{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   LEAHCIMLLEWDIT A","gend":0,"add":"EELC 5145YEBBA EV","city":"VIRGINIA BEACH","state":"VA","zip":"23462-9998","dob":"1971-06-07","age":"","mstatus":"","insh":"24000910*652","cliId":"","pno":"44\/7577868-8","cno":"","email":"","ename":"","eno":"","pphy":"HUNTLEY-WAGNER, MARY NP","ppno":"757\/333-7625","pcpadd":"813 INDEPENDENCE BLVD SUITE A","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":"","pcpname":"INDEPENDENCE FAMILY MEDICINE","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":["J44.9","G47.33","E11.65","I10.","E66.01","I89.0","E78.5","L03.213","K08.89","E11.628","Z79.4","E11.9","H35.033","H16.143","B02.39","B02.31","H17.822","H02.845","H02.844","H18.812","R06.02","E78.2","I87.2","Z12.11","H61.22","Z68.43","Z00.01","D72.829","E55.9","M70.22","M25.522","I48.0","Z00.00","R80.8","E11.42","B35.1","L02.91","L02.416","M54.5","R60.0","M79.661","M79.662","Z12.5","Z79.01","R07.89","R80.9","R60.9","Q82.0","L30.4","L30.9","Z71.9","M25.422","G47.30","I48.91","Z99.81","E66.8","F17.210","R51.9","M25.561","E11.51","F32.9","F17.209","M20.41","M20.42","E66.9"],"date":["2022-12-02","2022-11-25","2022-12-02","2022-12-02","2022-10-21","2022-11-10","2021-08-20","2021-08-12","2021-08-12","2021-08-12","2022-12-02","2022-06-22","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-09-17","2021-10-27","2022-12-02","2022-11-10","2022-07-13","2022-01-12","2022-12-02","2022-01-12","2022-01-12","2022-01-12","2022-05-06","2022-05-06","2022-10-21","2022-12-02","2022-10-05","2022-12-02","2022-12-02","2022-11-28","2022-11-23","2021-04-14","2022-11-10","2022-11-10","2022-11-10","2022-01-12","2022-06-22","2022-06-22","2022-10-05","2022-10-21","2022-11-10","2021-01-22","2021-01-22","2021-01-22","2022-04-07","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-08-12","2021-01-06","2021-08-20","2021-08-20","2022-12-02","2022-12-02","2022-12-02","2022-12-02"],"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":[["","43598083005","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","90","Select","Select",""],["","69452015120","VITAMIN D","CAP 50000UNT","12","Select","Select",""],["","08290320749","BD PEN NEEDL","MIS 32GX6MM","100","Select","Select",""],["","60505015701","BUPROPION","TAB 100MG","90","Select","Select",""],["","00093032001","DILTIAZEM","TAB 90MG","180","Select","Select",""],["","62559038201","FLECAINIDE","TAB 150MG","108","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","12","Select","Select",""],["","00168009960","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","00574200830","NYSTOP","POW 100000","60","Select","Select",""],["","00713022580","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","53746051105","SPIRONOLACT","TAB 25MG","90","Select","Select",""],["","65862020399","LOSARTAN POT","TAB 100MG","21","Select","Select",""],["","00310610530","ONGLYZA","TAB 5MG","49","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","15","Select","Select",""],["","00173068220","VENTOLIN HFA","AER ","18","Select","Select",""],["","27241009706","DULOXETINE","CAP 20MG","23","Select","Select",""],["","00173069600","ADVAIR DISKU","AER 250\/50","180","Select","Select",""],["","00173088710","TRELEGY","AER 100MCG","180","Select","Select",""],["","60505265401","TRAZODONE","TAB 100MG","90","Select","Select",""],["","00378932132","WIXELA INHUB","AER 250\/50","180","Select","Select",""],["","00378718705","METFORMIN","TAB 1000MG","42","Select","Select",""],["","65862076990","FENOFIBRATE","TAB 145MG","90","Select","Select",""],["","00781185220","AMOX\/K CLAV","TAB 875-125","14","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","00045029721","TYLENOL 8 HR","TAB 650MG","30","Select","Select",""],["","24208079535","NEO\/POLY\/DEX","OIN 0.1% OP","4","Select","Select",""],["","65862018501","CLINDAMYCIN","CAP 150MG","63","Select","Select",""],["","00378427677","VALACYCLOVIR","TAB 1GM","28","Select","Select",""],["","24208035305","ALREX","SUS 0.002","5","Select","Select",""],["","70461032203","FLUCLVX QUAD","INJ 2022-23","0","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","00088221905","LANTUS SOLOS","INJ 100\/ML","45","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","08496320401","EASY TOUCH","MIS 32GX6MM","100","Select","Select",""],["","00069108530","PAXLOVID","TAB 300-100","30","Select","Select",""],["","00169413212","OZEMPIC","INJ 2\/1.5ML","2","Select","Select",""],["","57599080000","FREESTY LIBR","KIT 2 SENSOR","2","Select","Select",""],["","00002822259","INSULIN LISP","INJ 100\/ML","15","Select","Select",""],["","65862042005","SMZ\/TMP DS","TAB 800-160","20","Select","Select",""],["","11877001140","BINAXNOW COV","KIT HOME TES","8","Select","Select",""],["","00093032001","DILTIAZEM HCL","90 MG","180","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":""}]}]}