{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"W C ARABRABREGREBSSIE","gend":1,"add":"NGAM 519EVA AILO","city":"NORFOLK","state":"VA","zip":"23508-9998","dob":"1958-06-25","age":"","mstatus":"","insh":"5692110*32","cliId":"","pno":"2475791203","cno":"","email":"","ename":"","eno":"","pphy":"SHEPHEARD, STUART L MD","ppno":7573374018,"pcpadd":"400 W BRAMBLETON AVE SUITE 202","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":"23510-9998","pcpcounty":"","pcpid":"","pcpname":"CHRISTOPHER DOWD","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":["R20.2","I10.","M54.12","G60.9","M35.9","M15.0","Z78.9","E03.8","E55.9","Z92.3","I73.00","R39.0","M62.81","R82.90","Z80.0","Z12.31","R22.41","M62.561","M48.02","M47.812","Z23.","N39.0","R09.1","R00.0","Z79.899","R19.7","Z79.1","M77.01","M77.02","M77.11","M77.12","M06.89","H04.123","M32.8","Z96.1","R79.89","K63.89","M47.22","M25.78","R53.1","E78.5","R20.0","G56.01","M18.11"],"date":["2023-04-12","2023-03-16","2023-03-16","2023-03-16","2022-12-07","2022-12-07","2022-12-07","2021-06-09","2022-12-07","2021-01-06","2022-06-10","2021-01-15","2021-02-04","2021-06-09","2022-03-31","2022-10-28","2022-12-27","2022-12-27","2021-02-16","2021-02-16","2021-08-25","2022-06-10","2022-06-10","2022-06-10","2023-04-05","2022-06-10","2022-12-07","2021-12-08","2021-12-08","2021-12-08","2021-12-08","2023-04-05","2023-04-05","2023-04-05","2022-10-12","2022-02-02","2022-03-31","2021-02-16","2021-02-16","2021-02-16","2022-02-02","2023-04-12","2023-04-12","2023-04-12"],"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":[["","70377000415","SIMVASTATIN","TAB 40MG","90","Select","Select",""],["","43598072101","HYDROXYCHLOR","TAB 200MG","180","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","60","Select","Select",""],["","16571020106","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","00378180310","LEVOTHYROXIN","TAB 50MCG","180","Select","Select",""],["","00093342210","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","52565002759","ERYTHROMYCIN","SOL 0.02","60","Select","Select",""],["","59762500801","MISOPROSTOL","200 MCG","180","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","69097012403","TOPIRAMATE","100 MG","180","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","45","Select","Select",""],["","00054350049","LIDOCAINE","SOL 2% VISC","200","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","10","Select","Select",""],["","77333098310","ZINC","CAP 220MG","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","8","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","28","Select","Select",""],["","58160089652","FLUARIX","INJ 2019-20","0","Select","Select",""],["","68180071909","AMLODIPINE","TAB 2.5MG","90","Select","Select",""],["","59762002901","DICLO\/MISOPR","TAB 75-0.2MG","180","Select","Select",""],["","50484001030","SANTYL","OIN 250\/GM","30","Select","Select",""],["","00025142160","ARTHROTEC","TAB ","180","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","69238152301","TETRACYCLINE","CAP 500MG","14","Select","Select",""],["","70377000612","ROSUVASTATIN","TAB 5MG","90","Select","Select",""],["","00093342210","CYCLOBENZAPR TAB","10MG","60","Select","Select",""],["","59762500801","MISOPROSTOL TAB","200MCG","180","Select","Select",""],["","00023916360","RESTASIS EMU","0.05% OP","180","Select","Select",""],["","43598072101","HYDROXYCHLOROQUINE SULFATE","200 MG","180","Select","Select",""],["","00378180310","LEVOTHYROXIN TAB","50MCG","180","Select","Select",""],["","00093226301","AMOXICILLIN TAB","500MG","28","Select","Select",""],["","16571020106","DICLOFENAC TAB","75MG DR","180","Select","Select",""],["","43598072101","HYDROXYCHLOR TAB","200MG","180","Select","Select",""],["","10702080806","CYCLOSPORINE EMU","0.05% OP","180","Select","Select",""],["","70377000612","ROSUVASTATIN TAB","5MG","27","Select","Select",""],["","69097012403","TOPIRAMATE TAB","100MG","180","Select","Select",""],["","68180071909","AMLODIPINE TAB","2.5MG","90","Select","Select",""],["","80777027399","MODERNA VAC INJ COVID-","19","0","Select","Select",""],["","59746000103","METHYLPRED TAB","4MG","21","Select","Select",""],["","65862050320","AMOX\/K CLAV TAB","875-125","14","Select","Select",""],["","59267030402","PFIZER BIVAL INJ BA","4\/BA5","0","Select","Select",""],["","00093342210","CYCLOBENZAPRINE HCL","10 MG","60","Select","Select",""],["","00378180310","LEVOTHYROXINE SODIUM","50 MCG","180","Select","Select",""],["","70377000612","ROSUVASTATIN CALCIUM","5 MG","90","Select","Select",""],["","16571020106","DICLOFENAC SODIUM","75 MG","180","Select","Select",""],["","68180071909","AMLODIPINE BESYLATE","2.5 MG","90","Select","Select",""],["","00023916360","RESTASIS","0.05 %","180","Select","Select",""],["","65862050320","AMOXICILLIN-CLAVULANATE POTASS","875-125 MG","14","Select","Select",""],["","59746000103","METHYLPREDNISOLONE","4 MG","21","Select","Select",""],["","80777028299","MODERNA COVID BIVAL(","6MO UP)EUA 50 MCG\/0.5","0.5","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":""}]}]}