{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YREFFEJNITRAM ","gend":0,"add":"ELGAE 0211B TPA EVA ","city":"NORFOLK","state":"VA","zip":"23518-9998","dob":"1970-11-15","age":"","mstatus":"","insh":"5448410*84","cliId":"","pno":"12\/7572927-4","cno":"757\/214-7292","email":"","ename":"","eno":"","pphy":"GALAN DEJESUS, MIRIAM CNP","ppno":"757\/623-8642","pcpadd":"STE 201 400 W BRAMBLETON AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":"","pcpname":"Skees Family Practice","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","M85.9","Z01.818","NO DATA","Z01.812","I48.92","Z98.890","Z20.828","I48.91","E87.1","E87.6","I48.3","I51.3","H81.10","Z63.72","I42.8","R06.00","I50.43","R06.02","Z86.74","Z95.810","Z79.01","I25.119","Z86.79","R06.09","I50.9","I10.","E78.5","E66.01","I25.10","F10.10","F15.10","F12.10","I50.42","I50.20","Z09.","E86.0","E34.9","I42.9","I50.30","R94.31","I48.0","Z45.02","J20.9","S69.92XA","M54.5","M19.90","I46.9","M47.816","M13.0","Z79.899","K21.9","I49.3","I50.21","E87.2","N18.3","I45.2","R14.0","I11.0","I50.22","M10.9","R73.9","G89.29","Z11.59","I48.4","M19.132","G56.02","S62.002S","F41.9","R20.0","F32.9","I13.0","Z68.41","N17.9","Z20.822","I25.2","Z95.0","Z82.61","Z82.49","G47.31","G47.33","Z86.718","Z86.19","Z79.82","Z88.0","T40.1X4S","G47.37","M10.031","D86.9","I49.9","E87.3","F12.20","D17.79","J40.","J45.30","I44.4","I45.10","J06.9","N18.9","R60.9","F19.10","I47.1","F41.8","R53.83","N28.9","G47.20","R93.89","Z99.89","R11.2","I50.23","E03.9","V58.69","Z91.128","Z51.81","Z53.21"],"date":["2022-10-25","2020-05-05","2022-04-12","2022-04-18","2020-04-25","2021-08-02","2021-08-12","2022-07-12","2021-06-07","2020-06-05","2020-06-05","2021-02-16","2020-06-23","2020-06-03","2021-07-19","2022-10-18","2021-08-12","2021-08-05","2021-02-11","2021-02-11","2022-10-21","2022-04-18","2021-03-25","2022-04-18","2021-02-18","2022-04-18","2021-08-05","2021-08-05","2021-08-05","2021-09-22","2022-10-25","2022-10-21","2022-10-21","2021-12-07","2021-03-10","2021-08-16","2021-08-16","2021-08-16","2021-10-05","2021-10-05","2022-04-12","2021-10-05","2022-04-18","2022-07-12","2020-02-21","2020-02-21","2020-02-21","2020-04-16","2021-05-10","2020-02-10","2022-04-18","2022-04-18","2020-06-01","2020-05-21","2020-06-03","2020-06-05","2020-06-04","2020-06-12","2020-06-15","2020-06-15","2022-04-18","2020-06-15","2020-06-15","2020-07-20","2020-09-14","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-07-06","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2021-08-02","2022-04-18","2021-08-02","2021-08-02","2022-04-18","2021-10-23","2021-11-16","2022-04-18","2022-04-18","2022-04-18","2022-04-18","2020-02-28","2021-07-15","2020-02-10","2020-02-10","2020-05-22","2020-06-02","2021-01-11","2021-05-10","2022-07-22","2022-07-22","2020-06-01","2020-06-01","2020-07-01","2021-08-12","2020-01-21","2020-06-11","2020-06-23","2020-09-14","2021-03-25","2021-03-25","2021-07-16","2021-07-16","2021-11-16","2021-08-02","2020-05-23","2020-05-21","2020-05-21","2020-05-21","2020-10-17","2021-07-27"],"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":[["","67877043990","ROSUVASTATIN","TAB 5MG","90","Select","Select",""],["","16729013516","ALLOPURINOL","TAB 300MG","90","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","00378456105","POT  CHLORIDE","TAB 10MEQ ER","68","Select","Select",""],["","69097040807","METOPROL","TAB 100MG ER","30","Select","Select",""],["","00185012901","BUMETANIDE","TAB 1MG","180","Select","Select",""],["","59746017710","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","70710135103","COLCHICINE","TAB 0.6MG","180","Select","Select",""],["","43547040111","FUROSEMIDE","TAB 20MG","180","Select","Select",""],["","00093216568","NALOXONE","SPR ","2","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00591544310","PREDNISONE","TAB 20MG","18","Select","Select",""],["","62135098505","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","63304061650","DOXYCYC","CAP 100MG","20","Select","Select",""],["","00781729685","ALBUTEROL","AER HFA","7","Select","Select",""],["","42806071405","BENZONATATE","CAP 100MG","21","Select","Select",""],["","00904628880","ASPIRIN","CHW 81MG","90","Select","Select",""],["","16714007106","BACLOFEN","TAB 10MG","90","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","00832532410","POT  CL MICRO","TAB 10MEQ ER","68","Select","Select",""],["","55111017915","TIZANIDINE","TAB 2MG","90","Select","Select",""],["","60258015001","SF","CRE 0.011","51","Select","Select",""],["","67877022310","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","50458057930","XARELTO","TAB 20MG","30","Select","Select",""],["","67877022501","MYCOPHENOLAT","TAB 500MG","60","Select","Select",""],["","60505296507","MYCOPHENOLIC","TAB 180MG DR","60","Select","Select",""],["","65580064371","METOLAZONE","TAB 2.5MG","15","Select","Select",""],["","60505014601","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00185067401","HYDROXYZ","CAP 25MG","9","Select","Select",""],["","12496120801","SUBOXONE","MIS 8-2MG","7","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","5","Select","Select",""],["","65862018830","ONDANSETRON","TAB 8MG","60","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":""}]}]}