{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"   AYNOEKAEHTEB L","gend":1,"add":"LADKAO 9071F TPA YAW E","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1975-10-25","age":"","mstatus":"","insh":"7041210*61","cliId":"","pno":"74\/7574103-3","cno":"757\/473-3014","email":"","ename":"","eno":"","pphy":"ESPINO, STEPHANIE L DO","ppno":"757\/548-0076","pcpadd":"725 VOLVO PKWY STE 100","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"Volvo 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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R91.1","J45.909","M54.9","E87.6","S16.1XXA","S39.012A","K21.9","Z88.1","Z79.899","M54.5","I10.","J45.40","J30.9","R06.02","M54.6","J45.901","Z00.00","Z12.4","Z12.31","R93.7","NO DATA","E78.5","D50.9","M43.6","J98.01","R05.","G43.909","R51.","E01.0","Z20.828","D72.828","M47.812","E04.2","R49.8","J30.1","D50.8","R79.89","E55.9","E53.8","E03.8","M19.90","I15.8","Z68.30","M48.02","R07.9","M48.12","R49.0","D72.829","M25.512"],"date":["2020-11-24","2020-09-30","2021-08-26","2020-01-13","2020-02-28","2020-02-28","2021-12-07","2020-02-28","2020-02-28","2020-06-05","2022-07-01","2020-11-24","2020-11-24","2022-08-16","2022-08-16","2020-08-06","2022-04-19","2022-04-19","2022-04-19","2022-04-19","2022-07-01","2022-07-01","2022-07-01","2022-04-19","2020-01-11","2020-09-17","2021-10-01","2020-02-28","2021-12-28","2021-05-11","2022-08-23","2022-07-20","2021-12-07","2021-12-07","2021-12-07","2022-08-09","2022-08-09","2022-08-09","2022-08-09","2022-08-09","2022-08-09","2022-08-09","2022-08-09","2021-12-28","2022-08-16","2022-10-26","2022-06-22","2022-07-01","2022-10-26"],"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":[["","00527143501","METAXALONE","TAB 800MG","90","Select","Select",""],["","29300011616","TOPIRAMATE","TAB 50MG","30","Select","Select",""],["","65862044830","VALACYCLOVIR","TAB 500MG","90","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","00245010810","FERROUS","TAB 325MG EC","90","Select","Select",""],["","29300041519","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","13107007501","BUT\/APAP\/CAF","CAP ","30","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","27241009803","DULOXETINE","CAP 30MG","30","Select","Select",""],["","00093075301","ATENOLOL","TAB 100MG","90","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","90","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","00591544305","PREDNISONE","TAB 20MG","21","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","20","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","60","Select","Select",""],["","31604002585","VITAMIN","CAP 2000UNIT","60","Select","Select",""],["","31604004073","D3","CAP 2000UNIT","60","Select","Select",""],["","00597016061","SPIRIVA","AER 1.25MCG","4","Select","Select",""],["","66993058597","FLUTIC\/SALME","AER 250\/50","60","Select","Select",""],["","45802008801","ALBUTEROL","AER HFA","8","Select","Select",""],["","00904759080","FEROSUL","TAB 325MG","90","Select","Select",""],["","59746000103","METHYLPRED","TAB 4MG","21","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","14","Select","Select",""],["","57896070310","IRON","TAB 325MG","90","Select","Select",""],["","68645056354","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","00172392570","DIAZEPAM","TAB 2MG","20","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","120","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00603107558","CHERATUSSIN","SYP AC","120","Select","Select",""],["","00173087310","INCRUSE","INH 62.5MCG","30","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":""}]}]}