2023-08-30","2023-07-24","2023-07-24","2023-07-24","2023-08-15","2023-07-24","2023-07-24","2023-07-24","2023-07-24","2023-07-24","2023-09-01","2023-09-01","2023-09-01","2023-09-01"],"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":[["","33342010210","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","60258017101","MAG OXIDE","TAB 400MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","150 MG","1","Select","Select",""],["","31722058330","DULOXETINE","CAP 60MG","30","Select","Select",""],["","00002751001","HUMALOG","INJ 100\/ML","10","Select","Select",""],["","69097068505","PREGABALIN","300 MG","180","Select","Select",""],["","69315011710","FUROSEMIDE","40 MG","30","Select","Select",""],["","49035045895","ALLERGY REL","TAB 10MG","30","Select","Select",""],["","69680013400","POT CHLORIDE","TAB 20MEQ ER","30","Select","Select",""],["","45802091939","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","67877021520","CEFUROXIME","TAB 250MG","14","Select","Select",""],["","31722070210","LOSARTAN POT","TAB 100MG","30","Select","Select",""],["","69238111806","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","69452015120","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","00185067405","HYDROXYZ PAM","CAP 25MG","120","Select","Select",""],["","00093220301","METOCLOPRAM","TAB 10MG","20","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","40","Select","Select",""],["","59762040101","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","00228202910","ALPRAZOLAM","0.5 MG","14","Select","Select",""],["","00168009930","KETOCONAZOLE","2 %","30","Select","Select",""],["","70700015010","OMEPRAZOLE","20 MG","60","Select","Select",""],["","50111032701","HYDRALAZINE","TAB 25MG","90","Select","Select",""],["","65862056090","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","45802000403","HYDROCORT","CRE 0.025","28","Select","Select",""],["","00904598348","AMMONIUM LAC","CRE 0.12","560","Select","Select",""],["","53885013610","ONETOUCH","MIS LANCETS","400","Select","Select",""],["","50111056001","TRAZODONE","TAB 50MG","30","Select","Select",""],["","53885000810","ONETOUCH DEL","MIS PLUS 33G","400","Select","Select",""],["","08290320109","BD PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","60505265605","TRIAMT\/HCTZ","TAB 37.5-25","30","Select","Select",""],["","51672400202","NORTRIPTYLIN","CAP 25MG","60","Select","Select",""],["","68001036500","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","68382056401","METOPROL SUC","TAB 25MG ER","30","Select","Select",""],["","62332042631","BENZONATATE","CAP 100MG","42","Select","Select",""],["","50111078751","AZITHROMYCIN","250 MG","6","Select","Select",""],["","17478071310","OFLOXACIN","DRO 0.3% OP","5","Select","Select",""],["","68180013501","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","61314063705","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","00002773701","INSULIN LISP","INJ 100\/ML","10","Select","Select",""],["","49502025175","SEMGLEE","INJ 100U\/ML","15","Select","Select",""],["","61314039603","CYCLOPENTOL","SOL 1% OP","2","Select","Select",""],["","60505095303","AZEL\/FLUTIC","SPR 137-50","23","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","60505083305","AZELASTINE","SPR 0.001","30","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","68180013501","ESCITALOPRAM OXALATE","10 MG","30","Select","Select",""],["","00002773701","INSULIN LISPRO","100\/ML","10","Select","Select",""],["","00002822259","INSULIN LISPRO KWIKPEN U-","100 100\/ML","15","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","300","Select","Select",""],["","60505083305","AZELASTINE HCL","137 MCG","30","Select","Select",""],["","00115180301","HYDROXYZINE PAMOATE","25 MG","120","Select","Select",""],["","00603020922","MAGNESIUM OXIDE","400 MG","30","Select","Select",""],["","42192060716","BROMPHENIRAMINE-PSEUDOEPHED-DM","2-30-10\/5","70","Select","Select",""],["","65162063709","PANTOPRAZOLE SODIUM","40 MG","30","Select","Select",""],["","16571040210","CETIRIZINE HCL","10 MG","30","Select","Select",""],["","65862057490","MONTELUKAST SODIUM","10 MG","30","Select","Select",""],["","29300024601","BUSPIRONE HCL","15 MG","60","Select","Select",""],["","68382056401","METOPROLOL SUCCINATE","25 MG","30","Select","Select",""],["","43547036209","LOSARTAN POTASSIUM","100 MG","30","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","72578000118","DOXYCYCLINE HYCLATE","100 MG","14","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","67877032005","IBUPROFEN","600 MG","40","Select","Select",""],["","50742026750","NORETHINDRONE ACETATE","5 MG","84","Select","Select",""],["","00135061502","FLONASE SENSIMIST","27.5 MCG","5.9","Select","Select",""],["","21922000909","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","37000045504","PRILOSEC OTC","20 MG","90","Select","Select",""],["","00378729253","NORETHINDRONE","0.35 MG","84","Select","Select",""],["","00713052612","PROMETHEGAN","25 MG","21","Select","Select",""],["","68196070279",""," ","30","Select","Select",""],["","00781808926","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","00093220301","METOCLOPRAM TAB","10MG","20","Select","Select",""],["","62332042631","BENZONATATE CAP","100MG","42","Select","Select",""],["","49035045895","ALLERGY REL TAB","10MG","30","Select","Select",""],["","00002751001","HUMALOG INJ","100\/ML","10","Select","Select",""],["","16729011915","MONTELUKAST TAB","10MG","30","Select","Select",""],["","69238111806","BUSPIRONE TAB","15MG","60","Select","Select",""],["","65862056090","PANTOPRAZOLE TAB","40MG","30","Select","Select",""],["","69097068505","PREGABALIN CAP","300MG","60","Select","Select",""],["","69315011710","FUROSEMIDE TAB","40MG","30","Select","Select",""],["","68382056401","METOPROL SUC TAB","25MG ER","30","Select","Select",""],["","00904598348","AMMONIUM LAC CRE","12%","560","Select","Select",""],["","00603020922","MAG OXIDE TAB","400MG","30","Select","Select",""],["","69680013400","POT CHLORIDE TAB","20MEQ ER","30","Select","Select",""],["","16571040210","CETIRIZINE TAB","10MG","30","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","00228202910","ALPRAZOLAM TAB","0.5MG","14","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","31722070210","LOSARTAN POT TAB","100MG","30","Select","Select",""],["","17478071310","OFLOXACIN DRO","0.3% OP","5","Select","Select",""],["","68180013501","ESCITALOPRAM TAB","10MG","30","Select","Select",""],["","00115180301","HYDROXYZ PAM CAP","25MG","120","Select","Select",""],["","61314063705","PREDNISOLONE SUS","1% OP","5","Select","Select",""],["","61314039601","CYCLOPENTOL SOL","1% OP","2","Select","Select",""],["","00002773701","INSULIN LISP INJ","100\/ML","10","Select","Select",""],["","00069108530","PAXLOVID TAB","300-100","30","Select","Select",""],["","68001036500","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","1","Select","Select",""],["","49502025175","SEMGLEE INJ","100U\/ML","15","Select","Select",""],["","00185012201","NITROFURANTN CAP","100MG","14","Select","Select",""],["","60505095303","AZEL\/FLUTIC SPR","137-50","23","Select","Select",""],["","60505083305","AZELASTINE SPR","0.1%","30","Select","Select",""],["","50383070016","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","08290309588","LUER-LOK SYRINGE-NEEDLE","23GX1\"","2","Select","Select",""],["","70069000510","CYANOCOBALAMIN INJECTION","1000MCG\/ML","2","Select","Select",""],["","60505095303","AZELASTINE-FLUTICASONE","137-50 MCG","23","Select","Select",""],["","00037024523","DYMISTA","137-50 MCG","23","Select","Select",""],["","71093014005","METHOCARBAMOL","500 MG","60","Select","Select",""],["","71143037501","XHANCE","93 MCG","48","Select","Select",""],["","00406051201","OXYCODONE-ACETAMINOPHEN","5 MG-325MG","24","Select","Select",""],["","50111033401","METRONIDAZOLE","500 MG","14","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":""}]}]}