{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  EINAHPETSHSILGNE F ","gend":1,"add":"EB AINIGRIV 9143127 ETS DVLB HCA","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1960-10-24","age":"","mstatus":"","insh":"60400210*80","cliId":"","pno":"27\/7578656-4","cno":"","email":"","ename":"","eno":"","pphy":"ELHASSAN, AMIRA S MD","ppno":"757\/738-1300","pcpadd":"4421 VIRGINIA BEACH BLVD STE 114","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23462,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS 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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N89.8","M16.0","M25.552","M25.561","M25.562","M54.2","M54.5","M54.6","R32.","N76.0","R14.0","N95.9","M17.11","E78.2","K21.9","J45.40","M62.838","J30.89","B00.1","I49.9","K59.09","F31.62","B00.9","Z68.22","T85.43XS","F41.1","A41.9","G93.41","A48.1","NO DATA","E87.1","F41.9","I10.","E78.5","F31.9","Z20.828","F17.210","I48.0","Z96.641","R19.7","J45.909","H91.91","Z11.3","Z11.4","N30.00","S23.41XA","Z12.11","R09.82","R05.9","N32.81","Z87.448","M25.551","M17.0","K76.0","R79.89","N39.46","M25.511","Z01.419","Z12.4","R10.2","Z12.39","N95.1","U07.1","Z03.818","B37.3","Z72.51","S22.32XA","T85.848A","M16.12","Z51.81","Z79.891","R51.9","R50.9","Z20.822","S16.1XXA","R10.9","B37.2","N39.0","R31.9","I47.1","E78.00","R53.83","Z88.1","Z88.5","Z88.8","M62.830","G89.4","R50.81","R74.8","R53.81","R06.00","M16.11","J40.","H04.123","H35.373","R31.0"],"date":["2020-01-30","2022-08-11","2022-11-10","2022-11-10","2022-11-10","2022-07-14","2021-02-12","2021-02-12","2022-11-02","2022-06-02","2022-07-11","2022-07-11","2022-11-10","2022-02-17","2022-02-17","2022-04-08","2022-02-17","2022-02-17","2020-10-23","2022-04-08","2021-06-15","2022-04-08","2020-10-23","2020-01-16","2020-04-14","2022-02-17","2020-06-10","2020-06-10","2020-06-15","2022-07-17","2020-06-10","2020-06-10","2022-04-08","2022-07-17","2020-06-07","2022-03-16","2022-06-20","2020-06-07","2020-06-07","2020-06-07","2020-06-07","2020-06-07","2022-08-29","2022-08-29","2021-11-14","2020-07-27","2022-02-17","2022-02-17","2022-06-20","2022-03-09","2022-03-09","2022-04-08","2022-04-08","2022-04-08","2022-04-08","2022-04-08","2022-05-09","2022-06-13","2021-02-25","2022-06-13","2021-02-25","2021-02-25","2022-06-22","2021-03-15","2022-08-29","2022-08-29","2020-06-26","2020-06-26","2022-02-02","2022-08-11","2022-08-11","2022-06-20","2022-06-20","2022-06-20","2022-07-11","2020-01-17","2020-02-11","2020-12-07","2020-01-22","2022-04-21","2022-04-21","2022-06-20","2022-06-20","2022-06-20","2022-06-20","2022-07-14","2020-02-18","2020-06-07","2020-06-07","2020-06-15","2020-06-15","2021-11-11","2022-06-22","2021-02-26","2021-02-26","2021-09-09"],"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":[["","69238199207","DIGOXIN","TAB 0.25MG","90","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","90","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","60","Select","Select",""],["","00186037220","SYMBICORT","AER 80-4.5","10","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","50742061610","METOPROL","TAB 50MG ER","60","Select","Select",""],["","68462065629","NORETH\/ETHIN","TAB 0.5-2.5","84","Select","Select",""],["","65862059501","DIVALPROEX","TAB 500MG ER","270","Select","Select",""],["","68382003416","VENLAFAXINE","CAP 37.5 ER","90","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","11534018701","BUT\/APAP\/CAF","CAP ","14","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","59779003875","STOOL","CAP 100MG","180","Select","Select",""],["","29300022705","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","90","Select","Select",""],["","66267008390","DOCUSATE","CAP 100MG","270","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","90","Select","Select",""],["","68462074617","ACYCLOVIR","OIN 0.05","15","Select","Select",""],["","00378967130","IPRATROPIUM\/","SOL ALBUTER","75","Select","Select",""],["","50428032084","GENUINE","TAB 325MG","30","Select","Select",""],["","00310737220","BUDES\/FORMOT","AER 80-4.5","10","Select","Select",""],["","61442010210","DICLOFENAC","TAB 50MG DR","14","Select","Select",""],["","50428152314","CVS","TAB 325MG","30","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","67877057505","BENZONATATE","CAP 200MG","90","Select","Select",""],["","00603533932","PREDNISONE","TAB 20MG","21","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","00054028325","OXYMORPHONE","TAB HCL 5MG","120","Select","Select",""],["","42571016242","AMOX\/K","TAB 875-125","20","Select","Select",""],["","65162055310","METAXALONE","TAB 800MG","20","Select","Select",""],["","70710122501","AMITRIPTYLIN","TAB 10MG","15","Select","Select",""],["","68462046160","TROSPIUM","TAB 20MG","90","Select","Select",""],["","00378247401","DICLOFEN","TAB 50MG","60","Select","Select",""],["","59651000305","OMEPRAZOLE","CAP 40MG","90","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","42192080201","PHENAZOPYRID","TAB 200MG","9","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","10631001030","KAPSPARGO","CAP 100MG","90","Select","Select",""],["","00187099445","ZOVIRAX","CRE 0.05","5","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","68462018135","CLOTRIMAZOLE","CRE 0.01","30","Select","Select",""],["","00536123201","ASPIRIN","TAB 325MG EC","30","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","4","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","10","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","40","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":""}]}]}