{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" V YRAMMOXOLB","gend":1,"add":"          DR NOTSOB 85013                         ","city":"PUNGOTEAGUE              ","state":"VA","zip":"23422-9998","dob":"1951-03-04","age":"","mstatus":"","insh":"10110360","cliId":"","pno":"4475714132","cno":"","email":"","ename":"","eno":"","pphy":"BALMORIA, SANDRA K","ppno":7577877374,"pcpadd":"20306 BADGER LN,","pcpcity":"Onancock","pcpstate":"VA","pcpzip":234171224,"pcpcounty":"","pcpid":"","pcpname":"ONLEY COMMUNITY HEALTH CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"                                                  ","add3":"","madd1":"PO BOX 383                                        ","madd2":"                                                  ","madd3":"","mcity":"PUNGOTEAGUE              ","mstate":"VA","mzip":"23422-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","1","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.8","M54.2","M25.60","E11.621","L97.521","E11.42","R39.81","I10","M06.9","M76.62","M76.822","R26.2","E11.29","N18.2","Z86.711","M15.4","M25.572","M79.672","M21.42","M21.41","Z12.31","D50.9","L30.4","E11.3393","H35.372","H04.123","H25.13","E11.3293","I49.9","Z92.29","Z23","Z71.3","B37.0","E55.9","H25.12","H25.811","H25.11","I49.3","I49.1","H26.492","Z01.818","E11.40","H25.812","E11.22","E78.5","Z87.891","E66.9","Z68.39","H25.813","D31.31","N18.32","Z12.11","Z91.81","L85.1","E11.9","B35.1","K21.9","R05.3","Z63.6","Z11.59"," ","Z79.899","H43.813"],"date":["2022-05-17","2021-02-02","2021-02-02","2022-05-13","2022-05-13","2022-01-06","2022-11-25","2022-11-25","2022-11-25","2021-03-30","2021-03-30","2021-03-30","2021-10-25","2022-02-23","2021-10-25","2020-03-18","2020-03-18","2020-03-18","2020-04-24","2020-04-24","2022-07-05","2021-11-19","2021-07-16","2021-07-19","2021-07-23","2021-07-19","2021-07-23","2022-12-08","2022-02-22","2022-10-28","2022-10-28","2022-10-28","2020-11-16","2021-11-19","2021-12-06","2021-12-20","2021-12-20","2022-03-11","2022-03-11","2022-03-14","2021-11-19","2022-02-23","2022-03-14","2022-10-28","2022-10-28","2022-06-03","2022-06-03","2022-06-03","2021-08-26","2021-08-26","2022-10-28","2022-06-03","2022-11-11","2022-08-26","2022-08-26","2022-08-26","2022-10-28","2022-10-28","2022-10-28","2022-11-02","2022-12-08","2022-12-08","2022-12-08"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","00169183711","NOVOLIN","INJ 70\/30","40","Select","Select",""],["","68645058259","METFORMIN","TAB 500MG","180","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","180","Select","Select",""],["","00093505698","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","31722070290","LOSARTAN","TAB 100MG","90","Select","Select",""],["","57237010099","METOPROL","TAB 25MG","180","Select","Select",""],["","43598072101","HYDROXYCHLOR","TAB 200MG","90","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","21","Select","Select",""],["","00781286810","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","68645051054","HYDROCHLOROT","TAB 25MG","90","Select","Select",""],["","68382039801","POT  CHLORIDE","TAB 20MEQ ER","90","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","90","Select","Select",""],["","61314012605","KETOROLAC","SOL 0.005","5","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","00832532511","POT  CL MICRO","TAB 20MEQ ER","90","Select","Select",""],["","00169183702","NOVOLIN70\/30","INJ RELION","60","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","10","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","6","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","00574200830","NYSTOP","POW 100000","30","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","400","Select","Select",""],["","00169210125","NOVOLOG","INJ FLEX REL","15","Select","Select",""],["","00527512170","NYSTATIN","SUS 100000","112","Select","Select",""],["","17478007035","ERYTHROMYCIN","OIN 5MG\/GM","3.5","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["1",""],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}