{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   EELMIKSNIKYOB R","gend":1,"add":"YENEERF 9802002 TPA EVA ","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1983-03-23","age":"","mstatus":"","insh":"64400210*82","cliId":"","pno":"15\/7574205-3","cno":"757\/606-4391","email":"","ename":"","eno":"","pphy":"MAPANAO, VIVIAN MD","ppno":"757\/483-7100","pcpadd":"Bridge Road Family Medicine 4868 Br","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":"","pcpname":"Bridge Road Family Medicine","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R07.2","R06.02","R79.1","E78.2","D63.8","F32.9","Z13.1","Z20.828","R07.89","Z95.2","Z01.810","R94.39","I48.0","E78.5","Z01.818","N92.0","J45.909","I48.91","E55.9","F41.9","K21.9","NO DATA","Z79.01","J18.9","U07.1","N30.90","R30.9","B34.9","J45.901","R53.83","Z00.00","R39.9","R10.2","R00.2","Z91.19","N93.9","A59.9","J20.9","S69.91XA","R73.02","D64.9","R07.9","N39.0","Z23.","I51.89","I51.7","I07.1","I37.1","N91.5","Z11.3","M54.16","Z68.41","E66.9","R07.81","I25.10","Z95.4","Z88.5","Z88.8","Z91.041","M17.12","N92.6","J30.9","L65.8","L72.0","J01.90","R35.0"],"date":["2020-08-14","2022-10-22","2020-12-10","2022-10-20","2022-10-20","2021-12-28","2020-09-30","2021-04-10","2021-06-21","2022-10-28","2021-12-30","2022-10-28","2022-10-28","2022-10-28","2022-10-28","2022-02-01","2022-10-20","2022-10-20","2022-08-25","2022-08-25","2022-08-25","2021-12-28","2022-10-22","2021-04-22","2021-04-22","2021-12-24","2021-12-24","2021-04-13","2021-04-15","2021-07-01","2021-07-01","2021-07-01","2022-07-08","2020-02-21","2022-07-14","2022-10-22","2021-11-12","2022-04-26","2019-12-27","2019-01-17","2022-10-20","2022-04-26","2019-09-12","2019-09-12","2019-11-08","2019-11-08","2019-11-08","2019-11-08","2022-08-25","2022-07-08","2019-05-13","2019-05-13","2022-02-01","2022-04-26","2022-04-26","2022-04-26","2022-04-26","2022-04-26","2022-04-26","2022-04-19","2022-08-25","2022-10-20","2022-09-29","2022-09-29","2022-10-20","2022-07-08"],"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":[["","27808008601","HYD","SUS 10-8\/5ML","70","Select","Select",""],["","59762219807","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00074364103","LUPRON","INJ 3.75MG","1","Select","Select",""],["","55111012290","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","68382059516","DILTIAZEM","CAP 120MG ER","30","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","00054429731","FUROSEMIDE","TAB 20MG","90","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","18","Select","Select",""],["","51672403201","WARFARIN","TAB 5MG","90","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","20","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","51672200306","CLOTRIMAZOLE","CRE 1% VAG","45","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","20","Select","Select",""],["","76204020060","ALBUTEROL","NEB 0.00083","360","Select","Select",""],["","60505265301","TRAZODONE","TAB 50MG","60","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","180","Select","Select",""],["","59762005601","MEDROXYPR","TAB 10MG","21","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","57237005920","CEFUROXIME","TAB 500MG","14","Select","Select",""],["","00574110404","BROM\/PSE\/DM","SYP ","200","Select","Select",""],["","42937070110","PHENAZOPYRID","TAB 100MG","12","Select","Select",""],["","60846050201","PYRIDIUM","TAB 200MG","6","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","20","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","59267100003","PFIZER","INJ COVID-19","0","Select","Select",""],["","43386055102","TINIDAZOLE","TAB 500MG","4","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","62037059790","CARTIA","CAP 120\/24HR","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","8","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","13","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","00173072020","FLOVENT","AER 220MCG","12","Select","Select",""],["","00186037028","SYMBICORT","AER 160-4.5","6","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","00069097193","VIBRAMYCIN","SYP 50MG\/5ML","200","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","120","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":""}]}]}