{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" YEROCNILSACUL D  ","gend":0,"add":"SI 7151TS CAA","city":"NORFOLK","state":"VA","zip":"23523-9998","dob":"1973-06-11","age":"","mstatus":"","insh":"2051210*78","cliId":"","pno":"72\/7576806-7","cno":"757\/277-6086","email":"","ename":"","eno":"","pphy":"KENNEY, BRENNA A NP","ppno":"757\/955-2828","pcpadd":"885 KEMPSVILLE RD STE 320","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23502,"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":["L30.9","M79.671","M79.672","R60.0","G47.33","M25.562","M10.9","M25.462","Z20.2","K27.9","M10.069","D64.9","U07.1","J12.89","R06.02","M19.071","M19.072","Q66.51","Q66.52","R07.9","K29.00","R10.9","D50.9","R19.4","E53.8","I10.","R53.1","Z79.899","R51.9","E55.9","M1A.09X0","E78.1","E78.2","R00.1","F41.9","R60.9","Z23.","K57.32","R59.0","J02.9","E04.1","D69.6","M10.062","Z68.26","K57.90","Z86.16","R05.","M54.2","M54.10","R06.83","Z72.821","R52.","R10.84","L03.115","R07.89","Z20.828","S80.11XA","M79.89","Z68.29","A60.02","N52.2","Z11.3","Z13.89","Z12.5","Z13.0","Z82.49","M79.602","B34.9","NO DATA","R53.83","R19.7","Z20.822","R00.2","Z68.28","R14.0","R11.0","Z87.39","Z71.89","Z68.27","M25.461","J06.9","R07.81","Z71.2","M54.6","E78.5","D50.8","R20.2","K57.30","G47.30","M19.90","G47.50","F51.3","G47.00","G90.521","G90.522","K76.0","Z12.11","K25.9","M25.512","M21.41","M21.42","R77.8","E78.00","Z82.0","K57.92","M62.838","Z71.9"],"date":["2022-03-08","2021-03-30","2021-03-30","2022-10-16","2022-08-19","2020-06-16","2021-03-05","2020-06-16","2020-06-22","2020-06-22","2020-06-22","2021-04-09","2020-07-14","2020-07-10","2022-06-05","2021-12-21","2021-12-21","2021-03-30","2021-03-30","2022-09-20","2021-04-14","2021-04-14","2022-06-02","2021-07-01","2022-09-09","2022-09-20","2022-07-27","2022-07-27","2022-07-27","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-08-29","2022-10-17","2021-12-14","2021-02-27","2021-02-27","2021-02-27","2021-02-27","2022-09-09","2021-06-02","2022-09-09","2021-07-01","2022-06-05","2021-08-06","2022-04-06","2022-04-06","2022-08-19","2021-07-14","2020-07-01","2020-04-01","2020-04-01","2022-09-20","2021-03-25","2021-07-19","2021-07-20","2021-11-19","2021-12-14","2021-12-14","2022-08-08","2022-08-08","2022-08-08","2021-12-14","2022-04-06","2022-04-06","2022-06-05","2022-06-05","2022-06-05","2022-06-05","2022-06-05","2022-10-21","2022-10-21","2020-03-31","2020-03-31","2022-10-16","2020-06-16","2022-09-26","2022-10-16","2020-01-28","2022-10-17","2020-10-13","2021-09-09","2022-05-04","2022-09-09","2021-03-05","2021-07-01","2021-07-01","2021-07-01","2020-05-19","2020-05-19","2020-02-19","2020-04-14","2020-04-14","2020-04-30","2021-03-31","2021-03-31","2021-07-09","2021-12-21","2021-12-21","2022-09-20","2020-05-19","2020-05-19","2021-03-31","2021-07-09","2022-03-08"],"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":[["","43547033810","BENAZEPRIL","TAB 40MG","90","Select","Select",""],["","70700010618","CLOBETASOL","OIN 0.0005","45","Select","Select",""],["","65162046450","IBUPROFEN","TAB 400MG","30","Select","Select",""],["","80681005000","DAILY-VITE","TAB ","90","Select","Select",""],["","60505257909","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","67877019905","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","00378306577","FENOFIBRATE","TAB 48MG","30","Select","Select",""],["","55111015901","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00603548321","PROPRANOLOL","TAB 20MG","60","Select","Select",""],["","59746021106","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","11822069301","SLOW","TAB IRON 45","30","Select","Select",""],["","10939095368","SLOW-RELEASE","TAB 45MG","30","Select","Select",""],["","68180035109","SERTRALINE","TAB 25MG","30","Select","Select",""],["","31722064330","TADALAFIL","TAB 2.5MG","14","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","21","Select","Select",""],["","65862037401","ESCITALOPRAM","TAB 10MG","30","Select","Select",""],["","31722059101","METOPROL","TAB 100MG ER","30","Select","Select",""],["","67877021901","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","45802039000","TACROLIMUS","OIN 0.0003","30","Select","Select",""],["","29300022701","METRONIDAZOL","TAB 500MG","20","Select","Select",""],["","51672130104","AMMONIUM","CRE 0.12","140","Select","Select",""],["","68462040601","INDOMETHACIN","CAP 25MG","3","Select","Select",""],["","11822511150","RA","TAB 1000 TR","60","Select","Select",""],["","63824071016","CEPACOL","LOZ 15-3.6MG","16","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","45802086802","POLYETH","POW 3350 NF","238","Select","Select",""],["","00179805401","FERROUS","TAB 325MG","30","Select","Select",""],["","00009005604","MEDROL","TAB 4MG","21","Select","Select",""],["","59746017306","PREDNISONE","TAB 10MG","43","Select","Select",""],["","00143301801","COLCHICINE","CAP 0.6MG","60","Select","Select",""],["","21922000909","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","50383070016","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","27808008601","HYD","SUS 10-8\/5ML","70","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","63824000820","MUCINEX","TAB 600MG ER","20","Select","Select",""],["","16729013501","ALLOPURINOL","TAB 300MG","90","Select","Select",""],["","10135065250","B-12","TAB 1000MCG","60","Select","Select",""],["","68462019001","NAPROXEN","TAB 500MG","20","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","16500054877","VITACRAVES","CHW MENS","90","Select","Select",""],["","00555032302","HYDROXYZ","CAP 25MG","42","Select","Select",""],["","65862044830","VALACYCLOVIR","TAB 500MG","60","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","00168005515","BETAMETH","CRE 0.0005","60","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","30","Select","Select",""],["","00536116134","MUCUS","TAB 30-600ER","20","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","18","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","11822330080","GAS","CAP 125MG","30","Select","Select",""],["","29300013201","ZALEPLON","CAP 10MG","2","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","31722070290","LOSARTAN","TAB 100MG","90","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":""}]}]}