{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"E   AINATANNOTGNIHSAW ","gend":1,"add":"LECITNOM 147D TPA EVA OL","city":"NORFOLK","state":"VA","zip":"23510-9998","dob":"1971-02-20","age":"","mstatus":"","insh":"38600210*08","cliId":"","pno":"37\/7575787-8","cno":"757\/738-7875","email":"","ename":"","eno":"","pphy":"NEWBY-GOODMAN, MARCIA MD","ppno":"757\/942-8020","pcpadd":"930 MAJESTIC AVE STE 220","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":"","pcpname":"Primary Care Specialists","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E11.9","H25.12","H25.11","K92.2","R07.9","I63.9","E11.65","Z79.84","Z91.128","D50.9","K64.8","Z23.","Z68.27","U07.1","H66.90","R05.9","J02.9","R11.0","R51.9","NO DATA","H92.09","I10.","M06.9","Z86.73","Z85.42","Z90.722","Z90.710","Z87.891","Z91.012","H16.143","I69.30","H53.30","K92.1","D64.9","G62.9","E78.5","M54.2","D50.0","M79.7","F33.9","J30.2","R52.","Z20.822","F41.9","K21.9","Z68.29","R07.89","M79.602","L60.8","Z12.39","H57.9","H16.142","Z79.899","R20.0","M25.511","Z71.89","M54.9","R10.9","R69.","N64.4","Z76.0","B34.9","H92.02","G93.89","Z68.26","F33.1","R19.5","E78.00","E11.36","H25.013","M25.552","Z01.812"],"date":["2022-09-01","2020-10-13","2022-01-24","2021-03-24","2022-04-22","2021-03-24","2021-11-29","2021-11-29","2021-11-29","2021-02-08","2021-02-08","2021-04-29","2022-03-01","2021-12-30","2021-12-30","2022-05-26","2021-12-30","2021-12-30","2021-12-30","2021-12-30","2021-12-30","2022-09-01","2022-05-26","2022-07-03","2022-07-03","2021-12-30","2021-12-30","2022-07-03","2022-07-03","2022-01-24","2021-03-01","2020-12-03","2020-12-21","2020-12-21","2021-03-24","2022-09-01","2021-02-01","2021-03-24","2022-09-01","2021-03-24","2021-01-12","2022-07-03","2022-07-03","2022-09-01","2022-09-01","2022-09-01","2022-04-26","2020-08-10","2020-08-10","2020-08-10","2020-10-13","2022-02-14","2022-07-03","2022-04-22","2022-04-26","2021-03-24","2022-07-03","2022-07-03","2021-12-30","2022-03-01","2022-03-01","2022-05-26","2022-05-26","2020-11-24","2020-11-24","2020-12-19","2020-12-19","2020-12-19","2020-12-19","2020-12-19","2020-12-19","2021-02-05"],"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":[["","00002143380","TRULICITY","INJ 0.75\/0.5","6","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","65162019011","NAPROXEN","TAB 500MG","30","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","67877041301","METFORMIN","TAB 500MG ER","30","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","49035056314","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","68645052254","SERTRALINE","TAB 50MG","30","Select","Select",""],["","00093505698","ATORVASTATIN","TAB 10MG","30","Select","Select",""],["","53885092701","ONETOUCH","KIT VERIO RE","1","Select","Select",""],["","56151146004","TRUE","TES GLUCOSE","100","Select","Select",""],["","08290320119","BD  PEN NEEDL","MIS 31GX5MM","100","Select","Select",""],["","68645055154","LISINOPRIL","TAB 5MG","90","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","29300034905","ALLOPURINOL","TAB 100MG","30","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","400","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","11877001140","BINAXNOW","KIT HOME TES","2","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","56151146104","RELION","TES METRIX","50","Select","Select",""],["","56151014701","TRUPLUS","MIS 33G","100","Select","Select",""],["","16729017117","AMITRIPTYLIN","TAB 10MG","30","Select","Select",""],["","16714008310","HYDROXYZ","TAB 50MG","90","Select","Select",""],["","49502025175","SEMGLEE","INJ 100U\/ML","15","Select","Select",""],["","55111064530","OMEPRAZOLE","CAP 40MG","60","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","30","Select","Select",""],["","81131009371","SV","TAB 325MG","90","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","65162089129","MOMETASONE","SPR 50MCG","17","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","4000","Select","Select",""],["","68645057454","GLIPIZIDE","TAB 5MG","60","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","20","Select","Select",""],["","08489846810","PEN  NEEDLES","MIS 31GX3\/16","100","Select","Select",""],["","69315030805","CIPROFLOXACN","SOL 0.3% OP","5","Select","Select",""],["","61314012605","KETOROLAC","SOL 0.005","5","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","81131074933","IRON","TAB 325MG","30","Select","Select",""],["","65862084003","MOXIFLOXACIN","SOL HCL 0.5%","3","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":""}]}]}