{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NICOLE M COLTRANE","gend":1,"add":"2512 MORTON ST","city":"PORTSMOUTH","state":"VA","zip":"23707-9998","dob":"1976-07-30","age":"","mstatus":"","insh":"6424333*01","cliId":"","pno":7575354248,"cno":7575354248,"email":"","ename":"","eno":"","pphy":"BHOWMIK, NIHAR MD","ppno":7573990701,"pcpadd":"301 GOODE WAY #103,","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":"23704-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7573993731,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E16.2","K91.1","M25.50","M10.9","M65.331","M65.332","E66.01","Z68.35","Z84.0","K86.89","E03.9","E55.9","M25.559","Z01.810","M50.021","M50.221","Z68.31","D64.9","M19.90","Z48.89","M50.30","M48.02","M47.816","G89.4","D50.9","E11.9","E53.8","Z98.84","E66.9","Z79.899","R10.13","R63.4","R11.0","R11.2","Z98.0","D57.3","Z90.710","E87.6","Z68.24","R19.7","I95.89","R42.","E83.42","E83.51","R55.","E87.8","E43.","K63.89","K90.2","M54.10","Z98.1","NO DATA","M25.531","M25.532","M25.552","M25.551","M16.11","M16.12","M10.071","M84.452A","E10.65","M20.21","L03.031","B95.61","D50.8","D50.0","D72.819","N92.1","Z68.37","K62.4","G95.9","M72.2","U07.1","R62.7","R64.","K21.9","K91.2","S52.532A","R73.9","Z68.36","S93.401A","M79.671","R22.40","K86.81","M25.571","M25.572","R22.43","G89.29","Z68.38","M77.41","M77.42","W20.8XXA","Z20.822","N39.0","R13.10","I44.1","I95.1","E86.1","E86.0","Z46.59","L70.0","L30.9","Z20.828","R49.0","J04.0","R10.30","R19.4","M16.0","R76.8","L81.9","M47.12","R26.9","K90.9","E11.649","I95.9","E88.09","D63.8","Z79.890","Z90.3","Z90.49","R53.83","Z86.16","N76.0","M79.89","M17.12","M85.862","M79.7","G56.01","G56.02","M84.40XA","M25.562","Z86.2","M70.62","M70.61","M79.672","L24.4","R47.01","I07.1","B35.1","G62.9","M65.871","G56.03","C25.9","Z68.28","R53.1","R60.9","Z68.30","Z87.39","Z12.4","M65.9","M85.80","M25.511","M25.512","K62.89","M76.821","R10.9","R30.0","Z30.9","I08.1","M20.22","M84.374A","M17.11","M25.561","I89.0","I87.2","M54.6","S52.572P","G89.18","M17.0","E44.1","M81.8","S52.502A","S52.615A","W19.XXXA","D70.9","D51.9","M62.89","R10.2","R73.03","R14.0","M81.0"],"date":["2023-06-26","2023-06-22","2021-11-15","2023-03-23","2023-01-05","2021-11-15","2023-03-23","2023-01-18","2021-11-15","2021-04-16","2023-06-26","2023-06-26","2021-09-03","2022-03-03","2022-03-28","2022-03-28","2022-11-01","2023-01-18","2023-03-23","2022-05-03","2022-05-03","2022-08-15","2023-08-15","2022-08-15","2023-05-18","2022-08-15","2023-07-12","2023-08-03","2022-05-03","2023-03-23","2023-01-18","2023-01-18","2022-06-16","2022-05-19","2022-05-19","2023-05-18","2022-06-25","2022-08-15","2022-10-14","2023-08-03","2022-12-31","2022-08-15","2022-07-26","2022-12-13","2022-08-01","2022-07-26","2022-12-31","2022-07-26","2022-07-26","2022-09-09","2022-11-01","2023-02-17","2022-11-01","2023-08-14","2023-01-03","2023-01-03","2023-01-03","2023-01-03","2023-04-05","2023-03-09","2023-06-22","2023-09-14","2021-05-18","2021-05-18","2022-10-14","2023-05-18","2023-01-18","2021-10-18","2021-10-27","2021-10-28","2022-01-07","2022-10-13","2022-08-15","2022-08-15","2022-08-15","2023-03-23","2022-12-31","2023-03-23","2023-03-23","2023-03-23","2022-10-29","2023-01-11","2022-10-29","2023-02-21","2023-01-29","2023-07-26","2021-06-30","2023-09-12","2021-10-28","2021-07-14","2021-07-14","2021-07-14","2022-06-30","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-07-19","2022-07-26","2022-09-09","2021-01-20","2021-03-30","2023-09-13","2021-06-14","2021-07-14","2021-10-28","2022-10-14","2023-07-28","2021-09-01","2022-03-28","2022-03-29","2022-06-25","2022-06-25","2022-07-19","2022-06-25","2022-06-25","2023-01-29","2022-06-25","2022-06-25","2022-06-29","2022-06-28","2023-08-16","2023-01-29","2023-09-12","2022-12-01","2023-08-15","2023-01-26","2023-01-05","2023-01-13","2023-09-12","2023-01-29","2023-07-28","2023-07-28","2023-01-11","2022-03-02","2022-06-29","2022-06-27","2022-10-13","2023-08-15","2022-11-30","2023-01-05","2021-01-14","2022-05-20","2022-06-25","2022-06-27","2022-10-29","2022-10-17","2022-12-12","2023-01-11","2023-01-13","2021-01-06","2021-01-06","2021-04-12","2021-08-04","2021-08-31","2021-08-31","2021-11-26","2022-07-21","2022-10-13","2022-11-01","2023-09-12","2023-09-12","2023-07-12","2023-06-06","2023-08-15","2023-08-07","2023-05-02","2023-09-12","2023-03-31","2023-03-31","2023-03-27","2023-03-27","2023-08-07","2023-05-18","2023-08-09","2023-09-13","2023-08-16","2023-08-16","2023-08-03","2023-09-12"],"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":[["","42794001812","LIOTHYRONINE","TAB 5MCG","29","Select","Select",""],["","69238183701","LEVOTHYROXIN","TAB 137MCG","90","Select","Select",""],["","31722053401","METHOCARBAM","TAB 750MG","60","Select","Select",""],["","68462010905","TOPIRAMATE","TAB 100MG","180","Select","Select",""],["","62756096888","CALCITRIOL","CAP 0.5MCG","120","Select","Select",""],["","00378808345","TRETINOIN","0.05 %","45","Select","Select",""],["","27808023302","DOXYCYCL HYC","CAP 100MG","30","Select","Select",""],["","68682090146","ERY\/BENZOYL","GEL 3-5%","47","Select","Select",""],["","00378427577","VALACYCLOVIR","500 MG","30","Select","Select",""],["","00591079401","DICYCLOMINE","CAP 10MG","120","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","27","Select","Select",""],["","00591352530","LIDOCAINE","5 %","30","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","53885027025","ONETOUCH","TES VERIO","75","Select","Select",""],["","00548585000","GLUCAGON","KIT 1MG","1","Select","Select",""],["","65702028810","FASTCLIX","MIS LANCETS","204","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00574011501","FLAVOXATE","TAB 100MG","12","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","08290320109","BD PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","64980056210","FUROSEMIDE","20 MG","30","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","60","Select","Select",""],["","42192034001","HYOSCYAMINE","TAB 0.125MG","180","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","6","Select","Select",""],["","00032122401","CREON","24-76-120K","180","Select","Select",""],["","68382050010","OMEPRAZOLE","40 MG","90","Select","Select",""],["","00245021211","MIDODRINE","TAB 5MG","300","Select","Select",""],["","31604001289","VITAMIN B-12","TAB 250MCG","90","Select","Select",""],["","11534016503","FOLIC ACID","TAB 1MG","30","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","28","Select","Select",""],["","00168034646","TERCONAZOLE","0.4 %","45","Select","Select",""],["","69097068205","PREGABALIN","150 MG","90","Select","Select",""],["","58980078011","VENELEX","OIN ","57","Select","Select",""],["","80681009700","VITAMIN B-1","TAB 50MG","450","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","16571066401","METRONIDAZOL","TAB 500MG","21","Select","Select",""],["","69238152201","TETRACYCLINE","CAP 250MG","46","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","14","Select","Select",""],["","11917020834","PAIN RELIEVI","PAD LIDOCAIN","10","Select","Select",""],["","69238183701","LEVOTHYROXINE SODIUM","137 MCG","90","Select","Select",""],["","31722054201","INDOMETHACIN","25 MG","30","Select","Select",""],["","70954006020","PREDNISONE","20 MG","15","Select","Select",""],["","70010077001","METHOCARBAMOL","750 MG","60","Select","Select",""],["","00406055201","OXYCODONE HCL","5 MG","12","Select","Select",""],["","72065012012","GVOKE HYPOPEN","2-PACK 0.5 MG\/0.1","0.2","Select","Select",""],["","00406012305","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","10","Select","Select",""],["","00548585000","GLUCAGON EMERGENCY KIT","1 MG","1","Select","Select",""],["","64980034214","ALENDRONATE SODIUM","70 MG","4","Select","Select",""],["","64380075906","ACARBOSE","50 MG","270","Select","Select",""],["","68682090146","ERYTHROMYCIN-BENZOYL PEROXIDE","3 %-5 %","46.6","Select","Select",""],["","69097052444","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","42794001812","LIOTHYRONINE TAB","5MCG","29","Select","Select",""],["","62756096888","CALCITRIOL CAP","0.5MCG","360","Select","Select",""],["","00591079401","DICYCLOMINE CAP","10MG","120","Select","Select",""],["","00054429731","FUROSEMIDE TAB","20MG","30","Select","Select",""],["","70010077001","METHOCARBAM TAB","750MG","60","Select","Select",""],["","65702028810","FASTCLIX MIS LANCETS","","204","Select","Select",""],["","53885027025","ONETOUCH TES VERIO","","75","Select","Select",""],["","65862044890","VALACYCLOVIR TAB","500MG","30","Select","Select",""],["","68462041820","LIDOCAINE OIN","5%","35","Select","Select",""],["","42192033901","HYOSCYAMINE SUB","0.125MG","120","Select","Select",""],["","68682090146","ERY\/BENZOYL GEL","3-5%","47","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","4","Select","Select",""],["","00143980305","DOXYCYCL HYC CAP","100MG","30","Select","Select",""],["","00378808345","TRETINOIN CRE","0.05%","45","Select","Select",""],["","00406051205","OXYCOD\/APAP TAB","5-325MG","6","Select","Select",""],["","00406055201","OXYCODONE TAB","5MG","28","Select","Select",""],["","42192034001","HYOSCYAMINE TAB","0.125MG","180","Select","Select",""],["","68382050010","OMEPRAZOLE CAP","40MG","30","Select","Select",""],["","00032122401","CREON CAP","24000UNT","180","Select","Select",""],["","00245021211","MIDODRINE TAB","5MG","240","Select","Select",""],["","08290320109","BD PEN NEEDL MIS","31GX8MM","100","Select","Select",""],["","51672130406","TERCONAZOLE CRE","0.4%","45","Select","Select",""],["","69097067905","PREGABALIN CAP","75MG","90","Select","Select",""],["","80681009700","VITAMIN B-","1 TAB 50MG","450","Select","Select",""],["","11534016503","FOLIC ACID TAB","1MG","30","Select","Select",""],["","16571066401","METRONIDAZOL TAB","500MG","21","Select","Select",""],["","69238152201","TETRACYCLINE CAP","250MG","46","Select","Select",""],["","58980078011","VENELEX OIN","","57","Select","Select",""],["","00093314705","CEPHALEXIN CAP","500MG","40","Select","Select",""],["","68382005105","MELOXICAM TAB","15MG","30","Select","Select",""],["","69097052444","DICLOFENAC GEL","1%","100","Select","Select",""],["","11917020834","PAIN RELIEVI PAD LIDOCAIN","","10","Select","Select",""],["","57237007710","ONDANSETRON TAB","4MG ODT","60","Select","Select",""],["","69238183701","LEVOTHYROXIN TAB","137MCG","90","Select","Select",""],["","65162062711","TRAMADOL HCL TAB","50MG","14","Select","Select",""],["","00093372755","DICLOFENAC EPOLAMINE","1.3 %","60","Select","Select",""],["","65862070901","RALOXIFENE HCL","60 MG","90","Select","Select",""],["","42858010301","OXYCODONE-ACETAMINOPHEN","7.5-325 MG","28","Select","Select",""],["","00143962125","CYANOCOBALAMIN INJECTION","1000MCG\/ML","3","Select","Select",""],["","74312071950","B-","12 1000 MCG","90","Select","Select",""],["","43547028910","BUPROPION HCL SR","150 MG","60","Select","Select",""],["","27808023302","DOXYCYCLINE HYCLATE","100 MG","30","Select","Select",""],["","53885027210","ONETOUCH VERIO TEST STRIP","","300","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":""}]}]}