{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" ELLEHCIMELBOC L  ","gend":1,"add":" YAB 12221NL ROBRAH","city":"CARROLLTON","state":"VA","zip":"23314-9998","dob":"1973-04-05","age":"","mstatus":"","insh":"6680110*17","cliId":"","pno":"32\/7575659-8","cno":"757\/238-9565","email":"","ename":"","eno":"","pphy":"SMITH, EDDIE L MD","ppno":"757\/238-8751","pcpadd":"130609 CARROLLTON BLVD STE 11","pcpcity":"CARROLLTON","pcpstate":"VA","pcpzip":23314,"pcpcounty":"","pcpid":"","pcpname":"EAGLE HARBOR MEDICAL ASSOCIATES","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.1","N92.0","N92.5","Z01.810","I11.9","R07.89","R56.9","R60.9","N39.0","R10.9","F11.20","F17.210","F12.10","N73.9","Z16.11","M19.90","K21.9","J44.9","B96.20","Z88.0","Z87.11","Z90.710","Z82.49","Z80.9","Z83.3","M25.559","M54.5","M25.812","M18.9","Z79.899","I10.","F41.9","G93.40","F10.231","R41.82","G40.909","F10.129","N17.9","R55.","G31.84","Z68.38","V54.12","R10.13","Z86.010","K44.9","K22.8","R63.5","R60.0","F12.90","Z72.0","N12.","Z20.822","Z96.89","K27.9","K52.9","T81.89XA","S62.647A","S30.1XXA","Z87.898","M25.50","Z12.31","Z68.36","M54.40","Z68.34","N95.2","N81.5","R07.9","Z01.818","R32.","S62.617A","I87.2","J02.9","E66.9","N39.3","N30.01","V58.69","R19.7","R11.2","R11.10","R52.","F41.1","L20.81","D48.5","Z20.828","N81.6","R39.198"],"date":["2021-03-02","2020-05-14","2020-05-14","2020-11-12","2020-09-04","2021-11-11","2020-09-04","2020-09-04","2022-01-24","2021-10-24","2022-10-19","2022-10-19","2022-10-19","2020-06-02","2020-05-21","2020-05-21","2021-11-08","2020-08-31","2020-05-21","2022-01-23","2021-10-24","2020-07-21","2020-05-21","2020-05-21","2020-05-21","2020-02-12","2020-02-12","2020-02-12","2020-02-12","2022-01-23","2022-01-23","2021-03-02","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-12-02","2020-11-11","2020-11-11","2020-11-17","2022-03-24","2020-02-06","2020-02-06","2020-02-06","2020-03-02","2020-03-02","2020-08-31","2021-11-11","2022-01-23","2022-01-23","2022-01-23","2022-03-24","2022-03-24","2020-05-21","2020-10-27","2021-04-22","2021-05-24","2022-08-09","2021-11-08","2021-09-14","2021-11-08","2021-11-08","2021-12-17","2022-03-01","2020-01-06","2020-05-07","2020-05-07","2020-11-06","2021-11-11","2022-08-09","2021-09-08","2020-05-14","2020-05-21","2021-09-08","2021-09-06","2021-10-27","2020-06-03","2020-06-03","2021-03-02","2022-07-13","2022-07-13","2021-02-25","2022-07-25","2022-07-25"],"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":[["","59651000305","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","65162079108","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","20","Select","Select",""],["","70010013901","NAPROXEN","TAB 500MG","20","Select","Select",""],["","65162068110","PHENAZOPYRID","TAB 100MG","9","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","21","Select","Select",""],["","00046087221","PREMARIN","CRE 0.625MG","30","Select","Select",""],["","68180098103","LISINOPRIL","TAB 20MG","60","Select","Select",""],["","00406052201","OXYCOD\/APAP","TAB 7.5-325","20","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","56","Select","Select",""],["","00093216568","NALOXONE","SPR ","2","Select","Select",""],["","45802006305","TRIAMCINOLON","CRE 0.00025","454","Select","Select",""],["","45802049326","AMMONIUM","CRE 0.12","385","Select","Select",""],["","69097015907","MELOXICAM","TAB 15MG","30","Select","Select",""],["","62332025118","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00121086816","NYSTATIN","SUS 100000","200","Select","Select",""],["","00093083205","CLONAZEPAM","TAB 0.5MG","60","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","8","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","15","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","28","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00093221001","SUCRALFATE","TAB 1GM","30","Select","Select",""],["","65162074510","PROMETHAZINE","TAB 12.5MG","30","Select","Select",""],["","65862039010","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","37000045502","PRILOSEC","TAB 20MG","60","Select","Select",""],["","69097014260","ALBUTEROL","AER HFA","7","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","00603233832","APAP\/CODEINE","TAB 300-30MG","5","Select","Select",""],["","00378021610","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","42858030101","HYDROMORPHON","TAB 2MG","10","Select","Select",""],["","49483060350","IBUPROFEN","TAB 600MG","30","Select","Select",""],["","43386035701","HYDROCO\/APAP","TAB 7.5-325","20","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","11822318460","ANTI-DIARRHE","TAB 2MG","30","Select","Select",""],["","47781030301","NITROFURANTN","CAP 100MG","20","Select","Select",""],["","65862007601","CIPROFLOXACN","TAB 250MG","20","Select","Select",""],["","65162027210","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","10702025301","BUT\/APAP\/CAF","TAB ","30","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","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":""}]}]}