{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AHSINNEKSEKOTS ","gend":1,"add":"IOP ROBRAH 563401 TPA TC ETN","city":"NORFOLK","state":"VA","zip":23523,"dob":"1987-06-17","age":"","mstatus":"","insh":"0751310*57","cliId":"","pno":"32\/7577658-9","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"757\/312-6797","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23523,"pcpcounty":"","pcpid":"","pcpname":"CHESAPEAKE REGIONAL MEDICAL GROUP","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":["Z33.3","V91.03","V23.3","O10.919","O41.1220","O60.12X1","Z37.2","O60.12X2","O75.3","O10.92","O32.1XX2","O99.820","B96.89","Z16.39","Z88.1","Z3A.23","Z88.0","Z91.048","Z90.5","O60.02","O63.2","Z37.0","Z39.2","Z20.828","Z01.810","Z20.822","R78.81","A41.9","R07.89","Z01.84","Z11.7","I10.","E66.9","Z68.35","Z48.02","Z34.91","O21.9","Z36.9","Z11.4","Z11.3","Z36.87","T14.90XA","O46.92","O10.012","A49.1","D72.829","O41.1290","Z01.419","Z12.4","Z30.41","N76.0","O26.891","O30.001","R10.9","Z3A.01","V23.89","Z3A.22","Z32.01","Z00.00","B37.3","Z13.21","Z68.36","P07.02","P07.22","P22.0","P28.4","R51.","Z01.818","Z41.1","R94.31","E78.1","J03.90","R10.2","R01.1","J02.0","G44.209","M62.838","I77.810","I42.0","I25.10","Z13.220","R05.9","N89.8","M54.2","I49.9","E78.5","U07.1","R82.90","R03.0","I42.9","Z68.31"],"date":["2019-07-03","2019-09-18","2019-07-03","2019-07-03","2019-09-16","2019-09-20","2019-09-16","2019-09-21","2019-09-16","2019-09-16","2019-09-16","2019-09-16","2019-09-16","2019-09-16","2022-07-14","2019-09-21","2022-07-14","2022-07-14","2019-09-16","2019-09-16","2019-09-21","2019-09-21","2019-10-30","2022-10-05","2022-02-24","2022-03-17","2019-10-08","2019-10-01","2019-09-30","2019-10-31","2019-11-02","2022-10-26","2022-10-05","2020-06-16","2020-08-20","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-05-28","2019-06-02","2019-09-16","2019-09-20","2019-09-24","2019-09-24","2019-09-24","2020-06-22","2020-06-22","2020-06-22","2022-10-17","2019-06-16","2019-05-15","2019-05-15","2019-06-02","2019-09-10","2019-09-10","2019-05-21","2019-03-12","2019-03-12","2019-03-12","2019-03-12","2019-10-02","2019-10-02","2019-10-02","2019-10-02","2020-06-02","2020-08-04","2020-08-04","2022-08-02","2020-08-04","2020-12-06","2019-06-02","2019-10-16","2020-03-22","2022-07-14","2022-07-14","2022-10-26","2022-11-03","2022-10-26","2022-09-27","2022-01-01","2022-05-03","2022-07-14","2022-10-13","2022-10-26","2022-01-07","2022-01-18","2022-01-01","2022-10-17","2022-10-05"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","53746051101","SPIRONOLACT","TAB 25MG","90","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","30","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","51672404801","CLOTRIM\/BETA","CRE DIPROP","15","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","","METRONIDAZOL"," METRONIDAZOL ","14","Select","Select",""],["","00121077504","GG\/CODEINE","SOL 100-10\/5","118","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","21","Select","Select",""],["","59779073041","CVS","CRE 7","45","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-300MG","","Select","Select",""],["","70645002512","CAPSAICIN","CRE 0.00025","120","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","5","Select","Select",""],["","00078065920","ENTRESTO","TAB 24-26MG","180","Select","Select",""],["","59779027408","ASPIRIN","CHW 81MG","30","Select","Select",""],["","50742061610","METOPROL","TAB 50MG ER","90","Select","Select",""],["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","","JUNEL","TAB 43831","","Select","Select",""],["","53746020301","OXYCOD\/APAP","TAB 5-325MG","18","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","00245531911","KLOR-CON","TAB 20MEQ ER","30","Select","Select",""],["","","DOXYCYCL","CAP 100MG","","Select","Select",""],["","","DOXYCYC","TAB 100MG","","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","10","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","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":""}]}]}