{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"L   AHSENETETIHWELPPA ","gend":1,"add":"EKORBMEP 021821 TPA NL ","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1980-03-30","age":"","mstatus":"","insh":"3705910*16","cliId":"","pno":"52\/7576384-5","cno":"757\/338-5973","email":"","ename":"","eno":"","pphy":"MUGAISI, HESED N MD","ppno":"757\/738-1375","pcpadd":"148 BURNETTS WAY STE 107","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS SUFFOLK 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":["Z23.","Z68.31","Z01.89","Z00.00","M79.604","Z01.84","I10.","K21.9","E66.9","R56.9","E55.9","R51.","Z20.828","U07.1","R05.","G47.00","R51.9","R94.31","I83.813","Z30.42","NO DATA","F39.","Z68.32","J02.9","Z30.430","Z32.02","S46.811A","R69.","Z20.822","Z11.59","Z30.432","T83.9XXA","R07.9","R06.02","R07.89","E66.3","I25.9","Z01.419","Z13.89","B34.9","L98.8","M79.672","Z68.30","J01.90","R60.0","S90.425A","B35.3","N64.4","N60.29","L03.119","Z88.5","Z88.6","G47.9","R53.81","R53.83","Z68.28","J41.1","J32.9","J30.89","B96.89","Z13.228","Z13.0","M25.572","R60.1","M79.662","J06.9"],"date":["2021-10-19","2021-04-29","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2021-12-01","2021-10-19","2021-12-01","2021-12-01","2020-08-31","2020-08-31","2020-12-02","2021-03-04","2021-04-29","2021-10-19","2021-09-30","2021-04-29","2021-05-03","2021-09-30","2021-12-01","2021-12-01","2021-12-01","2021-12-24","2020-03-18","2020-03-18","2021-10-19","2020-02-06","2021-03-31","2021-10-19","2020-02-25","2020-02-25","2021-03-04","2021-03-04","2021-05-03","2021-03-23","2021-04-01","2021-09-08","2021-09-08","2020-12-02","2019-05-14","2019-05-14","2019-08-20","2019-08-24","2019-11-14","2019-04-12","2019-04-12","2019-01-07","2019-01-07","2019-04-25","2019-04-12","2019-04-12","2019-06-18","2019-06-18","2019-06-18","2019-06-18","2019-12-19","2019-02-19","2019-02-19","2019-02-19","2019-02-19","2019-02-19","2019-11-07","2019-11-07","2019-11-07","2019-12-02"],"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":[["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","59762453701","MEDROXYPR","INJ 150MG\/ML","1","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","240","Select","Select",""],["","00591578201","ATENOL\/CHLOR","TAB 50-25MG","30","Select","Select",""],["","52817033200","CYCLOBENZAPR","TAB 10MG","21","Select","Select",""],["","","COMBIVENT","AER 20-100","","Select","Select",""],["","00054418325","DEXAMETHASON","TAB 2MG","5","Select","Select",""],["","50111043401","TRAZODONE","TAB 100MG","30","Select","Select",""],["","00054350049","LIDOCAINE","SOL 2% VISC","840","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","4","Select","Select",""],["","","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","64380080907","IBUPROFEN","TAB 400MG","21","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","65862064169","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00245531711","KLOR-CON","TAB 10MEQ ER","30","Select","Select",""],["","","DOXYCYC","TAB 100MG","","Select","Select",""],["","65162024709","CHLORTHALID","TAB 25MG","30","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","21","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","VENTOLIN","AER ","","Select","Select",""],["","16571040250","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","59651000205","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","00378821293","ERYTHROMYCIN","GEL 0.02","30","Select","Select",""],["","57237004705","DIVALPROEX","TAB 250MG DR","120","Select","Select",""],["","69238116609","DOXEPIN","CAP 10MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","120","Select","Select",""],["","50383008716","GUAIATUSSIN","SYP 100-10\/5","120","Select","Select",""],["","00363049539","WAL-ZYR","TAB 10MG","30","Select","Select",""],["","65162003311","APAP\/CODEINE","TAB 300-30MG","15","Select","Select",""],["","68382031910","TRAMADOL","TAB 50MG","20","Select","Select",""],["","65862018501","CLINDAMYCIN","CAP 150MG","60","Select","Select",""],["","62037071001","POT  CL MICRO","TAB 10MEQ CR","30","Select","Select",""],["","63824005718","MUCINEX","TAB 60-600MG","18","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":""}]}]}