{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" E   YMAGNIDEERB","gend":1,"add":"EMREDNIW 2374302 TPA TC ER","city":"VIRGINIA BEACH","state":"VA","zip":"23455-9998","dob":"1974-01-16","age":"","mstatus":"","insh":"48500210*70","cliId":"","pno":"13\/7579671-9","cno":"","email":"","ename":"","eno":"","pphy":"GAGLIONE, MARGARET M MD","ppno":"757\/644-6819","pcpadd":"1405 KEMPSVILLE ROAD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"COASTAL INTERNAL MEDICINE AND TIDEWATER BARIATRICS","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":["M47.817","M51.36","M54.5","M17.0","M25.569","Z79.899","M25.561","M25.562","R07.9","R77.8","E66.01","E11.9","I10.","Z87.891","Z68.44","R60.1","E11.59","R06.83","R79.89","Z96.89","F33.9","M54.16","F33.1","F41.1","F41.0","L02.91","L01.00","M17.11","J02.0","R07.89","F41.8","M17.9","G56.00","Z76.0","H04.123","Q14.1","H35.82","H25.13","Z68.43","E11.65","F32.9","Z83.3","I21.4","E78.5","M54.40","G89.29"],"date":["2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2020-11-30","2020-11-30","2020-06-09","2020-06-08","2020-07-30","2021-10-04","2020-06-09","2020-06-08","2020-09-01","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2020-07-30","2021-05-11","2022-07-12","2022-07-12","2022-07-12","2020-04-02","2020-04-02","2020-06-16","2020-03-11","2020-06-12","2020-06-12","2020-06-12","2020-03-05","2020-03-05","2021-10-04","2021-10-04","2021-10-04","2021-10-04","2020-06-08","2020-06-08","2020-06-08","2020-06-08","2020-06-09","2020-06-09","2020-09-01","2020-09-01"],"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":[["","70436001106","BUPROPN","TAB 300MG XL","30","Select","Select",""],["","70710112701","URSODIOL","TAB 250MG","60","Select","Select",""],["","33342007710","VALSART\/HCTZ","TAB 320-12.5","90","Select","Select",""],["","00002143380","TRULICITY","INJ 0.75\/0.5","2","Select","Select",""],["","42806008301","BUSPIRONE","TAB 7.5MG","60","Select","Select",""],["","49884012201","LABETALOL","TAB 100MG","60","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","13668000901","CITALOPRAM","TAB 10MG","90","Select","Select",""],["","00093506110","HYDROXYZ","TAB 25MG","90","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","24","Select","Select",""],["","00169406012","VICTOZA","INJ 18MG\/3ML","6","Select","Select",""],["","43598075205","BUPROPION","TAB 150MG SR","60","Select","Select",""],["","00406012501","HYDROCO\/APAP","TAB 10-325MG","120","Select","Select",""],["","65862052730","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","08290320550","BD  PEN NEEDL","MIS 32GX5\/32","100","Select","Select",""],["","59762444002","METHYLPRED","TAB 4MG","21","Select","Select",""],["","61442010305","DICLOFENAC","TAB 75MG DR","20","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","3","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","49281072010","FLUBLOK","INJ 2020-21","0","Select","Select",""],["","69315011610","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","00172392560","DIAZEPAM","TAB 2MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","69097081312","GABAPENTIN","CAP 100MG","60","Select","Select",""],["","00143993905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","67877046490","PREGABALIN","CAP 75MG","60","Select","Select",""],["","68180012101","CEPHALEXIN","CAP 250MG","42","Select","Select",""],["","51672131200","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","67877041305","METFORMIN","TAB 500MG ER","90","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":""}]}]}