{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   NWAHSALYENTIHW D","gend":1,"add":"P SLLEWES 54034B TPA DR TNIO","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1973-07-04","age":"","mstatus":"","insh":"0126210*01","cliId":"","pno":"04\/7575585-3","cno":"757\/403-5855","email":"","ename":"","eno":"","pphy":"SCHUELE, WERNER K MD","ppno":"757\/547-0688","pcpadd":"HMPT RDS-CONTRACT REP 5000 COX RD S","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","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":["L21.9","L91.8","L85.3","Z71.9","Z28.21","L73.9","M54.16","I10.","M79.604","L30.0","L20.9","K62.5","N76.0","Z83.71","K21.9","Z20.828","F41.1","J01.00","B34.9","U07.1","R06.02","R07.9","Z98.84","R05.9","NO DATA","E55.9","M54.5","R19.7","M54.31","J45.20","L24.4","J45.40","G57.01","Z21.","L29.9","M23.8X1","M25.561","Z20.822"],"date":["2022-10-07","2020-08-31","2022-10-07","2022-10-07","2020-08-31","2020-12-18","2022-05-26","2022-01-06","2020-12-24","2022-10-07","2021-01-21","2021-02-23","2022-07-21","2021-02-10","2021-02-10","2021-12-20","2021-12-20","2022-06-27","2021-12-20","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-01-06","2022-05-02","2020-08-07","2020-08-07","2022-06-27","2021-05-07","2021-05-07","2021-05-07","2021-07-27","2021-07-27","2020-12-18","2020-12-18","2022-03-04","2022-03-31","2022-06-20"],"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":[["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","51224001060","BENZONATATE","CAP 100MG","15","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","15","Select","Select",""],["","68382079101","ACYCLOVIR","TAB 400MG","15","Select","Select",""],["","00591042405","TRIAMT\/HCTZ","TAB 37.5-25","90","Select","Select",""],["","68462040601","INDOMETHACIN","CAP 25MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","31722053301","METHOCARBAM","TAB 500MG","40","Select","Select",""],["","51672128402","TRIAMCINOLON","OIN 0.001","30","Select","Select",""],["","00168004160","BETAMETH","LOT 0.001","60","Select","Select",""],["","69097067905","PREGABALIN","CAP 75MG","28","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","68462011940","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","16571066450","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00228202996","ALPRAZOLAM","TAB 0.5MG","10","Select","Select",""],["","62559043130","HYDROCORTISO","CRE 0.025","30","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","20","Select","Select",""],["","70700026390","LANSOPRAZOLE","CAP 30MG DR","90","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","51672131201","MUPIROCIN","OIN 0.02","30","Select","Select",""],["","08373982700","OPTICHAMBER","MIS DIA LG","1","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","30","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00363010412","PAIN","TAB 325MG","30","Select","Select",""],["","63824000832","MUCINEX","TAB 600MG ER","28","Select","Select",""],["","23155050105","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","75834002012","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00591544210","PREDNISONE","TAB 10MG","26","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":""}]}]}