{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"GABRIELLE L DEBROW","gend":1,"add":"182 DALE DR","city":"PORTSMOUTH","state":"VA","zip":"23704-9998","dob":"1998-02-17","age":"","mstatus":"","insh":"4313909*01","cliId":"","pno":7572155128,"cno":7572155128,"email":"","ename":"","eno":"","pphy":"OSMAN, RADWA M MD","ppno":7574465908,"pcpadd":"855 W BRAMBLETON AVE,","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23510-9998","pcpcounty":"","pcpid":"","pcpname":"EVMS Endocrine and Metabolic Disorders","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574467055,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R11.2","R10.10","K59.00","F12.10","E10.65","R10.31","E10.10","R00.0","F12.90","R11.0","M54.5","J45.20","R11.14","E10.43","K31.84","Z20.822","J45.909","E86.0","F17.210","K58.1","Z79.4","Z83.3","Z82.49","Z82.3","Z83.438","Z91.14","Z79.899","R10.84","O24.011","G93.41","E44.0","E87.1","N17.9","O99.321","E83.39","E86.1","E87.5","F17.200","O99.281","O25.11","R10.30","Z86.39","R07.9","NO DATA","E87.2","E11.9","O16.1","Z3A.00","E55.9","E87.6","O99.511","O99.611","O99.711","E11.65","E13.10","O03.9","O02.1","R60.9","E11.649","Z87.891","R10.9","D72.829","N39.0","E10.8","R65.10","A41.9","Z3A.18","Z30.430","N76.0","G89.29","Z83.49","Z91.19","R07.89","R10.2","E08.10","N12.","G44.209","N30.00","I10.","R60.0","N30.01","E16.2","F33.1","O20.0","Z32.02","B96.20","R03.0","O24.911","E11.00","Z3A.10","O24.012","O99.322","E10.36","O10.912","O26.832","F41.9","O10.012","H53.149","R10.814","R45.1","D51.0","R73.09","K52.9","R07.1","R10.32","O26.891","O24.111","O99.331","R41.82","Z68.1","R63.0","R19.7","Z97.5","Z34.90","E10.11","R06.9","R53.1","E16.1","R40.4","F32.9","E11.43","A59.01","Z01.419","Z11.3","N91.1","Z30.09","R73.9","K59.09","I51.7","O99.341","Z3A.12","R82.90","R94.31","E10.649","D69.59","D64.9","R31.9","N91.2","E53.8","Z91.198","Z23.","Z30.9","Z30.432","Z12.4","F32.1","N64.59","F17.201","E10.9","Z33.1","O99.211","V58.69","H26.9","V23.7","F44.89","O36.4XX0","F19.10","R06.82","I31.3","I42.8","R78.81","B96.1","Z91.199","Z34.91","T19.2XXA","N92.6","Z91.138","Z53.21","R22.0","Z3A.01","E10.69","O41.8X10","O46.8X1"],"date":["2023-06-09","2021-01-14","2023-06-28","2022-05-24","2023-08-24","2021-05-26","2023-09-22","2022-10-21","2023-07-31","2022-05-24","2021-02-04","2021-03-05","2021-03-05","2023-07-31","2023-07-31","2022-11-01","2023-09-02","2023-08-01","2022-05-24","2021-04-18","2023-08-24","2022-06-04","2022-06-04","2021-04-18","2021-04-18","2022-11-30","2022-11-30","2022-12-02","2022-04-21","2022-05-24","2022-02-28","2023-06-09","2022-10-21","2022-03-11","2022-11-30","2022-02-28","2022-10-21","2022-02-28","2022-03-31","2022-02-28","2023-06-09","2023-09-21","2022-09-30","2023-06-09","2022-07-13","2022-07-30","2022-02-11","2022-02-11","2022-03-03","2023-06-09","2022-04-09","2022-02-11","2022-02-11","2022-12-02","2022-05-24","2022-05-24","2022-05-27","2022-06-03","2022-06-12","2022-07-10","2023-09-20","2022-07-10","2022-11-01","2022-12-23","2022-07-13","2022-05-24","2022-05-27","2022-05-27","2022-11-04","2022-11-30","2021-03-02","2021-02-02","2021-04-12","2021-04-12","2021-06-13","2021-10-08","2022-06-04","2023-07-31","2022-07-30","2022-06-04","2022-07-29","2023-08-24","2021-07-27","2021-09-14","2023-08-22","2021-12-11","2021-12-11","2022-02-11","2022-03-03","2022-04-09","2022-05-26","2022-05-24","2022-06-04","2022-05-24","2022-05-24","2022-05-24","2022-05-26","2022-06-04","2022-07-30","2022-07-30","2022-11-30","2022-11-29","2023-06-28","2021-05-03","2021-05-26","2023-09-20","2022-04-09","2022-04-09","2022-04-09","2022-11-01","2022-11-01","2022-11-01","2022-11-01","2022-02-21","2022-02-28","2022-03-11","2022-03-11","2022-06-12","2022-06-12","2022-07-13","2023-06-09","2023-06-09","2021-01-11","2021-01-11","2021-01-11","2021-01-11","2022-09-30","2021-06-29","2021-08-01","2022-03-11","2022-04-21","2022-04-21","2022-06-12","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-10-21","2022-11-10","2022-11-30","2022-11-10","2021-03-16","2021-03-16","2021-03-16","2023-09-02","2022-03-11","2022-03-31","2023-07-31","2022-03-31","2022-03-31","2022-04-09","2022-05-24","2022-05-24","2022-05-24","2022-05-26","2022-05-26","2022-11-30","2022-11-30","2022-11-30","2023-09-21","2023-08-22","2023-08-22","2023-07-31","2023-07-31","2023-09-02","2023-09-20","2023-09-20","2023-09-20","2023-09-20"],"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":[["","00002751001","HUMALOG INJ","100\/ML","20","Select","Select",""],["","53885027210","ONETOUCH TES VERIO","","100","Select","Select",""],["","08290320550","BD PEN NEEDL MIS","32GX4MM","100","Select","Select",""],["","00088222033","LANTUS INJ","100\/ML","10","Select","Select",""],["","00088221905","LANTUS SOLOS INJ","100\/ML","15","Select","Select",""],["","00169633910","NOVOLOG INJ FLEXPEN","","15","Select","Select",""],["","00472173803","MICONAZOLE","3 SUP 200MG","3","Select","Select",""],["","50111033401","METRONIDAZOL TAB","500MG","14","Select","Select",""],["","00093220305","METOCLOPRAM TAB","10MG","30","Select","Select",""],["","00245531911","KLOR-CON M","20 TAB 20MEQ ER","9","Select","Select",""],["","39328010610","PRENATAL TAB","27-1MG","30","Select","Select",""],["","00002879959","HUMALOG KWIK INJ","100\/ML","15","Select","Select",""],["","00169643810","LEVEMIR INJ FLEXTOUC","","15","Select","Select",""],["","57599080000","FREESTY LIBR KIT","2 SENSOR","2","Select","Select",""],["","57599080300","FREESTY LIBR MIS","2 READER","1","Select","Select",""],["","00093557156","ERYTHROMYCIN TAB","250MG","90","Select","Select",""],["","59779067613","CVS C-LAX TAB","5MG","60","Select","Select",""],["","00536124701","SENEXON-S TAB","8.6-50MG","30","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","49884012301","LABETALOL TAB","200MG","60","Select","Select",""],["","00002822259","INSULIN LISP INJ","100\/ML","15","Select","Select",""],["","44523041501","POT CITRA ER TAB","1620MG","6","Select","Select",""],["","49884018601","DOXYL\/PYRID TAB","10-10MG","20","Select","Select",""],["","53885001110","ONETOUCH DEL MIS PLUS","30G","100","Select","Select",""],["","65162052110","PROMETHAZINE TAB","25MG","30","Select","Select",""],["","62088000031","INPEN","100EL MIS BLUE-HUM","2","Select","Select",""],["","69315012710","FOLIC ACID TAB","1000MCG","30","Select","Select",""],["","00904679480","ASPIRIN LOW CHW","81MG","60","Select","Select",""],["","50428050854","CVS PURELAX PAK","","10","Select","Select",""],["","62332002791","LOSARTAN POT TAB","25MG","30","Select","Select",""],["","00002614527","BAQSIMI TWO POW","3MG\/DOSE","2","Select","Select",""],["","65862085901","FAMOTIDINE TAB","20MG","60","Select","Select",""],["","80681013800","CALCIUM\/D","3 TAB 600MG","60","Select","Select",""],["","53885019401","ONETOUCH KIT VERIO FL","","1","Select","Select",""],["","51645075001","DOCUSATE SOD TAB","100MG","30","Select","Select",""],["","00955172805","INSULIN GLAR INJ","100U\/ML","9","Select","Select",""],["","00002614511","BAQSIMI ONE POW","3MG\/DOSE","1","Select","Select",""],["","50268067701","PRENATAL TAB PLUS","","30","Select","Select",""],["","00093314705","CEPHALEXIN CAP","500MG","14","Select","Select",""],["","75826011510","PHENAZOPYRID TAB","200MG","10","Select","Select",""],["","68462010530","ONDANSETRON TAB","4MG","30","Select","Select",""],["","00536100901","FERROUS SULF TAB","325MG","30","Select","Select",""],["","00054429731","FUROSEMIDE TAB","20MG","2","Select","Select",""],["","49483060450","IBUPROFEN TAB","800MG","90","Select","Select",""],["","16571041250","CIPROFLOXACN TAB","500MG","4","Select","Select",""],["","45802048678","DOCUSATE SOD CAP","100MG","30","Select","Select",""],["","08463702930","LANCETS MIS","30G","100","Select","Select",""],["","53885024450","ONETOUCH TES ULTRA","","50","Select","Select",""],["","74312001380","VITAMIN B-","12 TAB 1000MCG","30","Select","Select",""],["","68180051303","LISINOPRIL TAB","5MG","15","Select","Select",""],["","53885065701","ONETOUCH KIT VERIO","","1","Select","Select",""],["","53885004401","ONE TOUCH KIT VERIO FL","","1","Select","Select",""],["","53885092701","ONETOUCH KIT VERIO RE","","1","Select","Select",""],["","42858010201","OXYCOD\/APAP TAB","5-325MG","12","Select","Select",""],["","45802075930","PROMETHAZINE HCL","25 MG","10","Select","Select",""],["","65862039010","ONDANSETRON ODT","4 MG","12","Select","Select",""],["","53885027150","ONETOUCH VERIO TEST STRIP","","150","Select","Select",""],["","00088222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","53885027025","ONETOUCH","TES VERIO","50","Select","Select",""],["","00002751001","HUMALOG","100\/ML","20","Select","Select",""],["","08290320122","BD PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","15","Select","Select",""],["","00472173803","MICONAZOLE 3","SUP 200MG","3","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","39328010610","PRENATAL","TAB 27-1MG","30","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","4","Select","Select",""],["","49884012301","LABETALOL","TAB 200MG","60","Select","Select",""],["","00002822259","INSULIN LISP","INJ 100\/ML","15","Select","Select",""],["","00245531911","KLOR-CON M20","TAB 20MEQ ER","9","Select","Select",""],["","00093220305","METOCLOPRAM","TAB 10MG","30","Select","Select",""],["","57599080000","FREESTY LIBR","KIT 2 SENSOR","2","Select","Select",""],["","00002879959","HUMALOG KWIK","INJ 100\/ML","15","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","15","Select","Select",""],["","00093557156","ERYTHROMYCIN","TAB 250MG","90","Select","Select",""],["","59779067613","CVS C-LAX","TAB 5MG","60","Select","Select",""],["","00536124701","SENEXON-S","TAB 8.6-50MG","30","Select","Select",""],["","44523041501","POT CITRA ER","TAB 1620MG","6","Select","Select",""],["","53885001110","ONETOUCH DEL","MIS PLUS 30G","100","Select","Select",""],["","49884018601","DOXYL\/PYRID","TAB 10-10MG","20","Select","Select",""],["","62088000031","INPEN 100EL","MIS BLUE-HUM","1","Select","Select",""],["","80681013800","CALCIUM\/D3","TAB 600MG","60","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","30","Select","Select",""],["","69315012710","FOLIC ACID","TAB 1000MCG","30","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","30","Select","Select",""],["","00002614511","BAQSIMI ONE","POW 3MG\/DOSE","1","Select","Select",""],["","45802048678","DOCUSATE SOD","CAP 100MG","30","Select","Select",""],["","00002614527","BAQSIMI TWO","POW 3MG\/DOSE","2","Select","Select",""],["","00536100901","FERROUS SULF","TAB 325MG","30","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","2","Select","Select",""],["","00955172805","INSULIN GLAR","INJ 100U\/ML","9","Select","Select",""],["","62332002791","LOSARTAN POT","TAB 25MG","30","Select","Select",""],["","00904679480","ASPIRIN LOW","CHW 81MG","60","Select","Select",""],["","50428050854","CVS PURELAX","PAK ","10","Select","Select",""],["","65162052110","PROMETHAZINE","TAB 25MG","30","Select","Select",""],["","75826011510","PHENAZOPYRID","TAB 200MG","10","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","16571041250","CIPROFLOXACN","TAB 500MG","4","Select","Select",""],["","08463702930","LANCETS","MIS 30G","100","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","74312001380","VITAMIN B-12","TAB 1000MCG","30","Select","Select",""],["","53885004401","ONE TOUCH","KIT VERIO FL","1","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","00088221905","LANTUS SOLOSTAR","100\/ML (3)","15","Select","Select",""],["","08627007701","DEXCOM G","7 SENSOR","2","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","200","Select","Select",""],["","00002879959","HUMALOG KWIKPEN U-","100 100\/ML","15","Select","Select",""],["","08290328203","ULTRA-FINE ORIGINAL PEN NEEDLE","29 G X1\/2\"","100","Select","Select",""],["","68682010301","DICLOFENAC SODIUM ER","100 MG","30","Select","Select",""],["","69097015807","MELOXICAM","7.5 MG","30","Select","Select",""],["","50111033401","METRONIDAZOLE","500 MG","14","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","00143122701","DICYCLOMINE HCL","20 MG","30","Select","Select",""],["","49884012201","LABETALOL HCL","100 MG","90","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":""}]}]}