{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YLREBMIKRENRAW ","gend":1,"add":"BMIT 5643RD KCENRE","city":"HAYES","state":"VA","zip":"23072-9998","dob":"1969-04-11","age":"","mstatus":"","insh":"7252220*87","cliId":"","pno":"1840883935","cno":8048153942,"email":"","ename":"","eno":"","pphy":"COOK, NICOLE R PA","ppno":7575955001,"pcpadd":"704 THIMBLE SHOALS BLVD SUITE 600A","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":"23606-9998","pcpcounty":"","pcpid":"","pcpname":"THIMBLE SHOALS FAMILY 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":["Z12.31","R06.00","R63.5","M25.562","M25.552","Z96.652","M53.3","Z12.11","M48.061","M62.89","M99.53","G89.29","T84.023D","T84.84XA","T84.023A","T84.093A","F32.A","F98.8","Z83.3","Z82.49","Z80.9","Z86.73","M17.0","R26.2","R74.8","M54.16","G89.18","Z47.89","Z47.1","F33.1","F43.12","F41.1","F43.10","M54.50","Z68.26","M47.817","R39.9","M54.5","H18.891","B35.1","L60.0","Z01.812","I69.354","G43.909","M19.90","F41.9","F90.9","E66.9","Z79.82","Z90.710","Z90.49","Z91.81","M51.36","M47.816","M43.16","Z86.79","R06.09","N39.41","M62.459","R79.89","M54.9","Z00.00"],"date":["2022-09-20","2021-07-14","2021-11-12","2023-03-06","2022-04-21","2023-01-26","2022-04-21","2022-07-13","2023-01-26","2023-01-26","2023-01-26","2022-09-16","2022-12-10","2022-11-28","2022-12-07","2022-12-07","2022-12-10","2022-12-07","2022-12-07","2022-12-07","2022-12-07","2022-12-07","2022-12-07","2023-03-02","2021-09-02","2022-06-07","2022-12-07","2022-12-07","2022-12-07","2021-09-20","2021-09-20","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-11-30","2022-12-23","2021-08-23","2021-08-09","2021-02-23","2022-03-08","2022-11-30","2022-12-10","2022-12-10","2022-12-10","2022-12-10","2022-12-10","2022-12-10","2022-12-10","2022-12-10","2022-12-10","2022-12-10","2022-09-16","2022-09-16","2022-09-16","2022-09-16","2021-05-05","2021-06-18","2022-07-21","2021-04-27","2022-09-22","2022-09-22"],"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":[["","50419049104","CLIMARA","DIS WEEKLY","4","Select","Select",""],["","68462019001","NAPROXEN","TAB 500MG","40","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","40","Select","Select",""],["","00008112312","DUAVEE","TAB 0.45-20","30","Select","Select",""],["","65862015901","ZOLPIDEM","TAB 5MG","30","Select","Select",""],["","31722095801","BENZONATATE","CAP 200MG","20","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","51267089099","CONTRAVE","TAB 8-90MG","120","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","28","Select","Select",""],["","69543038810","KETOROLAC","TAB 10MG","9","Select","Select",""],["","31722094101","HYDROCO\/APAP","TAB 5-325MG","28","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","20","Select","Select",""],["","64764073030","TRINTELLIX","10 MG","30","Select","Select",""],["","16571020110","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","68462015813","ONDANSETRON","TAB 8MG ODT","9","Select","Select",""],["","70461032003","FLUCLVX","INJ 2020-21","0","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","58160082311","SHINGRIX","INJ 50\/0.5ML","1","Select","Select",""],["","50228018005","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","30","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","50458057830","XARELTO","TAB 15MG","6","Select","Select",""],["","00169280015","SAXENDA","INJ 18MG\/3ML","3","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","0","Select","Select",""],["","65862015901","ZOLPIDEM TAB","5MG","30","Select","Select",""],["","64764073030","TRINTELLIX TAB","10MG","30","Select","Select",""],["","13668000701","ZOLPIDEM TARTRATE","5 MG","30","Select","Select",""],["","00406048501","APAP\/CODEINE TAB","300-60MG","60","Select","Select",""],["","72647033104","METHYLPRED TAB","4MG","21","Select","Select",""],["","69238131009","PREGABALIN CAP","25MG","60","Select","Select",""],["","00172392660","DIAZEPAM TAB","5MG","30","Select","Select",""],["","72888001405","CYCLOBENZAPR TAB","10MG","30","Select","Select",""],["","49281042250","FLUZONE QUAD INJ","2022-23","0","Select","Select",""],["","80777028299","MODERNA BIVA INJ BA","4\/BA5","0","Select","Select",""],["","16714020030","ONDANSETRON ODT","4 MG","42","Select","Select",""],["","16714047701","AMOX\/K CLAV TAB","500-125","14","Select","Select",""],["","65862039010","ONDANSETRON TAB","4MG ODT","42","Select","Select",""],["","00093031401","KETOROLAC TAB","10MG","12","Select","Select",""],["","42858010201","OXYCOD\/APAP TAB","5-325MG","42","Select","Select",""],["","49483048110","ASPIRIN LOW TAB","81MG EC","50","Select","Select",""],["","00406012401","HYDROCO\/APAP TAB","7.5-325","28","Select","Select",""],["","00406012305","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","21","Select","Select",""],["","68382005001","MELOXICAM TAB","7.5MG","30","Select","Select",""],["","68645059459","FAMOTIDINE","20 MG","60","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":""}]}]}