{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ASSILEMYENAHC ","gend":1,"add":"IDENUD 726F TPA DR N","city":"PORTSMOUTH","state":"VA","zip":23701,"dob":"1975-06-21","age":"","mstatus":"","insh":"25200210*62","cliId":"","pno":"12\/7575916-5","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"757\/483-7100","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23701,"pcpcounty":"","pcpid":"","pcpname":"Bridge Road Family Medicine","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":["R07.89","F41.1","E11.65","Z79.4","R11.0","I10.","E66.9","Z68.38","F17.210","Z88.0","Z88.8","R07.9","E11.649","E11.8","I21.4","E11.9","E78.5","G89.4","M79.7","G40.909","F43.10","Z79.82","Z79.02","Z95.5","E11.40","E11.42","E78.2","E55.9","Z23.","F32.9","F41.9","R53.1","R51.","R56.9","R20.0","E53.8","E03.9","E10.65","R11.2","R55.","R53.81","R53.83","N10.","Z20.822","I49.3","R06.02","I24.9","Z68.41","G47.00","T63.301A","N61.0","G40.301","R29.898","Z53.09","F31.81","E66.01","E87.70","I25.10","E78.00","J43.9","N30.00","G43.009","G40.009","F41.0","E13.65","Z20.828","Z98.61","I51.7","R69.","R05.","R07.1","Z09.","NO DATA","Z86.39","I25.110","E11.69","F20.9","L02.01","F33.3","K08.89","E07.9","I25.2","M19.90","Z86.2","Z79.01","Z79.899","Z87.891","Z01.810","R42.","S00.412A","Z68.39","R51.9","U07.1","R00.2","E87.6","F31.4","R39.9","R33.9","R34.","S90.121A","M54.2","G62.89","G56.03","Z88.1","Z88.2","Z90.49","Z87.440","R06.9","R22.41","L30.8","F43.8","M77.11","M77.12","F31.9","R45.1","M79.602","Z76.89","Z68.36","F31.32","F06.4","M79.642","M25.531"],"date":["2022-07-12","2022-07-12","2022-09-22","2022-09-22","2021-11-23","2022-08-29","2022-07-25","2022-06-09","2022-07-12","2022-07-25","2021-11-23","2022-11-08","2022-09-22","2022-09-22","2021-12-06","2022-09-22","2022-08-29","2021-12-06","2022-07-25","2022-03-04","2021-12-06","2022-07-25","2021-12-06","2022-09-26","2022-07-25","2020-04-17","2020-04-17","2021-12-01","2020-06-24","2022-06-29","2022-07-18","2020-08-20","2020-08-20","2020-08-20","2020-08-20","2021-12-01","2022-07-25","2020-07-12","2020-07-12","2020-07-12","2022-07-09","2022-07-09","2021-11-08","2022-07-09","2021-11-23","2022-07-12","2022-03-21","2022-07-25","2022-06-29","2020-06-24","2020-06-24","2020-08-18","2020-08-19","2020-08-19","2021-01-27","2021-11-26","2021-11-24","2022-11-08","2022-07-25","2022-03-04","2022-08-17","2020-02-21","2020-02-21","2020-06-26","2020-07-12","2020-12-30","2022-11-08","2021-11-25","2020-01-15","2020-01-15","2021-11-24","2021-12-01","2022-03-10","2020-08-18","2022-09-26","2021-11-26","2022-07-12","2019-03-16","2019-03-22","2019-05-21","2022-03-04","2022-03-04","2022-07-25","2022-03-04","2022-03-04","2022-07-25","2022-03-04","2022-03-23","2022-08-17","2022-07-12","2022-11-08","2022-08-04","2022-08-17","2022-08-17","2022-08-17","2022-02-22","2022-07-25","2022-07-25","2022-07-25","2022-09-02","2022-09-02","2022-07-25","2022-07-25","2022-07-25","2022-07-25","2022-07-25","2022-07-25","2022-01-15","2022-02-25","2022-05-18","2022-07-06","2022-07-18","2022-07-18","2022-07-12","2022-01-15","2022-03-04","2022-03-10","2022-03-21","2022-03-29","2022-03-29","2022-07-25","2022-07-25"],"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":[["","68180098003","LISINOPRIL","TAB 10MG","30","Select","Select",""],["","13107008305","LORAZEPAM","TAB 0.5MG","12","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","63402030630","LATUDA","TAB 60MG","30","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","25","Select","Select",""],["","76385011250","CARVEDILOL","TAB 12.5MG","60","Select","Select",""],["","23155000810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","00002771227","HUMALOG","INJ 200\/ML","9","Select","Select",""],["","65162055310","METAXALONE","TAB 800MG","20","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","55111012390","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","69367019430","CLOPIDOGREL","TAB 300MG","2","Select","Select",""],["","72578008801","NYSTAT\/TRIAM","OIN ","60","Select","Select",""],["","27241009903","DULOXETINE","CAP 60MG","30","Select","Select",""],["","","CONTOUR","TES NEXT","","Select","Select",""],["","00904671980","ACETAMINOPHE","TAB 325MG","60","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","70461032203","FLUCLVX","INJ 2022-23","0","Select","Select",""],["","00555032402","HYDROXYZ","CAP 100MG","90","Select","Select",""],["","","CYANOCOBALAM","INJ 1000MCG","","Select","Select",""],["","65702028810","FASTCLIX","MIS LANCETS","204","Select","Select",""],["","72065012112","GVOKE","INJ 1MG\/.2ML","1","Select","Select",""],["","","TRAZODONE","TAB 50MG","","Select","Select",""],["","59779027408","ASPIRIN","CHW 81MG","30","Select","Select",""],["","43547040710","CLONAZEPAM","TAB 1MG","90","Select","Select",""],["","","ACCU-CHEK","KIT AVIVA PL","","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","","GUARDIAN","MIS TRANSMIT","","Select","Select",""],["","29300011201","LAMOTRIGINE","TAB 100MG","90","Select","Select",""],["","50228042360","RANOLAZINE","TAB 500MG ER","60","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","00904673080","ACETAMIN","TAB 500MG","21","Select","Select",""],["","","MICROLET","MIS LANCETS","","Select","Select",""],["","65862049501","QUETIAPINE","TAB 400MG","60","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","63304069205","CLINDAMYCIN","CAP 150MG","32","Select","Select",""],["","13668010410","ISOSORB","TAB 30MG ER","30","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","28","Select","Select",""],["","70436015301","POT  CHLORIDE","TAB 20MEQ ER","6","Select","Select",""],["","31722063231","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","","OZEMPIC","INJ 2\/1.5ML","","Select","Select",""],["","53885027210","ONETOUCH","TES VERIO","500","Select","Select",""],["","","3ML","MIS 25GX1\"","","Select","Select",""],["","","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","","ROSUVASTATIN","TAB 10MG","","Select","Select",""],["","00173064255","LAMICTAL","TAB 100MG","135","Select","Select",""],["","","GLUCAGON","KIT 1MG","","Select","Select",""],["","08290320749","BD  PEN NEEDL","MIS 32GX6MM","100","Select","Select",""],["","08290328466","INSULIN","MIS 0.5\/30G","400","Select","Select",""],["","69238183607","LEVOTHYROXIN","TAB 125MCG","30","Select","Select",""],["","65862020299","LOSARTAN","TAB 50MG","90","Select","Select",""],["","","SERTRALINE","TAB 100MG","","Select","Select",""],["","","CEPHALEXIN","CAP 500MG","","Select","Select",""],["","08290305916","SAFETYGLIDE","MIS 25GX1\"","3","Select","Select",""],["","65862052890","VENLAFAXINE","CAP 75MG ER","90","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","6","Select","Select",""],["","47781030801","NITROFUR","CAP 100MG","10","Select","Select",""],["","62088000033","INPEN","MIS PINK","1","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00186077760","BRILINTA","TAB 90MG","60","Select","Select",""],["","","ONDANSETRON","TAB 8MG ODT","","Select","Select",""],["","29300013510","CLONIDINE","TAB 0.1MG","105","Select","Select",""],["","68462029301","VERAPAMIL","TAB 180MG ER","30","Select","Select",""],["","","GLIMEPIRIDE","TAB 2MG","","Select","Select",""],["","62756014202","METFORMIN","TAB 500MG ER","360","Select","Select",""],["","","BYDUREON","INJ 2MG","","Select","Select",""],["","","ESZOPICLONE","TAB 3MG","","Select","Select",""],["","","VITAMIN","CAP 50000UNT","","Select","Select",""],["","","ZIPRASIDONE","CAP 40MG","","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","","ARIPIPRAZOLE","TAB 5MG","","Select","Select",""],["","","DIAZEPAM","TAB 2MG","","Select","Select",""],["","","MINIMED","MIS SENSOR","","Select","Select",""],["","","BUT\/APAP\/CAF","TAB ","","Select","Select",""],["","","BAYER","MIS LANCETS","","Select","Select",""],["","10702000350","PROMETHAZINE","TAB 25MG","60","Select","Select",""],["","00378535101","PERPHENAZINE","TAB 4MG","60","Select","Select",""],["","69238117309","DOXEPIN","CAP 100MG","60","Select","Select",""],["","67405065105","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","00002143480","TRULICITY","INJ 1.5\/0.5","12","Select","Select",""],["","57599000101","FREESTYLE    KIT SENSOR","KIT SENSOR","2","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","33342008850","RIZATRIPTAN","TAB 10MG","9","Select","Select",""],["","57599000200","FREESTYLE    MIS READER","MIS READER","1","Select","Select",""],["","69238134201","ETODOLAC","TAB 400MG","20","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":""}]}]}