{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   LATSYRCNAMEROF D","gend":1,"add":"S EKI 0172911 TOL T","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1982-07-29","age":"","mstatus":"","insh":"29300210*80","cliId":"","pno":"49\/7570211-4","cno":"","email":"","ename":"","eno":"","pphy":"MUSSELMANI, ZATTAM MD","ppno":"757\/543-3557","pcpadd":"1422 POINDEXTER ST","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23324,"pcpcounty":"","pcpid":"","pcpname":"ZATTAM MUSSELMANI","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":["R55.","T48.901A","R56.9","H61.21","G89.4","M54.5","M79.671","M79.672","M54.2","R10.2","F43.10","F41.1","K62.89","K59.00","F32.9","R29.6","S09.93XA","S02.80XA","S01.112A","S01.81XA","F10.920","S02.32XA","S93.601A","G40.009","G43.009","H81.10","I46.9","R07.89","R45.0","Z00.00","R07.9","G40.909","R51.","R10.0","R10.84","Z01.419","Z12.4","Z11.3","D64.9","E55.9","M79.606","S99.919A","NO DATA","F41.9","R23.2","M21.6X1","M19.071","M19.072","M21.6X2","Z84.89","J06.9","Z01.818","T84.84XA","Z51.81","Z79.891","M24.572","Z79.899","U07.1"],"date":["2019-04-27","2019-04-27","2022-05-09","2020-07-27","2022-07-20","2021-09-28","2022-03-24","2022-07-20","2020-12-29","2021-02-25","2022-10-25","2022-10-25","2019-04-21","2019-04-21","2022-03-10","2019-05-24","2019-05-24","2019-05-24","2019-06-24","2019-05-24","2019-05-24","2019-06-03","2021-02-19","2021-06-08","2021-06-08","2021-06-08","2021-09-09","2021-09-09","2019-10-08","2019-10-08","2021-09-09","2019-04-27","2019-04-27","2019-04-21","2019-04-21","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-02-04","2021-02-19","2021-02-19","2022-03-24","2022-03-10","2022-03-10","2022-05-09","2022-05-09","2022-06-20","2022-05-09","2022-08-27","2022-03-17","2022-06-20","2022-06-24","2022-03-24","2022-03-24","2022-06-20","2022-09-20","2022-09-20"],"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":[["","","SERTRALINE"," SERTRALINE ","30","Select","Select",""],["","","CLONAZEPAM"," CLONAZEPAM ","60","Select","Select",""],["","","QUETIAPINE"," QUETIAPINE ","60","Select","Select",""],["","","LEVETIRACETA"," LEVETIRACETA ","90","Select","Select",""],["","","PROPRANOLOL"," PROPRANOLOL ","60","Select","Select",""],["","","GABAPENTIN"," GABAPENTIN ","90","Select","Select",""],["","","BUT\/APAP\/CAF"," BUT\/APAP\/CAF ","45","Select","Select",""],["","","DIVALPROEX","TAB 250MG ER","","Select","Select",""],["","53530000501","ESTROVEN","CAP MENOPAUS","60","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","3","Select","Select",""],["","","OXYCODONE"," OXYCODONE ","120","Select","Select",""],["","42192060716","BROM\/PSE\/DM","SYP 2\/30\/10","200","Select","Select",""],["","00093216568","NALOXONE","SPR ","2","Select","Select",""],["","59762219803","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","31722094901","OXYCOD\/APAP","TAB 5-325MG","36","Select","Select",""],["","00093314701","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","57896090110","ASPIRIN","TAB 325MG","56","Select","Select",""],["","00406324401","HYDROMORPHON","TAB 4MG","40","Select","Select",""],["","50228015801","CELECOXIB","CAP 200MG","60","Select","Select",""],["","80681017400","VITAMIN","CAP 50000UNT","8","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","42","Select","Select",""],["","57237002801","AMOXICILLIN","TAB 500MG","21","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","40","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0","Select","Select",""],["","00254101196","SUCRALFATE","SUS 1GM\/10ML","160","Select","Select",""],["","65162011510","HYDROCO\/APAP","TAB 7.5-325","15","Select","Select",""],["","","CHLORHEX","SOL 0.0012","","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","","FLUTICASONE","SPR 50MCG","","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":""}]}]}