{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" SEMAJLLEWOH","gend":0,"add":"AB TS12 9159A2 TPA TS Y","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1964-03-22","age":"","mstatus":"","insh":"09400210*75","cliId":"","pno":"37\/7575955-7","cno":"","email":"","ename":"","eno":"","pphy":"FORTUNE, JENNIFER BROOKE PA","ppno":"757\/425-8590","pcpadd":"1253 NIMMO PKWY STE 110","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23456,"pcpcounty":"","pcpid":"","pcpname":"EAST BEACH MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","G47.00","F41.9","NO DATA","G62.9","R23.8","D22.9","L81.4","L82.1","F41.1","F33.1","F51.05","F32.1","E63.9","Z79.899","M19.022","G56.22","M25.622","Z68.25","F32.9","Z86.010","K57.30","J30.9","G56.02","V89.2XXA","Z68.24","M25.562","Z71.6","J42.","R06.83","Z01.89","J06.9","E55.9","Z12.11","Z12.5","Z20.2","Z23.","Z51.81","M25.522","R05.","Z72.0","E78.00","I10.","E66.9","G89.4","M54.5","M54.2","C44.42","Z71.9","M50.90","K66.0","M48.02","F41.0","D48.5","L91.8","I78.1","Z12.83","Z86.008","S39.012A","S16.1XXA","M70.32","F32.0","R36.9","R73.9","Z13.220","J01.90","M65.4","M54.12","M54.16","F19.90","L82.0","T14.8XXA","L81.8","C44.92","F17.210","N52.9","B37.2","Z13.6","Z11.59","Z68.22","Z68.23"],"date":["2021-12-20","2021-06-14","2021-11-30","2021-11-30","2021-10-29","2021-01-20","2021-01-20","2021-01-20","2021-01-20","2020-12-02","2020-12-02","2020-05-18","2020-12-02","2020-07-23","2021-02-12","2020-08-24","2020-05-11","2020-08-24","2020-05-11","2020-12-02","2021-01-22","2021-01-22","2021-10-29","2020-02-03","2020-02-03","2020-03-26","2020-03-26","2020-05-11","2021-11-30","2020-05-11","2020-05-11","2021-06-01","2021-10-29","2020-09-17","2021-10-29","2020-09-17","2020-09-17","2020-12-02","2021-05-11","2021-06-15","2021-06-15","2021-10-29","2019-02-06","2019-01-09","2019-01-09","2019-10-25","2019-10-25","2019-12-19","2019-08-21","2019-03-15","2019-03-15","2019-03-15","2019-06-18","2019-07-23","2019-07-23","2019-07-23","2019-07-23","2019-07-23","2019-11-25","2019-11-25","2019-11-25","2019-02-07","2019-11-06","2019-11-06","2019-11-06","2019-11-06","2019-02-04","2019-02-04","2019-02-04","2019-02-06","2019-08-13","2019-08-13","2019-08-13","2019-08-13","2019-10-25","2019-02-28","2019-02-28","2019-02-28","2019-02-28","2019-04-16","2019-06-11"],"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":[["","16729017301","AMITRIPTYLIN","TAB 50MG","30","Select","Select",""],["","47335030888","ZOLPIDEM","TAB 12.5MG","30","Select","Select",""],["","43547040711","CLONAZEPAM","TAB 1MG","30","Select","Select",""],["","59762372004","ALPRAZOLAM","TAB 0.5MG","30","Select","Select",""],["","52268001201","SUPREP","SOL PREP KIT","354","Select","Select",""],["","27241009990","DULOXETINE","CAP 60MG","60","Select","Select",""],["","00069046956","CHANTIX","TAB 1MG","56","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","71093011205","GABAPENTIN","TAB 800MG","90","Select","Select",""],["","43547040011","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","65862064163","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","60505476606","APO-VARENICL","TAB 1MG","56","Select","Select",""],["","16729011917","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","19515081852","FLULAVAL","INJ 2021-22","0","Select","Select",""],["","00310461612","BREZTRI","AER SPHERE","11","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","0","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","31722071101","SILDENAFIL","TAB 100MG","30","Select","Select",""],["","74312019491","MELATONIN","CAP 10MG","90","Select","Select",""],["","","TRIAMCINOLON","OIN 0.001","","Select","Select",""],["","","PREDNISONE","TAB 10MG","","Select","Select",""],["","51672411806","FLUOROURACIL","CRE 0.05","40","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","10702005701","OXYCODONE","TAB 20MG","60","Select","Select",""],["","00406902576","FENTANYL","DIS 25MCG\/HR","10","Select","Select",""],["","45802005935","NYSTATIN","CRE 100000","15","Select","Select",""],["","27505005096","LUCEMYRA","TAB 0.18MG","60","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","70461041910","FLUCLVX","INJ 2019-20","0","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":""}]}]}