{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  YELHSADRAZEC N","gend":1,"add":" YDARG 401H TPA SERC","city":"CHESAPEAKE","state":"VA","zip":23324,"dob":"1988-06-25","age":"","mstatus":"","insh":"1796610*53","cliId":"","pno":"37\/7571399-8","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"757\/436-7888","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23324,"pcpcounty":"","pcpid":"","pcpname":"Battlefield Medical Associates","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":["Z30.9","Z30.42","G47.33","NO DATA","E11.9","I10.","E78.5","R76.0","M15.3","R53.83","M79.89","S93.402A","M06.89","M13.0","Z79.899","Z01.419","Z20.2","N94.10","G58.8","M54.5","F43.22","F50.89","E66.01","E04.2","J34.2","J34.3","I26.99","M70.71","M47.816","E11.65","E11.21","Z79.4","R93.5","R80.9","E55.9","N76.0","M77.9","M25.50","J45.909","R52.","Z20.828","R51.","J18.1","M79.602","R00.0","Z86.711","E11.29","E10.65","Z82.69","Z78.9","Z23.","M35.9","H25.13","I26.90","R00.2","E11.8","Z32.02","R93.3","B37.9","N39.0","H40.013","G43.009","M54.12","L21.8","H66.92","H00.011","J01.00","J20.9","J18.9","Z30.09","E66.9","Z01.818","M54.9","U07.1","H00.013","H01.003","J32.9","N89.8","Z68.43","E78.00","Z79.84","Z79.51","Z90.49","R06.02","R51.9","E11.3292","H43.811","Z68.44","M19.90","Z79.01","B34.9","Z87.01","Z09.","E11.39","G47.30","Z83.3","Z82.49","R11.2","Z99.89","I87.1","K21.9","Q04.8","M47.22","Z00.00","N30.00","Z87.891","Z82.5","Z82.62","E87.6","G56.21","Z01.812","R09.81","G43.909"],"date":["2022-10-10","2022-10-10","2022-08-01","2019-05-21","2022-01-19","2022-07-15","2019-03-08","2019-08-20","2019-10-16","2019-10-07","2019-10-07","2020-01-22","2022-08-23","2020-04-17","2022-08-23","2021-01-12","2020-10-15","2020-10-15","2021-02-19","2021-08-03","2021-05-26","2021-05-26","2022-03-21","2022-03-21","2021-12-16","2021-12-16","2022-06-21","2022-08-23","2022-08-23","2020-09-15","2020-09-15","2022-06-09","2019-07-30","2019-02-18","2019-02-18","2019-09-10","2019-08-01","2019-08-01","2022-01-19","2020-06-29","2020-07-10","2020-06-29","2020-07-10","2020-08-11","2022-01-20","2022-01-19","2022-10-21","2019-05-21","2019-05-21","2019-05-21","2019-09-27","2021-11-11","2020-05-27","2020-07-09","2020-11-04","2022-06-09","2022-07-21","2019-07-30","2019-09-10","2019-09-10","2021-11-11","2022-10-26","2022-10-26","2021-09-03","2019-10-24","2019-12-11","2020-10-29","2020-01-26","2020-07-06","2021-01-12","2022-08-01","2022-01-12","2021-09-22","2021-12-28","2019-12-09","2019-12-09","2019-12-09","2022-10-21","2022-01-19","2020-07-06","2022-01-19","2020-07-06","2020-07-06","2022-05-11","2020-10-29","2021-11-11","2021-06-01","2021-06-15","2022-01-19","2022-01-19","2022-05-09","2020-07-23","2020-07-23","2021-11-11","2021-12-16","2022-01-19","2022-01-19","2019-02-27","2019-07-18","2021-11-08","2022-01-19","2022-08-29","2022-08-29","2022-10-21","2022-10-21","2022-01-19","2022-01-19","2022-01-19","2022-07-15","2022-10-26","2022-01-12","2022-05-11","2022-07-15"],"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":[["","10702001801","OXYCODONE","TAB 5MG","15","Select","Select",""],["","31604002718","B-12","TAB 2500MCG","30","Select","Select",""],["","69842087651","CVS","TAB 325MG","20","Select","Select",""],["","10135013201","THIAMINE","TAB 100MG","30","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","10006073043","VITAMIN","TAB 1000MCG","30","Select","Select",""],["","","LISINOPRIL"," LISINOPRIL ","30","Select","Select",""],["","","PIOGLITAZONE"," PIOGLITAZONE ","30","Select","Select",""],["","68180016011","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","","SEBEX","SHA ","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","00245531911","KLOR-CON","TAB 20MEQ ER","90","Select","Select",""],["","60432046400","LIDOCAINE","SOL 2% VISC","300","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","21","Select","Select",""],["","","TOPIRAMATE","TAB 25MG","","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","10","Select","Select",""],["","76385012450","METHOCARBAM","TAB 750MG","20","Select","Select",""],["","","FEXOFENADINE","TAB 180MG","","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","120","Select","Select",""],["","","FLUOCIN","OIL 0.01% SC","","Select","Select",""],["","49483034150","ACETAMINOPHN","TAB 500MG","50","Select","Select",""],["","60505384801","CELECOXIB","CAP 100MG","10","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","Select","Select",""],["","","SULFASALAZIN","TAB 500MG","","Select","Select",""],["","68682045570","METRONIDAZOL","GEL 0.75%VAG","70","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00002771559","BASAGLAR","INJ 100UNIT","30","Select","Select",""],["","00093321915","KETOCONAZOLE","CRE 0.02","15","Select","Select",""],["","68791010204","DERMA-SMOOTH","OIL \/FS SCLP","118","Select","Select",""],["","70710175806","ENOXAPARIN","INJ 40\/0.4ML","22","Select","Select",""],["","49483034010","ACETAMIN","TAB 325MG","20","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","30","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","","XARELTO","TAB 20MG","","Select","Select",""],["","00002143480","TRULICITY","INJ 1.5\/0.5","2","Select","Select",""],["","43598072101","HYDROXYCHLOR","TAB 200MG","60","Select","Select",""],["","","DOXYCYCL","TAB 100MG","","Select","Select",""],["","","BROM\/PSE\/DM","SYP ","","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","","DEXAMETHASON","TAB 4MG","","Select","Select",""],["","","CEFPROZIL","TAB 250MG","","Select","Select",""],["","","BUT\/APAP\/CAF","CAP ","","Select","Select",""],["","","AFRIN","SPR 0.0005","","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":""}]}]}