{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AEHTORODNNYW L  ","gend":1,"add":"NASUS 793TNATSNOC ","city":"NEWPORT NEWS","state":"VA","zip":"23608-9998","dob":"1978-09-01","age":"","mstatus":"","insh":"6377310*93","cliId":"","pno":"66\/7572069-0","cno":"757\/921-3542","email":"","ename":"","eno":"","pphy":"WEIXLER, WARREN PAUL MD","ppno":"757\/968-5700","pcpadd":"2855 DENBIGH BLVD","pcpcity":"GRAFTON","pcpstate":"VA","pcpzip":23692,"pcpcounty":"","pcpid":"","pcpname":"Patriot Primary Care","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":["J30.89","R09.81","H69.83","R09.82","J34.3","S93.512A","B00.9","Z71.9","F43.22","E66.01","K21.9","M19.90","E55.9","Z68.42","Z23.","Z68.41","Z98.84","R73.01","R63.5","Z71.3","J01.00","Z20.828","F50.9","G50.9","D16.12","G89.18","M25.511","K76.0","K44.9","Z90.710","E16.2","B37.3","K59.00","R11.0","K90.9","Z68.36","Z01.419","Z11.51","Z11.3","Z12.72","J02.9","M25.562","F41.9","K21.0","R13.14","R14.0","R19.7","M79.605","M79.606","J35.01","J35.1","R10.817","Z00.00","Z13.1","Z13.220","E53.8","J30.1","Z01.812","Z20.822","U07.1","Z01.810","Z13.89","Z13.30","H93.8X1","D48.5","Z68.39","N76.0","Z83.3","R35.0","L72.9","I10.","J20.9","Z76.89","R10.2","N94.89","R10.31","N39.0","L28.2"],"date":["2020-12-29","2020-09-11","2020-01-03","2020-09-11","2020-09-11","2020-06-11","2020-08-19","2020-08-19","2021-12-30","2021-07-26","2021-12-30","2021-06-24","2021-09-29","2021-06-24","2021-08-02","2021-07-26","2021-12-30","2020-01-14","2020-01-14","2021-01-12","2021-11-14","2021-03-16","2020-12-15","2021-02-13","2021-05-17","2021-06-14","2021-06-14","2021-06-24","2021-06-24","2021-06-24","2021-08-24","2021-08-24","2021-12-20","2021-12-20","2021-12-30","2021-12-30","2021-07-26","2020-07-16","2021-09-11","2021-07-26","2020-08-28","2021-02-04","2021-02-16","2020-05-21","2020-05-21","2020-05-21","2020-05-21","2021-07-05","2021-10-13","2020-09-11","2020-09-11","2020-10-19","2020-10-27","2020-10-27","2020-10-27","2020-10-27","2021-04-26","2021-06-18","2021-06-18","2020-12-10","2021-06-07","2021-07-26","2021-07-26","2020-02-22","2020-04-29","2021-09-29","2021-09-11","2019-12-23","2019-12-23","2019-11-13","2019-04-29","2019-10-29","2019-04-22","2019-01-08","2019-01-08","2019-01-08","2019-01-08","2019-05-08"],"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":[["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","30","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","60505083001","MOMETASONE","SPR 50MCG","17","Select","Select",""],["","00378623101","CITALOPRAM","TAB 10MG","30","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","15","Select","Select",""],["","41167580005","NASACORT","SPR 55MCG\/AC","17","Select","Select",""],["","00781324664","ENOXAPARIN","INJ 40\/0.4ML","6","Select","Select",""],["","65862044990","VALACYCLOVIR","TAB 1GM","4","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","60","Select","Select",""],["","65862064169","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","00172572860","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","08290305269","3ML","MIS 25GX5\/8\"","1","Select","Select",""],["","00143962125","CYANOCOBALAM","INJ 1000MCG","3","Select","Select",""],["","65862078330","ESOMEPRA","CAP 20MG DR","30","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","68462047401","URSODIOL","TAB 500MG","30","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","","METRONIDAZOL","TAB 500MG","","Select","Select",""],["","66685100100","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","30","Select","Select",""],["","00168034646","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","","AZELASTINE","SPR 0.001","","Select","Select",""],["","","PHENTERMINE","TAB 37.5MG","","Select","Select",""],["","","POLYETH","POW 3350 NF","","Select","Select",""],["","","EPINEPHRINE","INJ 0.3MG","","Select","Select",""],["","","CITRUCEL","POW ORANGE","","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00121077504","GG\/CODEINE","SOL 100-10\/5","118","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00713022580","TRIAMCINOLON","CRE 0.001","80","Select","Select",""],["","57237004105","PENICILLN","TAB 500MG","28","Select","Select",""],["","66993001968","ALBUTEROL","AER HFA","18","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","15","Select","Select",""],["","53746027205","SMZ\/TMP","TAB 800-160","6","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":""}]}]}