{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"J   AYNADNALLOH ","gend":1,"add":"TCEPSORP 252 TPA YWKP ","city":"PORTSMOUTH","state":"VA","zip":"23702-9998","dob":"1984-06-03","age":"","mstatus":"","insh":"5556110*38","cliId":"","pno":"85\/7576488-2","cno":"757\/582-8846","email":"","ename":"","eno":"","pphy":"PATEL, SONAL MD","ppno":"757\/312-6267","pcpadd":"908 EDEN WAY N STE 101","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"","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":["F43.23","R07.9","I67.1","M54.9","M79.7","F41.9","E66.9","F43.22","F32.9","Z68.31","R63.2","S09.91XA","Z88.5","Z91.018","R53.1","H00.11","N64.81","I77.89","I77.71","M54.2","G43.119","NO DATA","R53.83","N92.0","D25.9","I10.","K21.9","R10.10","G47.30","R51.9","F41.1","Z86.79","K59.00","N89.8","N92.5","R63.5","I44.1","Z87.39","R94.31","R00.2","R06.89","I44.30","I51.7","Z01.419","Z11.51","Z12.4","R00.1","R07.89","Z01.810","K44.9","R41.3","Z91.49","F41.8","K43.9","M62.08","R19.09","K59.09","K62.5","R10.84","K59.04","I20.8","E66.3","E78.00","J30.2","J30.9","E66.09","R06.02","Z72.4","Z72.3","R73.03","I44.39","M54.89","G43.909","Z87.19","R93.0","R19.7","Z79.899","Z32.02","Z86.69","R10.9","Z83.71","E04.2","E21.3","E83.52","E55.9","Z20.822","B34.9","J06.9","R05.1","Z01.411","N76.0","Z79.1","Z82.49","G25.81","G47.33","G47.00","G47.21","R93.3","R14.2","T63.441A","L03.116","L70.0","L73.9","Z71.9","R10.2","U07.1","D25.0","Z98.890","L91.0","Z11.3","G89.29","R45.1","Z79.891","M79.605","M79.89","J45.909","Z86.16","Z98.51","Z83.3"],"date":["2022-10-07","2021-07-01","2022-08-30","2022-08-25","2022-08-22","2022-07-11","2022-09-08","2022-07-16","2021-08-25","2021-08-25","2021-08-25","2021-09-07","2022-11-05","2022-08-22","2022-02-07","2021-11-01","2021-11-09","2022-02-23","2022-03-14","2022-04-04","2022-03-14","2022-08-25","2022-08-22","2021-08-27","2021-10-20","2021-01-06","2021-01-06","2021-01-06","2022-08-30","2022-02-07","2022-02-07","2022-09-08","2022-07-11","2022-08-28","2022-08-25","2020-09-10","2020-09-18","2020-09-18","2022-08-30","2022-08-30","2022-08-30","2022-08-30","2022-08-30","2022-08-02","2021-04-22","2022-08-02","2021-07-06","2021-07-06","2022-02-06","2022-02-06","2022-04-11","2022-04-11","2022-04-11","2022-05-16","2022-09-08","2022-05-16","2022-05-23","2022-05-23","2022-08-12","2022-07-21","2022-08-30","2022-08-30","2022-08-30","2020-10-13","2020-04-06","2021-08-10","2022-11-05","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-08-10","2021-12-16","2022-07-11","2022-11-05","2022-07-11","2022-09-08","2022-09-06","2021-06-29","2020-10-12","2020-10-12","2020-10-12","2020-10-13","2022-11-05","2022-11-05","2022-11-05","2022-11-05","2020-06-24","2020-06-24","2022-11-05","2022-11-05","2020-12-07","2021-02-28","2020-12-07","2020-12-07","2021-06-29","2021-06-29","2021-07-06","2021-07-06","2021-11-17","2021-11-17","2021-11-17","2022-08-28","2021-01-20","2021-09-27","2022-11-05","2022-06-08","2022-08-02","2022-08-22","2022-08-22","2022-08-22","2020-06-29","2020-06-29","2022-11-05","2022-11-05","2022-11-05","2022-11-05"],"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":[["","68462056435","MUPIROCIN","CRE 0.02","30","Select","Select",""],["","00456120230","LINZESS","CAP 290MCG","30","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","70377002711","ATORVASTATIN","TAB 10MG","90","Select","Select",""],["","00071015723","LIPITOR","TAB 40MG","30","Select","Select",""],["","12843013105","BAYER","CHW 81MG","60","Select","Select",""],["","59779010112","PAIN","TAB 500MG","30","Select","Select",""],["","45802075930","PROMETHAZINE","SUP 25MG","10","Select","Select",""],["","62756052169","SUMATRIPTAN","TAB 50MG","10","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","24","Select","Select",""],["","64380076921","PEG-3350\/KCL","SOL \/SODIUM","4000","Select","Select",""],["","59779030603","CVS","POW ","510","Select","Select",""],["","11523723402","MIRALAX","POW 3350 NF","119","Select","Select",""],["","69230032434","POLYETH","POW 3350","600","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","14","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","25","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","2","Select","Select",""],["","00603533831","PREDNISONE","PAK 10MG","48","Select","Select",""],["","69367017401","HYDROQUINONE","CRE 0.04","28","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","64380071207","BENZONATATE","CAP 100MG","21","Select","Select",""],["","70436005901","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","68180016013","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","14","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","12","Select","Select",""],["","52959028530","WELLBUTRIN","TAB 150MG SR","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","00781618667","CIPRO\/DEXA","SUS 0.3-0.1%","8","Select","Select",""],["","00713052612","PROMETHEGAN","SUP 25MG","10","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","12","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","6","Select","Select",""],["","21922000201","CLINDAMYCIN","SOL 0.01","60","Select","Select",""],["","68180065001","DOXYCYC","CAP 50MG","60","Select","Select",""],["","00378647099","SCOPOLAMINE","DIS 1MG\/3DAY","1","Select","Select",""],["","10702002501","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","62856052960","BELVIQ","TAB 10MG","30","Select","Select",""],["","00591292754","LEVALBUTEROL","AER 45\/ACT","15","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","10","Select","Select",""],["","00093310905","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","13668013601","ESCITALOPRAM","TAB 10MG","90","Select","Select",""],["","45802091987","CETIRIZINE","TAB 10MG","90","Select","Select",""],["","51672404801","CLOTRIM\/BETA","CRE DIPROP","60","Select","Select",""],["","13107008305","LORAZEPAM","TAB 0.5MG","30","Select","Select",""],["","50111033401","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","51991074890","DULOXETINE","CAP 60MG","30","Select","Select",""],["","65649030302","XIFAXAN","TAB 550MG","20","Select","Select",""],["","43598029490","PREGABALIN","CAP 100MG","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":""}]}]}