{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"C ALLEREPOO","gend":1,"add":"GUA 0292RIC ATSU","city":"VIRGINIA BEACH","state":"VA","zip":"23453-9998","dob":"1962-05-01","age":"","mstatus":"","insh":"0174110*85","cliId":"","pno":"1775713218","cno":"","email":"","ename":"","eno":"","pphy":"MATAWARAN, RAMON MD","ppno":7579754695,"pcpadd":"1232 PERIMETER PARKWAY STE 206","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23454-9998","pcpcounty":"","pcpid":"","pcpname":"ATLANTIC INTERNAL MEDICINE","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":["J18.9","Z12.31","U07.1","J12.82","I10.","F32.9","K21.9","D48.5","L93.2","Z71.9","Z12.11","M25.50","M54.12","M54.2","R20.2","R00.2","M72.2","M79.671","M24.571","M24.572","R13.10","K44.9","Z48.815","R07.9","E78.5","M79.7","M06.9","M32.9","J45.909","E66.9","Z87.891","Z68.30","Z86.11","Z82.49","Z90.49","Z80.8","Z88.8","Z88.2","Z91.018","N39.0","M46.1","R01.1","G89.4","R07.89","R05.3","R53.83","G89.29","M50.121","M48.03","H25.13","K11.7","E50.7","M48.02","M35.00","R61.","L30.9","M47.812","Z00.01","L93.0","Z23.","I49.1","I49.3","K22.89","H16.223","N95.1","E66.3","K21.00","R06.02","Z88.1","L93.1","H11.433","Z01.810","I51.7","N95.9","M70.61","M70.62","M54.5","G44.89","Z79.899","M47.816","M16.0","E04.2","E53.8","E55.9","M79.641","M79.642","M47.22","R10.84","K57.30","J98.4","J45.20","R06.83","J45.31","R19.5","M25.551","M25.552","B94.8","M15.0","M35.01","R92.8","M18.11","N64.89","H81.8X3","M79.644","H81.4","H81.8X9","Z68.29","J45.901","J44.1","M35.05"],"date":["2021-02-01","2023-04-26","2021-04-12","2023-06-05","2023-04-05","2022-05-31","2022-08-15","2021-05-11","2021-05-11","2021-05-11","2022-05-28","2023-05-30","2022-12-22","2023-01-23","2022-11-17","2023-03-20","2022-11-29","2022-11-29","2022-11-29","2022-11-29","2022-08-15","2022-08-15","2022-08-15","2022-08-21","2022-09-09","2023-03-20","2022-08-21","2022-08-21","2023-06-05","2022-03-16","2022-08-21","2021-01-07","2022-08-21","2021-01-07","2021-01-07","2021-01-07","2022-08-21","2021-01-07","2022-08-21","2021-04-23","2021-04-23","2021-09-01","2022-07-01","2022-08-26","2022-08-26","2022-08-26","2022-08-26","2022-11-01","2022-11-01","2022-11-07","2022-11-08","2022-11-08","2023-02-01","2023-05-30","2023-01-10","2023-01-10","2023-01-23","2021-03-15","2022-10-07","2021-03-15","2021-03-16","2021-03-16","2022-08-15","2022-11-03","2023-03-20","2023-03-20","2022-03-16","2022-08-21","2022-08-21","2022-08-31","2022-09-19","2022-10-19","2022-10-19","2023-02-01","2021-08-16","2021-08-16","2021-08-16","2021-09-15","2022-10-07","2021-05-18","2021-05-18","2022-03-10","2022-06-07","2022-06-07","2022-09-06","2022-09-06","2022-12-12","2021-01-07","2021-01-07","2021-01-07","2021-01-26","2021-01-26","2021-02-01","2021-02-01","2021-05-18","2021-05-18","2022-05-31","2023-05-30","2023-04-12","2023-05-10","2023-05-24","2023-05-10","2023-04-05","2023-05-22","2023-04-21","2023-04-21","2023-05-30","2023-06-05","2023-06-05","2023-06-05"],"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":[["","68645056259","IBUPROFEN","TAB 600MG","90","Select","Select",""],["","68645049254","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","68382080601","TRAZODONE","TAB 100MG","90","Select","Select",""],["","00591288601","VERAPAMIL","CAP 360MG SR","90","Select","Select",""],["","00713063437","MOMETASONE","CRE 0.001","45","Select","Select",""],["","59310020480","QVAR","AER 80MCG","9","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","00186091612","PULMICORT","INH 180MCG","3","Select","Select",""],["","43598072101","HYDROXYCHLOR","TAB 200MG","30","Select","Select",""],["","42806054701","VITAMIN","CAP 1.25MG","12","Select","Select",""],["","00172572970","FAMOTIDINE","TAB 40MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","29300011516","TOPIRAMATE","TAB 25MG","100","Select","Select",""],["","62332014231","CELECOXIB","CAP 200MG","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","10","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","20","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","20","Select","Select",""],["","49281042050","FLUZONE","INJ 2020-21","0","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","16","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00143992701","CIPROFLOXACN","TAB 250MG","14","Select","Select",""],["","50742061510","METOPROL","TAB 25MG ER","90","Select","Select",""],["","51267089099","CONTRAVE","TAB 8-90MG","70","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","00173068220","VENTOLIN HFA AER","","18","Select","Select",""],["","00169430713","RYBELSUS TAB","7MG","30","Select","Select",""],["","70700015010","OMEPRAZOLE CAP","20MG","90","Select","Select",""],["","70700015010","OMEPRAZOLE","20 MG","90","Select","Select",""],["","00046110281","PREMARIN","0.625 MG","30","Select","Select",""],["","72205001390","PREGABALIN CAP","75MG","60","Select","Select",""],["","62332014131","CELECOXIB CAP","100MG","30","Select","Select",""],["","24208050707","LOTEMAX SM GEL","0.38%","5","Select","Select",""],["","00023916360","RESTASIS EMU","0.05% OP","60","Select","Select",""],["","60505620202","CYCLOSPORINE EMU","0.05% OP","180","Select","Select",""],["","47335050696","CEQUA SOL","0.09%","180","Select","Select",""],["","65162003310","APAP\/CODEINE TAB","300-30MG","42","Select","Select",""],["","72618300002","NURTEC ODT","75 MG","16","Select","Select",""],["","75834015901","VERAPAMIL TAB","240MG ER","90","Select","Select",""],["","00713063437","MOMETASONE FUROATE","0.1 %","45","Select","Select",""],["","27241009803","DULOXETINE HCL","30 MG","30","Select","Select",""],["","50228017910","GABAPENTIN","100 MG","60","Select","Select",""],["","42806054701","VITAMIN D","2 1250 MCG","12","Select","Select",""],["","75834015901","VERAPAMIL ER","240 MG","90","Select","Select",""],["","00228282011","HYDROCHLOROTHIAZIDE","12.5 MG","30","Select","Select",""],["","59746012206","MECLIZINE HCL","12.5 MG","30","Select","Select",""],["","16714020130","ONDANSETRON ODT","8 MG","30","Select","Select",""],["","00173088210","BREO ELLIPTA","200-25 MCG","180","Select","Select",""],["","65162083366","DICLOFENAC SODIUM","1 %","100","Select","Select",""],["","66993013697","FLUTICASONE-VILANTEROL","200-25 MCG","180","Select","Select",""],["","65162019011","NAPROXEN","500 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":""}]}]}