{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BANITA L COFIELD","gend":1,"add":"2820 CARY AVE","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1989-09-03","age":"","mstatus":"","insh":"9462678*01","cliId":"","pno":7577690831,"cno":7577690831,"email":"","ename":"","eno":"","pphy":"GRAHAM, TAMARA FP","ppno":7574102287,"pcpadd":"112 GAINSBOROUGHQ STE 100,","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":"23320-9998","pcpcounty":"","pcpid":"","pcpname":"EVMS Internal Medicine","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":7574107747,"pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J45.909","J20.9","R76.8","R05.","J30.9","R09.82","K21.9","M79.7","E66.01","Z68.43","M25.50","NO DATA","E11.9","M54.2","R06.09","U09.9","M25.552","M25.551","B37.2","J45.40","J30.1","Z86.16","R10.13","R19.4","R11.2","R19.7","M32.9","R10.84","D57.3","Z88.6","Z88.3","Z88.5","Z91.013","Z91.018","J45.991","M26.623","E66.9","E11.42","G56.03","G44.52","G43.019","R60.0","R06.02","J30.89","Z84.0","R70.0","R10.2","L68.0","R63.5","N94.89","N85.9","Z30.09","Z32.02","M62.838","G43.909","R05.3","R06.00","U07.1","R41.840","R41.89","M25.561","M25.562","G89.29","R10.32","K64.8","R05.9","K80.20","K52.9","R06.83","R20.2","J40.","R73.9","D50.9","J45.50","Z00.00","M94.0","Z68.41","F34.1","Z30.430","Z30.9","K29.70","K44.9","R73.03","J45.20","F41.0","Z79.899","Z79.51","E28.2","F41.9","M54.10","Z13.31","Z13.9","F43.9","F33.1","N30.00","R11.10","D89.89","D64.9","R74.8","M62.81","R51.9","M79.2","J38.5","R49.0","K64.0","G47.30","Z79.890","Z88.8","Z82.5","Z82.3","G47.33","J38.3","G72.0","T38.0X5A","R53.81","S16.1XXA","R63.4","K29.60","G43.009","Z01.419","Z20.2","Z30.432","M79.10","R20.0","R42.","J20.8","Z79.52","J02.9","N93.9","G44.209","J01.90","N39.0","G54.0","B37.3","R07.89","R05.1","R10.9","N92.0","Z30.2","Z71.3","Z01.818","M67.873","L65.9","K76.0","Z01.89","M15.9","K58.9","J45.41","M67.471"],"date":["2023-09-21","2023-09-12","2022-10-10","2021-09-08","2021-09-02","2022-01-31","2023-09-21","2023-09-12","2023-09-21","2023-09-21","2021-10-15","2023-09-12","2023-09-21","2022-05-09","2022-05-09","2022-05-09","2023-08-04","2023-08-04","2022-05-19","2022-11-17","2022-11-17","2022-11-29","2022-10-28","2022-10-28","2022-10-28","2022-10-28","2022-11-29","2022-10-28","2022-11-29","2022-10-28","2022-10-28","2022-11-29","2022-11-29","2022-11-29","2022-11-10","2021-06-01","2022-10-10","2021-06-01","2021-06-01","2021-06-09","2021-06-01","2021-11-15","2021-06-22","2021-06-22","2021-06-22","2021-06-22","2022-04-29","2021-07-16","2022-07-08","2022-02-24","2022-02-24","2022-03-01","2022-03-17","2021-09-29","2022-11-29","2021-12-29","2021-12-29","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-04-20","2022-11-29","2022-11-29","2022-12-29","2021-03-05","2022-11-29","2021-05-11","2021-06-09","2021-08-15","2022-02-10","2022-02-10","2022-02-10","2022-02-10","2022-02-10","2022-10-18","2022-10-18","2022-03-17","2022-03-17","2022-03-28","2022-03-28","2022-03-28","2022-11-29","2022-03-28","2022-11-29","2022-03-28","2021-04-20","2022-07-08","2021-08-30","2021-04-20","2021-04-20","2021-04-20","2021-11-29","2022-09-20","2022-09-20","2022-10-10","2022-10-10","2022-10-10","2021-08-30","2022-10-06","2021-08-30","2021-09-08","2021-09-08","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2021-03-02","2021-04-23","2021-08-10","2022-03-10","2022-03-10","2022-03-10","2022-03-10","2022-03-10","2022-03-28","2021-04-06","2021-05-06","2021-05-06","2021-05-06","2021-07-12","2021-10-26","2021-12-07","2022-01-13","2022-01-13","2022-01-13","2022-04-29","2021-03-18","2021-03-18","2021-10-28","2021-10-28","2021-10-28","2021-11-15","2022-01-31","2022-10-06","2022-12-13","2022-12-13","2023-07-14","2023-09-21","2023-09-12","2023-09-12","2023-09-21","2023-09-21","2023-09-21","2023-09-21","2023-08-01","2023-08-01"],"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":[["","65162062711","TRAMADOL HCL TAB","50MG","21","Select","Select",""],["","68180031909","BUPROPN HCL TAB","150MG XL","30","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","00173089310","TRELEGY AER ELLIPTA","","60","Select","Select",""],["","70954005930","PREDNISONE PAK","10MG","21","Select","Select",""],["","78206011403","ASMANEX","14 AER 220MCG","1","Select","Select",""],["","00054429731","FUROSEMIDE TAB","20MG","90","Select","Select",""],["","00781808926","AZITHROMYCIN TAB","250MG","6","Select","Select",""],["","00031871612","ROBITUSSIN LIQ CF","","237","Select","Select",""],["","27808008602","HYD POL\/CPM SUS","10-8\/5ML","50","Select","Select",""],["","00591544305","PREDNISONE TAB","20MG","18","Select","Select",""],["","00031875718","ROBIT CGH DM LIQ","20-200","237","Select","Select",""],["","00406012305","HYDROCO\/APAP TAB","5-325MG","28","Select","Select",""],["","69452015120","VITAMIN D CAP","50000UNT","12","Select","Select",""],["","57237007710","ONDANSETRON TAB","4MG ODT","12","Select","Select",""],["","00406048410","APAP\/CODEINE TAB","300-30MG","15","Select","Select",""],["","65162006205","SUCRALFATE SUS","1GM\/10ML","420","Select","Select",""],["","11917009215","FERROUS SULF TAB","325MG","30","Select","Select",""],["","00904759080","FEROSUL TAB","325MG","30","Select","Select",""],["","00173069600","ADVAIR DISKU AER","250\/50","60","Select","Select",""],["","00378932132","WIXELA INHUB AER","250\/50","60","Select","Select",""],["","43547028110","ESCITALOPRAM TAB","10MG","49","Select","Select",""],["","72888001001","BACLOFEN TAB","10MG","90","Select","Select",""],["","76204020025","ALBUTEROL NEB","0.083%","375","Select","Select",""],["","31722072690","MONTELUKAST TAB","10MG","90","Select","Select",""],["","00378718505","METFORMIN TAB","500MG","30","Select","Select",""],["","00597007541","SPIRIVA CAP HANDIHLR","","90","Select","Select",""],["","00173071720","ADVAIR HFA AER","230\/21","12","Select","Select",""],["","00378727253","NORETHINDRON TAB","0.35MG","84","Select","Select",""],["","68382050010","OMEPRAZOLE CAP","40MG","90","Select","Select",""],["","00597016061","SPIRIVA AER","1.25MCG","4","Select","Select",""],["","00597008717","ATROVENT HFA AER","17MCG","13","Select","Select",""],["","59267102504","PFIZER VACC INJ ADLT RTU","","0","Select","Select",""],["","42806071401","BENZONATATE CAP","100MG","90","Select","Select",""],["","66993013697","FLUTIC\/VILAN INH","200-25","60","Select","Select",""],["","60505082701","IPRATROPIUM SPR","0.06%","15","Select","Select",""],["","00574200802","NYSTOP POW","100000","60","Select","Select",""],["","00378163193","FORMOTEROL NEB","20\/2ML","120","Select","Select",""],["","49502080693","YUPELRI SOL","","360","Select","Select",""],["","51672300805","LIDOCAINE OIN","5%","50","Select","Select",""],["","51672130005","AMMONIUM LAC LOT","12%","225","Select","Select",""],["","00173088210","BREO ELLIPTA INH","200-25","60","Select","Select",""],["","10702002701","PHENTERMINE CAP","30MG","30","Select","Select",""],["","00169413212","OZEMPIC INJ","2\/1.5ML","2","Select","Select",""],["","00186037020","SYMBICORT AER","160-4.5","10","Select","Select",""],["","00310737020","BUDES\/FORMOT AER","160-4.5","10","Select","Select",""],["","00173087310","INCRUSE ELPT INH","62.5MCG","30","Select","Select",""],["","49502060530","PERFOROMIST NEB","20MCG","360","Select","Select",""],["","66993008096","FLUTICAS HFA AER","220MCG","12","Select","Select",""],["","68180098430","BUDESONIDE SUS","0.5MG\/2","120","Select","Select",""],["","49502010202","EPINEPHRINE INJ","0.3MG","2","Select","Select",""],["","00173072020","FLOVENT HFA AER","220MCG","12","Select","Select",""],["","00002149580","MOUNJARO INJ","5MG\/0.5","4","Select","Select",""],["","00169452514","WEGOVY INJ","0.25MG","2","Select","Select",""],["","00093314705","CEPHALEXIN CAP","500MG","40","Select","Select",""],["","64380076621","PEG-","3350 SOL ELECTROL","4000","Select","Select",""],["","00093342605","LORAZEPAM TAB","1MG","2","Select","Select",""],["","00591079501","DICYCLOMINE TAB","20MG","30","Select","Select",""],["","10702000350","PROMETHAZINE TAB","25MG","120","Select","Select",""],["","00045029532","IMODIUM A-D TAB","2MG","32","Select","Select",""],["","00363037507","ANTI-DIARRHE TAB","2MG","32","Select","Select",""],["","10702025350","BUT\/APAP\/CAF TAB","","120","Select","Select",""],["","43386009019","GAVILYTE-G SOL","","4000","Select","Select",""],["","45963055650","GABAPENTIN CAP","300MG","180","Select","Select",""],["","64380080707","IBUPROFEN TAB","800MG","90","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","3","Select","Select",""],["","00173088710","TRELEGY AER","100MCG","120","Select","Select",""],["","42806040021","METHYLPRED TAB","4MG","21","Select","Select",""],["","65862042005","SMZ\/TMP DS TAB","800-160","14","Select","Select",""],["","00121077516","GG\/CODEINE SOL","100-10\/5","300","Select","Select",""],["","00591544210","PREDNISONE","10 MG","18","Select","Select",""],["","00904759080","FEROSUL","325(65) MG","30","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","4","Select","Select",""],["","43547028110","ESCITALOPRAM OXALATE","10 MG","90","Select","Select",""],["","69097067905","PREGABALIN","75 MG","60","Select","Select",""],["","00406048501","ACETAMINOPHEN-CODEINE","300MG-60MG","28","Select","Select",""],["","42806071401","BENZONATATE","100 MG","90","Select","Select",""],["","69367027216","CODEINE-GUAIFENESIN","10-100MG\/5","300","Select","Select",""],["","00173068220","VENTOLIN HFA","90 MCG","18","Select","Select",""],["","31722072690","MONTELUKAST SODIUM","10 MG","90","Select","Select",""],["","64980056210","FUROSEMIDE","20 MG","30","Select","Select",""],["","00378718505","METFORMIN HCL","500 MG","30","Select","Select",""],["","00002143380","TRULICITY","0.75MG\/0.5","2","Select","Select",""],["","60505082901","FLUTICASONE PROPIONATE","50 MCG","16","Select","Select",""],["","00169418113","OZEMPIC .","25 OR 0.5","3","Select","Select",""],["","68462039701","OMEPRAZOLE","40 MG","60","Select","Select",""],["","42135010000","COMPACT SPACE CHAMBER","","1","Select","Select",""],["","00186091612","PULMICORT FLEXHALER","180 MCG","1","Select","Select",""],["","00173089310","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","65162062711","TRAMADOL HCL","TAB 50MG","21","Select","Select",""],["","68180031909","BUPROPN HCL","TAB 150MG XL","30","Select","Select",""],["","78206011403","ASMANEX 14","AER 220MCG","1","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","27808008602","HYD POL\/CPM","SUS 10-8\/5ML","50","Select","Select",""],["","00031875718","ROBIT CGH DM","LIQ 20-200","237","Select","Select",""],["","00031871612","ROBITUSSIN","LIQ CF","237","Select","Select",""],["","13107006001","APAP\/CODEINE","TAB 300-60MG","60","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","28","Select","Select",""],["","11917009215","FERROUS SULF","TAB 325MG","90","Select","Select",""],["","00254101196","SUCRALFATE","SUS 1GM\/10ML","420","Select","Select",""],["","00378932132","WIXELA INHUB","AER 250\/50","180","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","00173069600","ADVAIR DISKU","AER 250\/50","60","Select","Select",""],["","43547028110","ESCITALOPRAM","TAB 10MG","49","Select","Select",""],["","52817032010","BACLOFEN","TAB 10MG","90","Select","Select",""],["","76204020025","ALBUTEROL","NEB 0.00083","375","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","00378727253","NORETHINDRON","TAB 0.35MG","84","Select","Select",""],["","00173071720","ADVAIR HFA","AER 230\/21","12","Select","Select",""],["","00378718505","METFORMIN","TAB 500MG","30","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","10702002701","PHENTERMINE","CAP 30MG","30","Select","Select",""],["","60505082701","IPRATROPIUM","SPR 0.0006","15","Select","Select",""],["","51672300805","LIDOCAINE","OIN 0.05","50","Select","Select",""],["","49502060530","PERFOROMIST","NEB 20MCG","360","Select","Select",""],["","68180098430","BUDESONIDE","SUS 0.5MG\/2","120","Select","Select",""],["","00378163193","FORMOTEROL","NEB 20\/2ML","180","Select","Select",""],["","49502080693","YUPELRI","SOL ","180","Select","Select",""],["","00597008717","ATROVENT HFA","AER 17MCG","13","Select","Select",""],["","00173088210","BREO ELLIPTA","INH 200-25","60","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","66993008096","FLUTICAS HFA","AER 220MCG","12","Select","Select",""],["","00173087310","INCRUSE ELPT","INH 62.5MCG","30","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","00173072020","FLOVENT HFA","AER 220MCG","12","Select","Select",""],["","59267102504","PFIZER VACC","INJ ADLT RTU","0","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","51672130005","AMMONIUM LAC","LOT 0.12","225","Select","Select",""],["","66993013697","FLUTIC\/VILAN","INH 200-25","60","Select","Select",""],["","00002149580","MOUNJARO","INJ 5MG\/0.5","4","Select","Select",""],["","00574200802","NYSTOP","POW 100000","60","Select","Select",""],["","10702025350","BUT\/APAP\/CAF","TAB ","120","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","14","Select","Select",""],["","00169452514","WEGOVY","INJ 0.25MG","2","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","59651036205","IBUPROFEN","800 MG","90","Select","Select",""],["","00093342605","LORAZEPAM","TAB 1MG","2","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","120","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","240","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00045029532","IMODIUM A-D","TAB 2MG","32","Select","Select",""],["","64380076621","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","59762501701","FLUCONAZOLE","150 MG","3","Select","Select",""],["","45963055650","GABAPENTIN","CAP 300MG","180","Select","Select",""],["","00363037507","ANTI-DIARRHE","TAB 2MG","32","Select","Select",""],["","00121077516","GG\/CODEINE","SOL 100-10\/5","300","Select","Select",""],["","71399802201","ACETAMINOPHEN","500 MG","100","Select","Select",""],["","00185012201","NITROFURANTOIN MONO-MACRO","100 MG","10","Select","Select",""],["","68001024717","ONDANSETRON ODT","8 MG","12","Select","Select",""],["","00121077504","GUAIFENESIN-CODEINE","10-100MG\/5","300","Select","Select",""],["","68001037700","URSODIOL","250 MG","180","Select","Select",""],["","42806040021","METHYLPREDNISOLONE","4 MG","21","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":""}]}]}