{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NIMAJNEBZELAZNOG","gend":0,"add":"IRBSGNIK HTRON 1B TPA ECALP EGD","city":"CHESAPEAKE","state":"VA","zip":"23322-9998","dob":"1965-12-20","age":"","mstatus":"","insh":"6242810*32","cliId":"","pno":"5675706470","cno":"","email":"","ename":"","eno":"","pphy":"LEUZZI, REBECCA A NP","ppno":7573522020,"pcpadd":"1168 FIRST COLONIAL RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":"23454-9998","pcpcounty":"","pcpid":"","pcpname":"Endocrinology Consultants Chesapeake","plan":"OHP","program":"ACA","lob":"Small Group","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":["T87.81","L03.116","M86.9","E11.51","E11.40","I70.212","I10.","E11.69","B95.61","I70.201","G89.29","F17.210","Z20.822","Z79.84","Z79.899","Z89.422","M86.172","R60.9","M79.672","M79.89","Z98.890","B99.9","I70.245","I73.9","E11.65","E11.621","R09.89","E11.628","T81.42XA","L97.524","H35.30","Z91.19","H40.9","L97.528","E11.9","S91.302A","E78.2","Z12.11","U07.1","L97.509","M77.32","T81.31XA","T81.49XA","S98.132A","R41.3","H40.1113","H40.1122","Z00.00","Z12.5","L97.529","K21.9","Z86.16","Z87.891","I77.1","H25.813","H40.1121","H40.1112","H04.123","H11.153","S91.105A","Z01.818","R22.0","T81.30XA","R60.0","I87.2","B35.1","S91.309A","S81.809A","L97.919","R52.","R22.42","M89.8X7","R39.9","K62.5","S09.90XA","M86.142","M87.9","L03.019","L03.032","M60.9","M79.675"],"date":["2022-03-13","2022-03-31","2023-06-15","2023-06-15","2022-05-18","2022-03-13","2023-06-15","2023-06-15","2022-03-25","2022-03-13","2022-03-13","2023-06-15","2022-03-13","2023-06-15","2023-06-15","2023-06-15","2022-03-18","2022-03-15","2022-03-15","2022-03-15","2022-03-27","2022-03-15","2022-05-23","2023-06-15","2023-01-01","2023-06-15","2022-09-07","2022-03-25","2022-03-25","2023-06-15","2022-03-25","2022-03-25","2022-09-07","2022-05-10","2023-06-15","2022-04-19","2022-05-23","2021-08-30","2022-02-02","2022-05-09","2022-02-14","2022-03-26","2022-03-31","2023-06-15","2022-03-31","2022-09-09","2022-09-09","2022-09-07","2022-09-07","2023-06-14","2022-02-14","2022-02-14","2022-05-10","2022-04-19","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2021-12-06","2021-12-28","2022-01-31","2022-03-15","2022-03-18","2022-05-10","2022-03-23","2022-03-23","2023-06-02","2022-05-25","2022-03-24","2022-09-07","2021-12-28","2022-03-27","2023-06-02","2023-06-02","2023-06-02","2023-06-14","2023-06-14","2023-06-14","2023-06-15","2023-06-15","2023-06-15"],"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":[["","43547035411","LISINOPRIL","20 MG","90","Select","Select",""],["","00069046903","CHANTIX","PAK 1MG","56","Select","Select",""],["","68180052002","LISINOP\/HCTZ","TAB 20-25MG","90","Select","Select",""],["","00310620530","FARXIGA","TAB 5MG","60","Select","Select",""],["","00065414727","SIMBRINZA","SUS 1-0.2%","24","Select","Select",""],["","51224000760","METFORMIN","TAB 500MG ER","180","Select","Select",""],["","50458014090","INVOKANA","TAB 100MG","90","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","00378875006","DICLOFENAC","GEL 0.01","300","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","10","Select","Select",""],["","00006057761","JANUMET","50-1000 MG","60","Select","Select",""],["","61314014405","BRIMONIDINE","SOL 0.0015","5","Select","Select",""],["","24208046325","LATANOPROST","0.005 %","2.5","Select","Select",""],["","08627005303","DEXCOM","MIS SENSOR","3","Select","Select",""],["","00023917705","ALPHAGAN","SOL 0.0015","5","Select","Select",""],["","71093012105","GABAPENTIN","300 MG","270","Select","Select",""],["","57237000511","FLUCONAZOLE TAB","150MG","5","Select","Select",""],["","00093314705","CEPHALEXIN CAP","500MG","20","Select","Select",""],["","60505056401","BRIMONIDINE SOL","0.15%","15","Select","Select",""],["","00006057761","JANUMET TAB","50-1000","60","Select","Select",""],["","16714047802","AMOX\/K CLAV TAB","875-125","14","Select","Select",""],["","00406012305","HYDROCO\/APAP TAB","5-325MG","10","Select","Select",""],["","00006027754","JANUVIA TAB","100MG","30","Select","Select",""],["","53885004601","ONETOUCH KIT ULTRA","2","1","Select","Select",""],["","68180052002","LISINOP\/HCTZ TAB","20-25MG","90","Select","Select",""],["","53885024450","ONETOUCH TES ULTRA","","50","Select","Select",""],["","68645055354","LISINOPRIL TAB","20MG","90","Select","Select",""],["","56151195002","TRUE METRIX KIT METER","","1","Select","Select",""],["","65162027250","SMZ\/TMP DS TAB","800-160","20","Select","Select",""],["","70010006310","METFORMIN TAB","500MG","60","Select","Select",""],["","00093505898","ATORVASTATIN TAB","40MG","30","Select","Select",""],["","56151014260","TRUPLUS LANC MIS","28G","300","Select","Select",""],["","31722088390","ROSUVASTATIN TAB","10MG","30","Select","Select",""],["","65162010211","GABAPENTIN CAP","300MG","270","Select","Select",""],["","70069042101","LATANOPROST SOL","0.005%","8","Select","Select",""],["","53885000810","ONETOUCH DEL MIS PLUS","33G","100","Select","Select",""],["","00591352530","LIDOCAINE PAD","5%","10","Select","Select",""],["","56151149102","RELION TRUE KIT MET AIR","","1","Select","Select",""],["","00023917705","ALPHAGAN P SOL","0.15%","5","Select","Select",""],["","69543012350","GLIMEPIRIDE TAB","1MG","180","Select","Select",""],["","56151146004","TRUE METRIX TES GLUCOSE","","300","Select","Select",""],["","00002150680","MOUNJARO INJ","2.5\/0.5","2","Select","Select",""],["","42571014126","DORZOLAMIDE SOL","2% OP","10","Select","Select",""],["","42571014726","DORZOL\/TIMOL SOL","22.3-6.8","10","Select","Select",""],["","42571014726","DORZOLAMIDE-TIMOLOL","22.3-6.8\/1","10","Select","Select",""],["","08627001601","DEXCOM G","6 TRANSMITTER","1","Select","Select",""],["","16729000101","GLIMEPIRIDE","1 MG","180","Select","Select",""],["","60505258009","ATORVASTATIN CALCIUM","40 MG","90","Select","Select",""],["","16252051501","CIPROFLOXACIN HCL","500 MG","14","Select","Select",""],["","00093314701","CEPHALEXIN","500 MG","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":["",""],"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":""}]}]}