{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   NYLORACSNIKNEJ S","gend":1,"add":"CNIW 0023RD RETSEH","city":"PORTSMOUTH","state":"VA","zip":"23707-9998","dob":"1958-03-31","age":"","mstatus":"","insh":"8666510*12","cliId":"","pno":"9375742779","cno":7574850674,"email":"","ename":"","eno":"","pphy":"DUMARAN, RAYMOND MD","ppno":7574845828,"pcpadd":"7185 HARBOUR TOWNE PKWY SUITE 206","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":"23435-9998","pcpcounty":"","pcpid":"","pcpname":"Internists Of Churchland","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":["E11.65","E04.1","G47.33","M54.2","M54.59","M54.6","E11.9","Z79.4","M54.50","M51.36","M50.30","Z79.899","M54.16","U07.1","Z88.6","Z88.8","Z88.3","M79.10","J45.50","M50.322","M75.22","M79.602","I10.","G89.29","Z12.31","Z20.822","H93.19","H91.90","Z12.11","J45.51","K63.5","E78.5","K21.9","F33.0","R53.83","Z20.828","R05.","R06.02","R09.81","J06.9","M54.12","Z68.36","M47.816","M62.838","M51.04","M54.14","G89.4","R51.9","R11.2","J40.","Z09.","M79.605","R60.9","M79.622","M51.37","M47.896","M47.897","M51.24","M51.34","H69.82","I73.9","Z99.89","Z68.37","E66.01","M47.812","M50.323","F40.240","H90.3","L20.9","M26.622","E11.3293","E11.3292","M50.31","M47.814","M54.5","C54.1","F66.","N95.2","E11.40","S99.922A","I83.93","Z68.35","M46.96","R22.1"],"date":["2023-01-18","2022-05-21","2022-04-29","2022-01-12","2021-11-04","2022-03-26","2022-04-29","2023-01-18","2022-05-06","2023-03-03","2022-09-14","2023-03-03","2023-03-03","2022-07-29","2022-07-24","2022-07-24","2022-07-24","2022-07-24","2022-10-10","2023-03-03","2023-03-03","2023-02-15","2022-04-29","2022-03-07","2021-10-23","2021-10-26","2021-10-29","2021-10-29","2022-04-29","2022-07-29","2022-04-29","2022-04-29","2022-04-29","2021-10-29","2022-04-29","2021-01-06","2021-01-06","2021-01-06","2021-01-06","2022-01-14","2021-08-02","2022-03-07","2022-04-04","2022-04-04","2022-04-04","2022-04-04","2022-04-04","2022-07-24","2022-07-24","2022-12-07","2021-05-14","2021-06-21","2021-07-19","2021-07-19","2021-09-27","2021-09-27","2021-09-27","2022-03-26","2022-03-26","2023-02-27","2021-12-16","2022-04-29","2022-04-29","2022-03-07","2021-11-17","2021-11-17","2021-11-17","2022-01-31","2022-01-31","2022-01-31","2022-10-25","2021-03-29","2021-09-27","2021-09-27","2021-09-30","2022-03-03","2022-03-03","2022-03-03","2021-04-23","2022-11-28","2021-06-23","2021-06-23","2021-12-01","2022-05-21"],"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":[["","00591544305","PREDNISONE","TAB 20MG","10","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","200","Select","Select",""],["","00002143480","TRULICITY","INJ 1.5\/0.5","2","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","31","Select","Select",""],["","68180071160","CEFDINIR","CAP 300MG","14","Select","Select",""],["","50458014130","INVOKANA","TAB 300MG","30","Select","Select",""],["","00002771227","HUMALOG","INJ 200\/ML","24","Select","Select",""],["","65862047705","RAMIPRIL","CAP 10MG","180","Select","Select",""],["","60505257908","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","50111064801","FLUOXETINE","CAP 20MG","90","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","49502010202","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","26","Select","Select",""],["","08560940001","V-GO","KIT ","30","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","58160082311","SHINGRIX","INJ 50MCG","1","Select","Select",""],["","57237015630","MOXIFLOXACIN","TAB 400MG","7","Select","Select",""],["","51672130301","ECONAZOLE","CRE 0.01","15","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","60","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","31","Select","Select",""],["","69097052444","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","68682010810","NIFEDIPINE","TAB 30MG ER","90","Select","Select",""],["","00173089201","NUCALA","INJ 100MG\/ML","1","Select","Select",""],["","00024587102","TOUJEO","INJ 300IU\/ML","18","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","60","Select","Select",""],["","00173068220","VENTOLIN","AER ","54","Select","Select",""],["","08627005303","DEXCOM","MIS SENSOR","9","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00597015330","JARDIANCE","TAB 25MG","90","Select","Select",""],["","68462010805","TOPIRAMATE","TAB 25MG","60","Select","Select",""],["","27241009803","DULOXETINE","CAP 30MG","30","Select","Select",""],["","00781207410","TRIAMT\/HCTZ","CAP 37.5-25","90","Select","Select",""],["","00173088710","TRELEGY","AER ELLIPTA","60","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","2","Select","Select",""],["","62756022483","TIAGABINE","TAB 4MG","30","Select","Select",""],["","88888888887","DMR","T ","1","Select","Select",""],["","23155013525","DOXYCYC","TAB 100MG","20","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":""}]}]}