{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DWANDA  T FRANKLIN","gend":1,"add":"20 JUDY DR","city":"WILLIAMSBURG","state":"VA","zip":"23185-9998","dob":"1971-05-01","age":"","mstatus":"","insh":"4029194*01","cliId":"","pno":7578871262,"cno":7578871262,"email":"","ename":"","eno":"","pphy":"RICHMAN, STACEY S NP","ppno":7572593279,"pcpadd":"SUITE D 5249 OLDE TOWNE ROAD,","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":"23188-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7572201953,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.84","R09.02","I10.","R52.","K65.1","J44.9","R10.30","B37.9","I50.9","I13.0","E11.22","F17.210","Z79.899","N89.8","T30.0","R06.02","R42.","I50.22","J96.11","J41.0","R73.09","E11.65","J96.12","Z79.4","M25.511","Z99.81","R07.9","F41.9","NO DATA","R73.9","R07.89","R06.89","I13.10","N18.9","R00.0","Z20.822","E78.5","E66.9","Z59.01","G47.33","I11.0","I42.9","G47.30","R51.9","R10.13","K21.9","F14.20","F41.8","N39.0","B96.20","E11.9","R10.31","G89.18","R10.813","E66.01","Z86.19","Z96.89","Z68.32","Z99.89","R10.9","Z53.21","R18.8","S09.90XA","S30.0XXA","S80.02XA","K63.2","R63.4","F17.218","F14.188","K37.","I25.10","R74.01","F14.10","K59.00","R79.89","E66.09","Z68.36","R10.11","R19.4","R11.0","M54.5","G89.29","K80.10","Z68.39","Z72.0","J84.9","E66.2","I42.8","M25.561","M25.562","J43.9","E16.1","E16.2","R19.7","R53.1","R20.2","R54.","K43.2","H54.40","Z68.41","R31.9","K60.2","U07.1","Z68.34","Z91.19","Z79.82","R06.4","Z09.","T81.89XA","R06.00","A49.8","L02.31","Z90.49","R41.82","N28.89","E10.65","G89.4","K56.7","R45.7","B96.89","R55.","K64.1","R58.","I45.81","S80.811A","L08.9","N28.9","E55.9","R93.3","I50.23","K22.8","K31.89","R11.2","M54.89","I27.20","F41.1","R06.9","J44.1","E86.0","M19.90","M62.81","J96.21","J96.22","E11.649","I50.32","L02.32","Z68.33","T22.012A","F19.939","Y04.8XXA","W19.XXXA","I51.7","F17.200","M47.816","R07.81","R77.8","I49.3","F43.22","M48.02","Z79.85","E87.1","G44.89","I82.409","J20.9","Z91.14","Z68.31","Z79.51","M54.9","M54.2","K35.80","K44.9","R11.11","L02.91","K91.89","Z97.8","Z87.39","Z87.19","Z86.69","Z98.51","Z98.890","M79.604","M79.605","I36.1","I51.89","F43.20","I13.2","I50.21","N18.6","F14.24","R60.0","D69.6","R74.8","F14.90","F20.9","I50.41","E83.42","Z97.0","T25.121A","N17.9","F91.8","S80.12XA","R60.9","Z91.199","I50.43","T25.021A","F41.0","Z02.2","Z00.00","Z11.1","Z83.49"],"date":["2023-01-20","2023-05-16","2023-07-25","2023-01-02","2022-08-26","2023-07-01","2022-06-20","2022-06-20","2023-05-25","2023-05-16","2023-05-16","2023-05-16","2023-01-20","2022-06-20","2022-10-25","2023-05-08","2022-06-20","2022-08-26","2023-05-16","2022-08-20","2022-08-20","2023-01-14","2022-08-26","2023-05-27","2022-11-14","2023-05-16","2023-05-08","2023-01-02","2023-05-27","2023-01-29","2023-02-23","2023-01-29","2023-01-20","2023-05-06","2023-01-20","2023-01-20","2023-05-06","2023-05-16","2023-04-12","2021-06-18","2023-05-03","2023-07-20","2023-01-14","2022-01-16","2021-03-15","2023-05-16","2023-05-06","2023-05-15","2022-02-27","2022-02-27","2023-05-27","2022-04-10","2022-04-10","2022-03-23","2023-05-06","2022-03-23","2022-04-10","2022-03-23","2022-03-23","2022-03-23","2022-03-23","2022-08-02","2022-11-14","2022-08-02","2023-05-06","2022-08-26","2022-08-26","2022-08-26","2022-08-26","2022-09-18","2023-01-14","2023-01-14","2023-04-27","2023-01-14","2023-01-14","2023-01-14","2023-01-14","2021-04-06","2021-03-15","2021-03-04","2021-01-08","2021-06-05","2021-03-29","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-03-30","2021-06-05","2023-05-16","2021-09-01","2022-02-15","2022-02-15","2022-01-16","2022-01-16","2023-05-15","2021-02-24","2021-02-24","2021-02-24","2023-05-06","2021-04-03","2021-08-22","2022-01-16","2022-01-16","2022-02-15","2022-11-14","2022-02-20","2023-07-20","2022-03-09","2022-08-02","2022-08-26","2022-08-24","2022-08-24","2023-01-20","2021-02-26","2021-02-18","2021-02-18","2021-04-06","2022-12-12","2022-02-15","2023-01-29","2022-09-26","2022-09-26","2023-02-24","2023-01-29","2023-01-29","2021-01-10","2021-02-26","2021-02-19","2023-05-27","2021-03-15","2021-03-15","2021-03-15","2021-04-03","2021-07-01","2022-03-21","2023-05-16","2022-12-13","2022-01-12","2022-12-12","2022-06-20","2023-05-15","2023-05-15","2023-02-23","2022-08-18","2022-08-18","2023-05-16","2022-10-25","2022-11-14","2022-11-14","2022-11-14","2023-04-13","2023-01-02","2023-01-02","2023-02-23","2023-02-23","2023-02-24","2023-03-07","2022-11-14","2022-11-14","2021-02-13","2021-03-04","2021-06-06","2022-01-12","2022-03-21","2022-04-10","2022-04-10","2022-08-02","2022-08-02","2022-09-18","2021-03-15","2021-04-06","2022-02-20","2022-03-09","2022-03-09","2022-03-09","2023-05-16","2022-03-09","2022-03-09","2022-03-09","2023-05-12","2023-05-15","2023-05-27","2023-04-16","2023-05-15","2023-05-15","2023-05-15","2023-05-15","2023-05-15","2023-05-16","2023-05-16","2023-05-16","2023-05-25","2023-05-27","2023-05-07","2023-04-27","2023-04-27","2023-05-03","2023-05-06","2023-05-08","2023-05-15","2023-05-25","2023-04-12","2023-05-06","2023-05-06","2023-05-06","2023-07-20","2023-07-20","2023-07-25","2023-07-25"],"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":[["","00406012301","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","69097081312","GABAPENTIN","100 MG","21","Select","Select",""],["","65702010210","ACCU-CHEK","MIS AVIVA","1","Select","Select",""],["","49281042050","FLUZONE QUAD","INJ 2020-21","0","Select","Select",""],["","00186037020","SYMBICORT","160-4.5MCG","10.2","Select","Select",""],["","65862050301","AMOX\/K CLAV","TAB 875-125","28","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","7","Select","Select",""],["","43547040111","FUROSEMIDE","20 MG","30","Select","Select",""],["","45802046635","ECONAZOLE","CRE 0.01","15","Select","Select",""],["","08290305930","INSULIN SYRG","MIS 1ML\/29G","30","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","28","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","6","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","7","Select","Select",""],["","42806016005","HYDROXYZ HCL","TAB 25MG","60","Select","Select",""],["","00169185189","NOVOFINE","MIS 32GX6MM","100","Select","Select",""],["","47335070349","ALBUTEROL","NEB 0.00083","90","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","37000045504","PRILOSEC OTC","TAB 20MG","30","Select","Select",""],["","00169185550","NOVOFINE PLS","MIS 32GX4MM","100","Select","Select",""],["","00597010061","SPIRIVA","SPR 2.5MCG","4","Select","Select",""],["","70377000812","ROSUVASTATIN","TAB 20MG","7","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","7","Select","Select",""],["","70710122901","AMITRIPTYLIN","TAB 100MG","7","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","31604001870","VITAMIN D","TAB 1000UNIT","360","Select","Select",""],["","59779061275","ALLERGY RELF","TAB 10MG","90","Select","Select",""],["","70436005901","BUPROPION","TAB 150MG SR","14","Select","Select",""],["","00173088210","BREO ELLIPTA","INH 200-25","60","Select","Select",""],["","68180012202","CEPHALEXIN","500 MG","14","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","7","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","20","Select","Select",""],["","50428050854","CVS PURELAX","PAK ","10","Select","Select",""],["","00597015330","JARDIANCE","25 MG","90","Select","Select",""],["","59310057922","PROAIR HFA","AER ","8","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","31","Select","Select",""],["","00085113201","PROVENTIL","AER HFA","7","Select","Select",""],["","00496088315","LMX 5","CRE 0.05","28","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","15","Select","Select",""],["","69584009150","BUSPIRONE","TAB 5MG","60","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","68180086111","AZITHROMYCIN","250 MG","6","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","67877054360","CEFDINIR","CAP 300MG","20","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","15","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","4","Select","Select",""],["","16571041250","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","00310654004","BYDUREON BC","INJ 2\/0.85ML","3","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","65162046410","IBUPROFEN","TAB 400MG","10","Select","Select",""],["","70752011303","LIDOCAINE","5 %","35.44","Select","Select",""],["","00574709012","HYDROCORT AC","SUP 25MG","12","Select","Select",""],["","57896044305","BISACODYL","SUP 10MG","30","Select","Select",""],["","45802086803","POLYETH GLYC","POW 3350 NF","507","Select","Select",""],["","69315031228","PROCTO-MED","CRE HC 2.5%","28","Select","Select",""],["","00378064110","PREDNISONE","10 MG","10","Select","Select",""],["","00093005805","TRAMADOL HCL","TAB 50MG","12","Select","Select",""],["","08290236712","LACTINEX","GRA ","60","Select","Select",""],["","33342006807","OLANZAPINE","5 MG","30","Select","Select",""],["","45802086801","POLYETHYLENE GLYCOL","3350 17 G\/DOSE","119","Select","Select",""],["","59779048478","PAIN RELIEF EXTRA STRENGTH","500 MG","20","Select","Select",""],["","47335070349","ALBUTEROL SULFATE","2.5 MG\/3ML","150","Select","Select",""],["","00088502005","LANTUS SOLOSTAR","100\/ML (3)","30","Select","Select",""],["","00310654004","BYDUREON BCISE","2MG\/0.85ML","3.4","Select","Select",""],["","00169633910","NOVOLOG FLEXPEN","100\/ML (3)","15","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","200","Select","Select",""],["","53885004401","ONETOUCH VERIO FLEX METER","","1","Select","Select",""],["","59779060027","ASPIRIN EC","81 MG","30","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","100","Select","Select",""],["","68180072103","AMLODIPINE BESYLATE","10 MG","90","Select","Select",""],["","69584009150","BUSPIRONE HCL","5 MG","60","Select","Select",""],["","70377000812","ROSUVASTATIN CALCIUM","20 MG","45","Select","Select",""],["","00310737020","BUDESONIDE-FORMOTEROL FUMARATE","160-4.5MCG","10.2","Select","Select",""],["","53885044801","ONETOUCH ULTRA","2","1","Select","Select",""],["","00093317431","ALBUTEROL SULFATE HFA","90 MCG","8.5","Select","Select",""],["","42806016005","HYDROXYZINE HCL","25 MG","60","Select","Select",""],["","62332002791","LOSARTAN POTASSIUM","25 MG","45","Select","Select",""],["","00597010061","SPIRIVA RESPIMAT","2.5 MCG","4","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","69097084507","CYCLOBENZAPRINE HCL","5 MG","20","Select","Select",""],["","49502039475","INSULIN GLARGINE-YFGN","100\/ML (3)","30","Select","Select",""],["","68180016011","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","59746000103","METHYLPRED TAB","4MG","21","Select","Select",""],["","64380071207","BENZONATATE CAP","100MG","30","Select","Select",""],["","67877054360","CEFDINIR CAP","300MG","20","Select","Select",""],["","00143122701","DICYCLOMINE TAB","20MG","30","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","20","Select","Select",""],["","00597015330","JARDIANCE TAB","25MG","7","Select","Select",""],["","70710122901","AMITRIPTYLIN TAB","100MG","7","Select","Select",""],["","68180098003","LISINOPRIL TAB","10MG","7","Select","Select",""],["","42806016005","HYDROXYZ HCL TAB","25MG","180","Select","Select",""],["","69584009150","BUSPIRONE TAB","5MG","60","Select","Select",""],["","10702001801","OXYCODONE TAB","5MG","15","Select","Select",""],["","43547040111","FUROSEMIDE TAB","20MG","7","Select","Select",""],["","45802065078","LORATADINE TAB","10MG","7","Select","Select",""],["","42858010201","OXYCOD\/APAP TAB","5-325MG","4","Select","Select",""],["","16571041250","CIPROFLOXACN TAB","500MG","14","Select","Select",""],["","70377000812","ROSUVASTATIN TAB","20MG","7","Select","Select",""],["","68180072003","AMLODIPINE TAB","5MG","7","Select","Select",""],["","70436005901","BUPROPION TAB","150MG SR","14","Select","Select",""],["","76204020060","ALBUTEROL NEB","0.083%","180","Select","Select",""],["","08290305930","INSULIN SYRG MIS","1ML\/29G","30","Select","Select",""],["","00310654004","BYDUREON BC INJ","2\/0.85ML","3","Select","Select",""],["","00169413212","OZEMPIC INJ","2\/1.5ML","2","Select","Select",""],["","00169633910","NOVOLOG INJ FLEXPEN","","15","Select","Select",""],["","53746010901","HYDROCO\/APAP TAB","5-325MG","10","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","65862050301","AMOX\/K CLAV TAB","875-125","28","Select","Select",""],["","70710113908","FLUCONAZOLE TAB","150MG","2","Select","Select",""],["","00603188016","LIDOCAINE PAD","5%","15","Select","Select",""],["","08290236712","LACTINEX GRA","","60","Select","Select",""],["","00574709012","HYDROCORT AC SUP","25MG","12","Select","Select",""],["","57896044305","BISACODYL SUP","10MG","30","Select","Select",""],["","50428050854","CVS PURELAX PAK","","10","Select","Select",""],["","65162046410","IBUPROFEN TAB","400MG","10","Select","Select",""],["","69315031228","PROCTO-MED CRE HC","2.5%","28","Select","Select",""],["","45802086803","POLYETH GLYC POW","3350 NF","507","Select","Select",""],["","00536127803","LIDOCAINE CRE","4%","15","Select","Select",""],["","16714087801","LIDOCAINE OIN","5%","35","Select","Select",""],["","17478071130","LIDOCAINE GEL","2% JELLY","30","Select","Select",""],["","00093005805","TRAMADOL HCL TAB","50MG","12","Select","Select",""],["","66993001968","ALBUTEROL AER HFA","","18","Select","Select",""],["","00378064205","PREDNISONE TAB","20MG","10","Select","Select",""],["","29300014701","QUETIAPINE FUMARATE","25 MG","120","Select","Select",""],["","80777028299","MODERNA COVID BIVAL(","6MO UP)EUA 50 MCG\/0.5","0.5","Select","Select",""],["","76282066339","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","31722053101","TORSEMIDE","20 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":""}]}]}