{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"F L   ATSEKRUBREDNU","gend":1,"add":"D KRAP 531I TPA N R","city":"PETERSBURG","state":"VA","zip":"23805-9998","dob":"1962-11-30","age":"","mstatus":"","insh":"67200210*11","cliId":"","pno":"93\/4081022-7","cno":"804\/426-3295","email":"","ename":"","eno":"","pphy":"SARAIYA, BHAVNA MD","ppno":"","pcpadd":"50 MEDICAL PARK BLVD SUITE C","pcpcity":"PETERSBURG","pcpstate":"VA","pcpzip":23805,"pcpcounty":"","pcpid":"","pcpname":"SOUTHSIDE PHYSICIANS NETWORK - INTERNAL MEDICINE","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","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":["C77.3","C50.811","Z13.6","Z13.89","Z13.83","R25.2","F32.9","I10.","J45.20","R82.90","R53.83","R68.89","C50.911","F41.9","Z79.811","K21.9","Z17.0","Z01.810","Z90.11","Z92.3","R50.9","Z48.3","J45.909","I25.10","Z79.891","Z79.52","Z48.817","R63.5","Z85.3","Z68.32","R10.2","M17.0","I51.7","M23.331","M70.51","M17.11","L76.82","D72.829","L03.313","Z51.11","Z51.89","M62.830","K59.00","K29.00","M25.562","D17.5","K57.90","K25.9","I50.30","I34.0","R06.02","R94.31","Z45.2","Z20.822","E89.0","M19.90","E66.9","Z96.653","Z92.21","Z79.51","Z79.899","Z91.040","Z91.018","Z88.5","C50.112","R07.9","M15.9","M50.30","M51.36","R62.7","A41.9","T81.41XA","D64.9","I95.9","Z23.","Z56.0","Z88.2","Z88.8","Z12.31","C50.111","L28.0","L29.8","L20.84","L81.4","L90.5","Z51.0","M17.12","S83.92XA","Z20.828","R06.00","R42.","R53.1","Z01.818","Z13.9","R10.30","R50.82","Z98.890","B95.8","D23.71","R51.9","R07.89","R94.39","R55.","R00.2","R35.0","C50.919","I45.9","R30.0","Z11.3","NO DATA","I37.1","R10.32","M06.4","R69.","R52.","E07.9","Z80.1","Z82.49","Z83.3","Z90.49","Z90.13","Z01.411","Z12.4","R10.9","R13.10","K63.5","R19.4","I47.1","Z86.79","N65.1","H53.9","C50.011","R01.1","I36.1","I31.3","Z01.419","D35.02","R63.8","E11.9","E86.0","C50.411","R19.7","Z85.9","T81.49XA","I50.21","R92.8","I21.29","R68.83","R10.13","R77.8","N76.0","N89.8","E55.9","Z87.440","Z13.220","N30.01","N95.0","N84.0","N17.9","F99.","I21.4","D35.00","Z68.30","S80.861A","L53.8","N30.00"],"date":["2020-03-11","2022-10-06","2020-11-09","2020-11-09","2020-11-09","2021-01-20","2022-05-04","2022-10-06","2022-10-06","2021-06-22","2021-01-20","2021-01-20","2022-07-12","2022-10-06","2022-10-06","2021-01-20","2022-10-06","2021-03-02","2021-08-11","2021-04-07","2021-04-21","2021-05-04","2022-08-11","2021-05-04","2021-05-04","2021-05-04","2021-05-21","2021-11-04","2022-10-06","2022-03-21","2022-03-21","2021-02-23","2022-08-31","2021-02-03","2021-02-23","2021-02-23","2021-04-18","2021-04-18","2021-05-08","2020-08-03","2020-08-03","2020-07-07","2022-10-06","2020-07-07","2020-07-07","2020-11-02","2020-11-02","2020-11-02","2020-11-13","2022-08-10","2020-11-13","2020-11-13","2021-03-02","2021-04-18","2021-04-18","2021-04-07","2022-10-06","2021-04-07","2021-04-07","2022-10-06","2022-10-06","2021-04-07","2021-04-07","2021-09-24","2020-03-10","2021-04-17","2021-03-23","2021-03-23","2021-03-23","2021-04-14","2021-04-18","2021-04-21","2021-04-18","2021-04-18","2021-04-18","2021-04-18","2021-09-24","2021-04-18","2022-07-12","2021-06-04","2022-05-04","2022-05-04","2022-05-04","2022-05-04","2021-10-27","2020-03-02","2020-12-22","2020-10-14","2020-11-09","2020-11-09","2020-11-09","2021-09-24","2021-07-29","2021-04-06","2021-04-18","2021-04-18","2021-07-29","2021-04-21","2021-05-26","2021-09-24","2022-08-31","2020-11-20","2022-08-31","2022-08-31","2020-04-07","2022-08-11","2021-04-20","2022-09-13","2021-06-22","2022-07-12","2020-01-14","2020-06-15","2021-02-23","2021-05-11","2021-09-24","2022-03-10","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2021-09-24","2020-08-20","2020-08-20","2020-10-22","2020-10-22","2020-10-22","2020-10-22","2020-11-13","2020-11-20","2021-08-11","2021-09-24","2019-09-09","2019-08-28","2019-08-28","2022-08-31","2019-05-13","2019-07-01","2019-06-07","2019-06-07","2019-09-20","2019-06-21","2019-08-28","2019-12-03","2019-06-25","2019-11-01","2019-05-22","2019-07-02","2019-08-27","2019-08-27","2022-08-10","2022-09-23","2022-09-23","2022-05-04","2022-05-04","2022-05-04","2022-03-10","2022-04-01","2022-04-01","2022-08-11","2022-08-11","2022-08-12","2022-10-06","2022-10-06","2022-05-04","2022-05-04","2022-07-12"],"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":[["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","31604002671","VITAMIN","TAB 400UNIT","60","Select","Select",""],["","","MONTELUKAST","TAB 10MG","","Select","Select",""],["","43547035011","PAROXETINE","TAB 40MG","30","Select","Select",""],["","55111017915","TIZANIDINE","TAB 2MG","90","Select","Select",""],["","11509000372","VAGISIL","CRE 20-3%","28","Select","Select",""],["","","ANASTROZOLE","TAB 1MG","","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","45802005436","TRIAMCINOLON","OIN 0.00025","80","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","61269073063","MICONAZOLE","CRE 0.02","45","Select","Select",""],["","","PREDNISONE","TAB 50MG","","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","20","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","68180051902","LISINOP\/HCTZ","TAB 20-12.5","30","Select","Select",""],["","00574222545","TRETINOIN","CRE 0.00025","45","Select","Select",""],["","00093101042","MUPIROCIN","OIN 0.02","22","Select","Select",""],["","68382070718","DOXYCYC","CAP 100MG","60","Select","Select",""],["","00254100752","ALBUTEROL","AER HFA","7","Select","Select",""],["","70461031903","FLUCLVX","INJ 2019-20","0","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","00054032756","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","67877032005","IBUPROFEN","TAB 600MG","21","Select","Select",""],["","57896045401","GERI-KOT","TAB 8.6MG","14","Select","Select",""],["","70000044701","SENNA","TAB 8.6MG","14","Select","Select",""],["","67877022301","GABAPENTIN","CAP 300MG","18","Select","Select",""],["","00115164501","NITROFUR","CAP 100MG","10","Select","Select",""],["","00363032706","GENTLE","TAB 5MG EC","10","Select","Select",""],["","57896010201","ACETAMINOPHE","TAB 325MG","84","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","14","Select","Select",""],["","00904645760","DOK","CAP 100MG","14","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00406055201","OXYCODONE","TAB 5MG","20","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","68462010630","ONDANSETRON","TAB 8MG","30","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","00591264001","BUT\/APAP\/CAF","CAP ","20","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","28","Select","Select",""],["","10135012310","ACETAMIN","TAB 325MG","20","Select","Select",""],["","65162062711","TRAMADOL","TAB 50MG","12","Select","Select",""],["","00527155201","BUT\/ASA\/CAFF","CAP ","10","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0","Select","Select",""],["","","ATENOLOL","TAB 50MG","","Select","Select",""],["","67877019810","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","","PHENAZOPYRID","TAB 200MG","","Select","Select",""],["","","LINZESS","CAP 145MCG","","Select","Select",""],["","","BP","KIT WRIST","","Select","Select",""],["","","GAVILYTE-G","SOL ","","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","","PYRIDIUM","TAB 200MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 5MG","","Select","Select",""],["","","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","","WIXELA","AER 250\/50","","Select","Select",""],["","","POLYETH","POW 3350 NF","","Select","Select",""],["","","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","","SYMBICORT","AER 160-4.5","","Select","Select",""],["","","GOLYTELY","SOL ","","Select","Select",""],["","","AFLURIA","INJ 2020-21","","Select","Select",""],["","","PEG-3350","SOL ELECTROL","","Select","Select",""],["","","BANOPHEN","CAP 50MG","","Select","Select",""],["","","NABUMETONE","TAB 500MG","","Select","Select",""],["","00228202996","ALPRAZOLAM","TAB 0.5MG","3","Select","Select",""],["","62332000191","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","69367016607","FERROUS","TAB 325MG EC","180","Select","Select",""],["","49281058905","MENACTRA","INJ ","0","Select","Select",""],["","00406324301","HYDROMORPHON","TAB 2MG","28","Select","Select",""],["","16729017101","AMITRIPTYLIN","TAB 10MG","30","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","20","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","30","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","00054418425","DEXAMETHASON","TAB 4MG","12","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":""}]}]}