{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   ANAIKENOOB A","gend":1,"add":"VRAC 8RIC RE","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1994-08-15","age":"","mstatus":"","insh":"6431410*84","cliId":"","pno":"73\/7576655-2","cno":"","email":"","ename":"","eno":"","pphy":"ERIKSSON, AVERY W PA","ppno":"757\/488-3333","pcpadd":"3925 PORTSMOUTH BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":"","pcpname":"Family Medicine Healthcare, PLLC","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":["F32.9","R51.","G47.00","H40.53X0","H40.211","H40.051","H21.511","D86.9","U07.1","Z79.52","Z79.899","F41.9","N92.6","R42.","M54.9","B34.9","H44.113","H47.11","H21.543","R52.","E55.9","Z13.31","H40.2234","H25.13","R10.9","I10.","Z32.02","K59.00","Z72.0","Z87.891","H57.11","H44.112","H47.13","J02.9","F33.2","Z68.33","Z20.822","S39.92XA","R03.0","H25.11","H26.9","H40.2224","Z53.21","Z01.818","NO DATA","K58.9","D64.9","H30.893","H40.43X4","M79.609","M13.0","J30.9","M35.9","M65.9","E78.5","Z68.35","M47.816","O26.892","N89.8","B00.9","Z33.1","H53.8","H25.12","Z96.1","O13.4","O99.824","Z37.0","Z3A.37","Z3A.00","O21.9","O26.893","N76.0","Z3A.31","W19.XXXA","O9A.213","O98.312","A60.04","Z3A.17","O99.891","Z39.1","O98.32","A60.09","A59.9","O99.02","O99.334","F17.210","O99.324","F12.90","O99.284","E87.6","O13.3"],"date":["2021-08-31","2020-07-14","2022-02-01","2019-06-14","2020-07-14","2019-06-21","2019-06-21","2020-08-03","2020-08-03","2020-08-03","2022-10-14","2022-02-01","2020-12-17","2021-04-20","2021-04-23","2019-03-03","2021-03-19","2019-03-13","2019-03-13","2019-11-15","2019-11-15","2020-04-01","2022-01-12","2021-06-14","2021-07-14","2021-07-13","2021-07-13","2021-07-14","2019-07-17","2019-09-11","2020-07-14","2021-01-08","2021-03-19","2021-08-14","2020-10-27","2020-10-27","2021-04-19","2021-04-21","2021-04-21","2021-09-14","2022-02-08","2019-12-03","2021-04-20","2022-02-01","2022-09-05","2021-10-28","2022-10-14","2019-02-27","2019-02-27","2019-04-04","2019-12-05","2021-07-30","2019-04-04","2019-04-04","2020-04-01","2019-05-22","2019-12-05","2022-05-30","2022-05-30","2022-05-30","2022-03-01","2022-02-01","2022-02-08","2022-02-23","2022-10-15","2022-10-15","2022-10-15","2022-10-15","2022-10-15","2022-04-29","2022-09-05","2022-09-05","2022-09-05","2022-09-05","2022-09-05","2022-05-30","2022-05-30","2022-05-30","2022-05-30","2022-10-04","2022-10-14","2022-10-14","2022-10-14","2022-10-14","2022-10-14","2022-10-14","2022-10-14","2022-10-14","2022-10-14","2022-10-14","2022-10-14"],"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":[["","00378427577","VALACYCLOVIR","TAB 500MG","60","Select","Select",""],["","00904667840","OXYCODONE","SOL 5MG\/5ML","12","Select","Select",""],["","68001038203","LABETALOL","TAB 200MG","90","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","16","Select","Select",""],["","","PREDNISONE","TAB 20MG","","Select","Select",""],["","00054350049","LIDOCAINE","SOL 2% VISC","150","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","24208045705","DICLOFENAC","SOL 0.1% OP","5","Select","Select",""],["","","CITALOPRAM","TAB 20MG","","Select","Select",""],["","68462010630","ONDANSETRON","TAB 8MG","30","Select","Select",""],["","24208060203","PROLENSA","SOL 0.0007","3","Select","Select",""],["","00904531360","PRENATAL","TAB 27-0.8MG","30","Select","Select",""],["","","HYDROXYZ","CAP 50MG","","Select","Select",""],["","","ZOLPIDEM"," ZOLPIDEM ","30","Select","Select",""],["","49884068905","METOCLOPRAM","TAB 10MG","60","Select","Select",""],["","","ACETAMIN","TAB 650MG","","Select","Select",""],["","68382004001","PROMETHAZINE","TAB 12.5MG","60","Select","Select",""],["","00363053112","PAIN","TAB 500MG","30","Select","Select",""],["","","PREDNISOLONE"," PREDNISOLONE ","15","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","4","Select","Select",""],["","00904759060","FEROSUL","TAB 325MG","30","Select","Select",""],["","","ETONOGESTREL","MIS ETHY EST","","Select","Select",""],["","","ELURYNG","MIS ","","Select","Select",""],["","52817033010","CYCLOBENZAPR","TAB 5MG","30","Select","Select",""],["","59651018201","METHOTREXATE","TAB 2.5MG","24","Select","Select",""],["","00023921115","COMBIGAN","SOL 0.2\/0.5%","15","Select","Select",""],["","24208050707","LOTEMAX","GEL 0.0038","5","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","48","Select","Select",""],["","11534016503","FOLIC","TAB 1MG","90","Select","Select",""],["","70010077001","METHOCARBAM","TAB 750MG","20","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","24208048510","DORZOLAMIDE","SOL 2% OP","10","Select","Select",""],["","65649000330","TRULANCE","TAB 3MG","30","Select","Select",""],["","00378543035","MOXIFLOXACIN","SOL HCL 0.5%","3","Select","Select",""],["","61314012605","KETOROLAC","SOL 0.005","5","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","9","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","00574041207","POLYETH","POW 3350 NF","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","65862001305","SERTRALINE","TAB 100MG","30","Select","Select",""],["","","ETONOGESTERE","MIS ETHY EST","","Select","Select",""],["","65862090901","CELECOXIB","CAP 200MG","15","Select","Select",""],["","","TRAZODONE","TAB 50MG","","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","DIAZEPAM","TAB 2MG","","Select","Select",""],["","","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","00766784730","NICORETTE","GUM 2MG MINT","100","Select","Select",""],["","","ACETAMINOPHE","TAB 650MG ER","","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":""}]}]}