{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"EL   NYLIRAMEOTEPPIR HGI","gend":1,"add":"S LLIM 105DAOR ENOT","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1958-10-21","age":"","mstatus":"","insh":"8920210*13","cliId":"","pno":"45\/7574731-6","cno":"757\/717-2313","email":"","ename":"","eno":"","pphy":"GRAHAM, MARY O MD","ppno":"757\/460-1207","pcpadd":"1147 INDEPENDENCE BLVD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23455,"pcpcounty":"","pcpid":"","pcpname":"FAMILY MEDICAL PRACTITIONERS","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","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":["R05.9","I10.","M62.830","R53.83","Z03.818","Z00.00","E11.65","E55.9","R31.1","Z12.11","E11.9","E78.3","R31.9","D50.8","E78.2","J44.9","R06.2","J01.00","H10.31","M54.5","M54.16","T84.84XA","M51.36","M43.16","M25.511","K21.9","M47.817","G89.29","M54.41","M51.37","N20.0","Z96.642","Z90.710","Z90.49","F17.210","Z88.1","Z88.5","J20.9","Z00.01","F33.1","J02.0","Z79.891"],"date":["2022-03-08","2022-03-08","2021-02-19","2021-06-15","2021-02-19","2021-02-19","2022-03-08","2021-06-15","2021-02-19","2021-05-23","2021-06-15","2021-06-15","2021-06-15","2021-02-23","2022-03-08","2021-06-15","2021-06-15","2021-10-28","2019-05-25","2019-12-08","2019-12-08","2019-05-21","2019-07-16","2019-09-24","2020-11-10","2020-12-22","2019-12-08","2019-09-24","2019-09-24","2019-09-24","2019-09-24","2019-09-24","2019-09-24","2019-09-24","2019-09-24","2019-09-24","2019-09-24","2020-03-27","2019-04-25","2019-04-25","2020-01-24","2019-12-08"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"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":[["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","29300040001","ATENOL\/CHLOR","TAB 50-25MG","-30","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","00378027105","DIAZEPAM","TAB 2MG","-2","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","30","Select","Select",""],["","65862029490","ROSUVASTATIN","TAB 10MG","30","Select","Select",""],["","51224000760","METFORMIN","TAB 500MG ER","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00591544210","PREDNISONE","TAB 10MG","10","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","6","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","00054004641","IPRATROPIUM","SPR 0.0006","15","Select","Select",""],["","66685100100","AMOX\/K","TAB 875-125","20","Select","Select",""],["","55111014512","FLUCONAZOLE","TAB 150MG","-2","Select","Select",""],["","64980051505","OFLOXACIN","DRO 0.3% OP","-5","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","60505083001","MOMETASONE","SPR 50MCG","17","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","08290309570","3ML","MIS 25GX5\/8\"","-4","Select","Select",""],["","00054818325","DEXAMETHASON","TAB 6MG","-10","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00143962125","CYANOCOBALAM","INJ 1000MCG","4","Select","Select",""],["","00363217305","MINOXIDIL","SOL 2% WOMEN","180","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","30","Select","Select",""],["","00093360782","FLUTIC\/SALME","INH 55\/14","-1","Select","Select",""],["","68462020130","TELMISARTAN","TAB 80MG","-90","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}