{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"M   ASILNODROJ ","gend":1,"add":"NIPSA 6551B TPA TS ","city":"NORFOLK","state":"VA","zip":"23502-9998","dob":"1970-02-07","age":"","mstatus":"","insh":"40300210*51","cliId":"","pno":"99\/7578623-8","cno":"757\/354-8476","email":"","ename":"","eno":"","pphy":"BEVERLY, VERNIS MD","ppno":"757\/484-2001","pcpadd":"STE A 3800 POPLAR HILL RD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":"","pcpname":"Adult and Pediatric Medical Associates","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":["H90.0","F14.90","L27.0","I50.41","J96.01","I42.9","F14.20","N39.0","E87.1","H49.02","I95.9","G43.909","F17.210","B96.89","H04.123","R53.1","R59.0","L30.8","T39.1X5A","D64.9","R21.","I50.9","R50.9","H91.93","R50.81","R23.4","I67.1","A41.9","G44.311","Q16.9","Z86.69","R10.9","H25.13","G44.89","M25.561","M25.562","W19.XXXA","Z72.0","G47.33","J45.909","M19.90","F32.9","H52.13","R82.81","R53.81","R51.","F41.9","M79.605","M54.9","R35.0","L30.9","H90.3","J20.9","NO DATA","T78.40XA","I08.8","C85.80","K80.20","I72.9","K21.9","T78.2XXA","L50.9","R06.02","I50.42","Z09.","R45.851","Z86.59","Z91.14","R55.","G43.801","Z86.79","R79.89","Z20.828","F17.200","Z88.6","Z88.0","G44.221","G43.019","G43.719","M26.609","F45.8","G47.63","G47.10","K08.89","H91.90","E66.9","Z68.30","R51.9","R52.","F14.10","M77.42","S92.341P","M77.41","M19.072","M19.071","S20.211A","V19.9XXA","F31.9","I10.","R10.11","G89.18","H53.2","H93.13","S39.012A","L24.89","K80.80","Z20.822","K66.0","Z53.31","Z79.899","Z83.79","Z82.49","Z82.3","Z82.5","Z84.1","Z82.61","F19.959","Z90.49","E55.9","F25.9","F14.23","Z80.9","Z81.8","Z87.828","Z87.892","H54.7","V62.84","G45.9","H83.2X3","H10.9","H49.22","H57.02","T16.2XXA","R44.3","T88.7XXA","I51.7","I51.9","R10.84","Z23."],"date":["2020-07-15","2020-07-15","2020-10-15","2020-09-21","2020-10-03","2020-12-22","2020-09-21","2020-10-03","2020-09-21","2022-05-27","2020-09-21","2022-09-30","2020-09-21","2020-09-21","2020-09-21","2020-09-21","2020-10-02","2020-11-09","2020-09-21","2020-09-25","2021-10-19","2020-09-25","2020-10-03","2022-10-25","2020-10-02","2020-11-09","2022-08-08","2020-10-03","2020-11-09","2020-11-09","2020-11-09","2022-07-29","2020-11-25","2022-09-30","2021-11-15","2021-11-15","2021-11-15","2021-12-13","2020-03-04","2022-11-22","2022-11-22","2020-03-04","2020-06-25","2020-09-21","2020-09-21","2020-09-21","2022-07-29","2021-03-01","2022-11-22","2021-04-06","2022-02-08","2022-09-30","2020-08-22","2022-07-29","2020-09-11","2020-09-22","2020-10-01","2022-09-14","2020-11-17","2021-03-01","2020-09-11","2021-10-19","2020-09-11","2020-12-22","2020-12-22","2021-06-05","2022-10-04","2021-06-05","2021-12-13","2021-12-13","2020-09-02","2020-09-05","2020-09-05","2022-08-31","2022-09-30","2022-09-30","2020-01-06","2020-01-06","2020-01-06","2021-03-01","2020-01-06","2020-01-06","2020-01-06","2021-11-15","2022-07-29","2021-11-15","2021-11-15","2022-10-04","2022-07-27","2019-08-30","2019-09-21","2019-09-21","2019-09-21","2019-09-21","2019-09-21","2019-12-06","2019-12-06","2019-09-19","2022-11-22","2022-09-30","2022-10-25","2022-10-04","2022-07-05","2022-07-27","2022-07-27","2022-08-29","2022-08-29","2022-08-31","2022-08-31","2022-09-30","2022-08-31","2022-09-30","2022-08-31","2022-08-31","2022-09-30","2022-08-31","2022-09-13","2022-11-22","2022-11-22","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-30","2022-09-08","2022-11-22","2022-07-14","2022-07-29","2022-09-30","2022-09-30","2022-03-22","2022-09-06","2022-09-06","2022-10-02","2022-10-02","2022-11-17","2022-11-22"],"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":[["","69238207807","PROPRANOLOL","TAB 20MG","60","Select","Select",""],["","76385012450","METHOCARBAM","TAB 750MG","56","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","10","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","","ESCITALOPRAM","TAB 10MG","","Select","Select",""],["","45802049383","AMMONIUM","CRE 0.12","140","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","68462022517","MOMETASONE","OIN 0.001","15","Select","Select",""],["","50428047796","SKIN","LOT 0.12","400","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","68382003616","VENLAFAXINE","CAP 150MG ER","30","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","24208031510","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","30","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","16714048401","DIVALPROEX","TAB 250MG ER","49","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","41167005840","ASPERCREME","PAD LIDO 4%","30","Select","Select",""],["","67618012012","SENOKOT","TAB 17.2MG","36","Select","Select",""],["","00904675180","ASPIRIN","TAB 81MG EC","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","6","Select","Select",""],["","70461032103","FLUCLVX","INJ 2021-22","0","Select","Select",""],["","","PREDNISONE","TAB 10MG","","Select","Select",""],["","50428028552","ACETAMINOPHN","TAB 500MG","21","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","20","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","71930005552","APAP\/CODEINE","TAB 300-30MG","12","Select","Select",""],["","","CELECOXIB","CAP 100MG","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","CVS","CAP 25MG","","Select","Select",""],["","","EPINEPHRINE","INJ 0.3MG","","Select","Select",""],["","","PAIN","TAB 500MG","","Select","Select",""],["","","DOXYCYC","CAP 100MG","","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","","ONDANSETRON","TAB 8MG ODT","","Select","Select",""],["","","ACETAMIN","TAB 500MG","","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","49281041950","FLUZONE","INJ 2019-20","0","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":""}]}]}