{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  ARABRABXOCLIW J ","gend":1,"add":"B AINIGRIV E 2142F9 TPA DVLB HCAE","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1942-07-11","age":"","mstatus":"","insh":"73000910*936","cliId":"","pno":"53\/7579704-8","cno":" ","email":"","ename":"","eno":"","pphy":"NEWBY-GOODMAN, MARCIA MD","ppno":"757\/942-8020","pcpadd":"930 MAJESTIC AVE STE 220","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":"","pcpname":"Primary Care Specialists","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":" ","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["H92.02","R42.","M26.629","H20.011","H04.123","H18.51","N39.0","R31.9","M25.532","M25.432","M25.552","S19.9XXA","I48.91","Z79.01","I25.10","I10.","Z86.73","Z91.013","R07.9","E78.5","Z00.00","Z78.0","Z91.81","Z68.35","H18.221","Z94.7","N12.","R35.0","R53.1","S39.91XA","S29.9XXA","R10.9","T78.1XXA","Z68.38","W19.XXXA","Z86.79","R10.84","W18.09XA","B96.89","I12.9","N18.9","R05.","Z76.89","R73.9","I38.","R71.8","Z68.37","R07.89","S70.02XA","Z20.822","M19.90","Z82.49","Z79.899","Z79.52","R26.81","R01.1","Z68.36","J45.901","I11.0","I50.42","R63.5","S79.912A","S69.92XA","M79.672","S79.922A","R26.89","R29.898","R68.89","H18.513","Z74.3","R53.83","M79.89","R82.71","R10.12","M54.5","M16.12","M54.9","I48.0","I34.8","R06.89","I45.10","R94.31","I11.9","M54.2","R51.9","M25.511","R09.89","J84.10","Z76.0","R55.","I50.9","I48.20","R00.1","R82.998","Z68.34","M79.621","R05.9","R07.81","R22.31","M79.601","S62.620A","R52.","Z53.29","R06.02","L29.9","S00.03XA","I48.92","R91.8","S62.624A","M19.031","M25.531","M10.9","M25.431","J45.909","I63.9","R05.3","J34.89","W23.0XXA","M25.641","M15.2","T61.94XA","Z53.20","S59.901A","S09.90XA","M79.644","S62.620D","W23.0XXD","Z46.89","Z87.81","Z68.33","J44.9","R00.2","Z79.82","M79.641","S39.012A","N30.00","E66.9","Z68.31","S40.021A","S49.91XA","S43.101A","M54.50","R07.2","R05.8","I25.2"],"date":["2020-07-01","2021-09-19","2020-07-01","2020-07-24","2021-07-27","2020-08-28","2022-06-07","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2021-09-03","2022-12-05","2022-12-05","2022-12-05","2022-12-05","2022-12-05","2022-12-05","2022-08-26","2022-09-22","2021-07-29","2021-07-29","2021-07-29","2021-07-29","2020-06-05","2021-07-27","2021-12-05","2022-06-10","2021-12-05","2021-05-13","2021-05-13","2022-07-20","2022-04-24","2020-05-29","2021-01-22","2022-02-01","2021-01-22","2021-09-03","2021-09-19","2021-09-19","2021-09-19","2021-09-19","2020-03-31","2020-03-31","2020-03-31","2022-01-27","2022-05-04","2022-04-24","2021-01-22","2022-03-25","2022-06-07","2022-06-07","2022-06-07","2021-01-22","2022-06-05","2021-03-30","2021-03-30","2020-03-15","2022-02-01","2020-03-15","2020-03-15","2021-09-03","2021-09-03","2020-09-08","2021-01-22","2021-05-03","2021-05-03","2021-05-03","2021-07-27","2022-05-21","2020-09-08","2022-05-21","2021-11-02","2021-11-02","2021-12-05","2021-12-05","2021-12-05","2020-04-01","2020-04-01","2020-04-01","2022-06-07","2020-04-01","2020-04-01","2021-09-03","2022-04-13","2022-07-06","2022-10-04","2022-06-10","2021-06-03","2022-02-01","2022-02-01","2022-02-01","2022-02-01","2022-01-27","2022-01-27","2022-04-13","2022-04-29","2022-04-29","2022-03-24","2022-04-13","2022-12-05","2022-03-24","2022-04-24","2022-06-07","2022-04-24","2022-04-29","2022-06-07","2022-06-06","2022-12-05","2022-03-25","2022-03-25","2022-03-25","2022-03-25","2022-09-19","2022-03-25","2022-05-04","2022-05-04","2022-05-24","2022-06-14","2022-06-14","2022-04-24","2022-04-24","2022-04-29","2022-04-29","2022-12-05","2022-06-14","2022-06-14","2022-05-24","2022-05-21","2022-09-19","2022-06-07","2022-06-07","2022-06-07","2022-06-30","2022-07-20","2022-07-20","2022-04-10","2022-04-10","2022-04-13","2022-07-06","2022-07-06","2022-07-24","2022-08-26","2022-09-19","2022-08-26"],"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":[["","11822334950","RA ALLERGY MEDICATION","CAP 25MG","30","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","00065924007","DUREZOL","EMU 0.0005","-5","Select","Select",""],["","31722058901","METOPROLOL SUCCINATE ER","TAB 25MG ER","90","Select","Select",""],["","70010075401","METHOCARBAMOL","TAB 500MG","28","Select","Select",""],["","59746012110","MECLIZINE HCL","TAB 25MG","30","Select","Select",""],["","65862084003","MOXIFLOXACIN HYDROCHLORIDE","SOL HCL 0.5%","-3","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","180","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA","AER HFA","18","Select","Select",""],["","00406012301","HYDROCODONE\/ACETAMINOPHEN","TAB 5-325MG","10","Select","Select",""],["","47335070349","ALBUTEROL SULFATE","NEB 0.00083","-375","Select","Select",""],["","61314063705","PREDNISOLONE ACETATE","SUS 1% OP","-5","Select","Select",""],["","16729000515","SIMVASTATIN","TAB 20MG","90","Select","Select",""],["","31722099601","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","TAB 5-325MG","6","Select","Select",""],["","65162027210","SULFAMETHOXAZOLE\/TRIMETHOPRIM DS","TAB 800-160","10","Select","Select",""],["","00781543820","CEFPODOXIME PROXETIL","TAB 100MG","14","Select","Select",""],["","55111017915","TIZANIDINE HCL","TAB 2MG","15","Select","Select",""],["","68462063945","NITROGLYCERIN","SUB 0.4MG","-25","Select","Select",""],["","65162044210","MECLIZINE HYDROCHLORIDE","TAB 25MG","42","Select","Select",""],["","75826011510","PHENAZOPYRIDINE HCL","TAB 200MG","6","Select","Select",""],["","57896022110","ACETAMINOPHEN","TAB 500MG","18","Select","Select",""],["","65162079108","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","70010013901","NAPROXEN","TAB 500MG","-28","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","57664037708","TRAMADOL HCL","TAB 50MG","-12","Select","Select",""],["","66993058597","FLUTICASONE PROPIONATE\/SALMETEROL DISKUS","AER 250\/50","60","Select","Select",""],["","50383070016","FLUTICASONE PROPIONATE","SPR 50MCG","16","Select","Select",""],["","11822010233","RA PAIN RELIEF ACETAMINOPHEN","TAB 500MG","60","Select","Select",""],["","65162083366","DICLOFENAC SODIUM","GEL 0.01","500","Select","Select",""],["","11822316910","RA ASPIRIN EC","TAB 81MG EC","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}