{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   AYNORBROLYAT E","gend":1,"add":"KCUSYENOH 2105801 TPA NL EL","city":"CHESAPEAKE","state":"VA","zip":"23321-9998","dob":"1981-11-20","age":"","mstatus":"","insh":"2101110*79","cliId":"","pno":"35\/7579722-5","cno":"","email":"","ename":"","eno":"","pphy":"TAYLOR, ANDREA NP","ppno":"757\/738-1600","pcpadd":"2613 TAYLOR RD STE 201","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS WESTERN BRANCH PRIMARY CARE","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":["E11.65","G43.001","M62.838","K21.9","R11.2","I10.","E78.2","R21.","Z68.29","E10.10","D72.829","NO DATA","Z68.31","E10.11","E10.649","E78.00","D25.9","A08.4","E86.0","G43.909","J42.","J45.909","N28.9","F17.210","Z79.4","Z79.899","Z98.891","Z79.51","R11.0","E13.65","E83.39","E10.65","E55.9","F43.10","F33.9","R05.","Z68.30","L87.1","Z71.9","R10.11","N30.00","K92.0","F32.9","J40.","Z48.817","Z48.01","E10.9","L29.9","R23.8","R93.3","R10.13","G89.18","E10.49","M20.41","M20.42","R07.9","G62.9","B35.1","M24.572","M24.571","A49.02","M54.2","M62.81","Z68.27","F41.9","Z87.891","K44.9","K29.90","K92.2","R07.89","R79.89","R42.","R00.0","Z82.49","Z83.3","Z20.822","J01.00","Z20.828","L30.4","K22.11","K29.51","N30.01","G89.29","E78.5","K29.80","E87.6","K52.9","N76.4","R41.82","S92.351A","E11.9","S92.901A","S92.351K","L03.116","Z47.89","B37.81","M25.571","S92.353A","L02.811","L20.9","Z01.812","L05.01","R60.0","J20.4","M79.671","S92.901K","L70.0","S92.301A","S92.909A","Z01.818","B37.9","I87.2","R05.1","J01.10"],"date":["2021-01-12","2022-03-16","2022-03-25","2022-04-13","2021-05-05","2022-04-13","2022-03-25","2020-10-08","2020-10-08","2021-12-01","2021-03-07","2022-04-13","2022-02-21","2021-11-22","2021-03-07","2022-04-13","2021-11-15","2021-03-07","2021-03-07","2021-03-07","2021-03-07","2022-04-13","2021-03-07","2021-09-07","2022-04-13","2022-04-13","2021-03-07","2022-04-13","2021-03-07","2021-11-15","2021-03-09","2022-03-25","2022-03-25","2022-11-17","2022-11-17","2021-09-28","2022-03-16","2022-10-19","2022-10-19","2021-11-22","2021-11-22","2021-11-30","2020-06-12","2021-07-28","2021-08-11","2021-08-11","2022-04-13","2021-11-03","2022-08-10","2021-11-17","2021-11-17","2021-01-12","2021-09-07","2021-03-25","2021-03-25","2021-11-30","2020-12-24","2021-09-07","2020-12-24","2020-12-24","2021-09-07","2021-06-29","2021-11-15","2020-02-12","2021-11-15","2022-04-13","2022-04-13","2021-11-17","2021-11-17","2021-11-29","2021-11-29","2020-08-18","2021-11-15","2021-11-15","2021-11-15","2022-10-31","2020-01-28","2021-02-13","2021-06-10","2021-11-15","2021-11-15","2021-11-15","2021-11-15","2022-03-21","2021-11-15","2021-11-15","2021-03-07","2021-08-07","2021-11-15","2022-03-21","2022-03-21","2022-03-21","2022-09-20","2022-09-20","2022-06-30","2022-02-28","2022-02-14","2022-03-21","2022-08-12","2022-03-17","2022-03-18","2022-04-23","2022-09-07","2022-09-22","2022-03-16","2022-03-17","2022-01-27","2022-03-21","2022-09-20","2022-03-16","2022-10-19","2022-10-19","2022-10-31","2022-10-31"],"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":[["","63304071990","DILTIAZEM","CAP 180MG ER","30","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","23155050001","HYDROXYZ","TAB 10MG","120","Select","Select",""],["","55111012305","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","10702000201","PROMETHAZINE","TAB 12.5MG","15","Select","Select",""],["","00187516445","RETIN-A","CRE 0.001","45","Select","Select",""],["","13107005801","APAP\/CODEINE","TAB 300-15MG","20","Select","Select",""],["","00378668999","PANTOPRAZOLE","TAB 40MG","16","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","67877043003","ARIPIPRAZOLE","TAB 2MG","30","Select","Select",""],["","00002879959","HUMALOG","INJ 100\/ML","45","Select","Select",""],["","51672128202","TRIAMCINOLON","CRE 0.001","30","Select","Select",""],["","53885024510","ONETOUCH","TES ULTRA","100","Select","Select",""],["","00378110101","PRAZOSIN","CAP 1MG","30","Select","Select",""],["","00316022130","NYSTATIN","CRE 100000","30","Select","Select",""],["","68462010905","TOPIRAMATE","TAB 100MG","180","Select","Select",""],["","16714009701","LIDOCAINE","SOL 2% VISC","200","Select","Select",""],["","00054032756","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","40","Select","Select",""],["","68180013601","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","67877025001","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","08290328468","INSULIN","MIS 0.5\/31G","200","Select","Select",""],["","51672130009","AMMONIUM","LOT 0.12","400","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","20","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","00527169505","BUT\/APAP\/CAF","TAB ","90","Select","Select",""],["","49884072703","DOXYCYC","CAP 100MG","90","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","28","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","28","Select","Select",""],["","00045049923","TYLENOL","TAB 500MG","21","Select","Select",""],["","62135098505","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","61442010210","DICLOFENAC","TAB 50MG DR","14","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","62037059890","CARTIA","CAP 180\/24HR","30","Select","Select",""],["","57237000630","FLUCONAZOLE","TAB 200MG","7","Select","Select",""],["","70954005930","PREDNISONE","PAK 10MG","21","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","42806071501","BENZONATATE","CAP 200MG","30","Select","Select",""],["","00574110404","BROM\/PSE\/DM","SYP ","150","Select","Select",""],["","00378808445","TRETINOIN","CRE 0.001","45","Select","Select",""],["","43386048024","ORPHENADRINE","TAB 100MG ER","60","Select","Select",""],["","00486112501","K-PHOS","TAB NEUTRAL","6","Select","Select",""],["","00168008031","HYDROCORT","CRE 0.025","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","64380080807","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00363017508","PAIN","TAB 500MG","21","Select","Select",""],["","11917016741","GLUCOSE","CHW 4GM","50","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","42","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","99073070827","FREESTYLE    TES LITE","TES LITE","100","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","90","Select","Select",""],["","59762040101","SUCRALFATE","TAB 1GM","120","Select","Select",""],["","00536001583","ALMACONE","SUS STRENGTH","355","Select","Select",""],["","16714071503","OMEPRAZOLE","CAP 20MG","120","Select","Select",""],["","00597015230","JARDIANCE","TAB 10MG","30","Select","Select",""],["","65862020299","LOSARTAN","TAB 50MG","90","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","67877021620","CEFUROXIME","TAB 500MG","20","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","3","Select","Select",""],["","99073070805","FREESTYLE    MIS LITE","MIS LITE","1","Select","Select",""],["","00234057504","HIBICLENS","LIQ 0.04","118","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}