{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   SAMOHTREIPAN M","gend":0,"add":"TAERTER 8074983 TPA NL ","city":"FREDERICKSBURG","state":"VA","zip":"22408-9998","dob":"1993-12-16","age":"","mstatus":"","insh":"1151210*51","cliId":"","pno":"05\/7576113-0","cno":"757\/500-3116","email":"","ename":"","eno":"","pphy":"WILSON, KEVIN D MD","ppno":"757\/738-1225","pcpadd":"3537 AIRLINE BLVD STE 1","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23701,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","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":["R10.9","L73.9","L70.0","B20.","Z23.","B35.3","Z00.00","R64.","R10.30","R10.84","N28.89","E86.0","F43.0","K63.89","N52.9","R79.89","N48.9","F41.1","F69.","Z04.6","L50.9","R10.31","R93.3","J45.20","F17.200","F12.10","NO DATA","R30.0","K62.5","L81.0","C64.1","Z79.899","Z91.013","Z88.8","S05.01XA","X58.XXXA","Y92.89","Y93.89","Z03.818","Z20.822","Z13.30","F17.210","Z21.","Z83.3","Z82.49","R69.","K35.80","R10.32","E87.6","R11.0","E55.9","Z53.20","Z02.0","R03.0","N48.29","I44.0","R06.02","L02.01","Z01.818","H93.90"],"date":["2020-07-29","2022-07-28","2022-09-23","2022-08-09","2020-09-30","2020-05-20","2020-05-20","2020-05-20","2020-07-23","2020-07-23","2022-06-14","2022-01-24","2022-01-24","2020-07-25","2020-12-01","2020-12-01","2021-07-08","2022-03-01","2022-07-03","2022-07-03","2020-05-26","2020-10-24","2020-07-24","2020-07-24","2022-06-14","2020-07-24","2020-10-25","2022-01-24","2020-10-16","2022-04-27","2022-09-07","2022-06-14","2022-06-14","2022-06-14","2022-10-01","2022-10-01","2022-10-01","2022-10-01","2021-07-07","2021-07-07","2022-07-03","2022-07-03","2022-07-03","2022-07-03","2022-07-03","2020-07-13","2020-10-24","2020-10-24","2020-10-24","2020-10-24","2022-08-09","2022-08-09","2022-08-09","2022-08-09","2020-02-19","2020-10-24","2020-10-24","2021-11-08","2022-08-31","2022-09-23"],"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":[["","62135098550","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","61958190101","GENVOYA","TAB ","30","Select","Select",""],["","67405082505","BENZOYL","LIQ 5% WASH","148","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","45802056201","CLINDAMYCIN","SOL 0.01","30","Select","Select",""],["","70000004302","ADAPALENE","GEL 0.001","45","Select","Select",""],["","00299492030","DIFFERIN","GEL 0.001","45","Select","Select",""],["","65862018730","ONDANSETRON","TAB 4MG","20","Select","Select",""],["","51991031359","MEGESTROL","SUS 625MG\/5M","150","Select","Select",""],["","65862044930","VALACYCLOVIR","TAB 1GM","14","Select","Select",""],["","40985027415","D3-1000","CAP 1000UNIT","60","Select","Select",""],["","17478076106","DRONABINOL","CAP 2.5MG","60","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","31722094901","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","31604002675","D3","CAP 1000UNIT","60","Select","Select",""],["","24208031510","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","20","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","45802000403","HYDROCORT","CRE 0.025","28","Select","Select",""],["","65862064290","AZITHROMYCIN","TAB 500MG","5","Select","Select",""],["","72140011047","AQUAPHOR","OIN ADVANCED","10","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","10","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","51672129803","KETOCONAZOLE","CRE 0.02","60","Select","Select",""],["","63304061650","DOXYCYC","CAP 100MG","28","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","21","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","42858000101","OXYCODONE","TAB 5MG","15","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":""}]}]}