{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"C YLLEKYLLONNO","gend":1,"add":"EDEVLEB 2117 TPA DR ER","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1976-03-18","age":"","mstatus":"","insh":"75200210*60","cliId":"","pno":"13\/7570178-8","cno":"757\/373-2188","email":"","ename":"","eno":"","pphy":"MARKOVIC, VLADIMIR MD","ppno":"757\/393-6363","pcpadd":"3415 GRANBY STREET","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":"","pcpname":"Park Place Family Medical Center","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Q18.0","M54.2","G89.29","R22.1","C83.31","J18.9","M54.5","G89.3","C85.90","D70.9","Z51.5","R07.81","F11.20","Z20.828","F19.20","Z51.0","Z11.59","R10.12","K59.00","A41.02","R68.83","R11.2","R19.7","J45.909","F31.9","F60.3","I88.9","Z51.11","Z51.12","M35.00","J15.212","K92.2","F31.63","D70.1","T45.1X5A","K92.1","Z45.2","R10.9","S30.0XXA","R55.","R63.0","M25.50","C85.91","F51.01","F90.0","F41.9","R41.3","F33.2","L04.0","J45.40","Z76.5","F39.","R56.9","R41.0","L30.9","S80.01XA","M62.830","I87.2","R30.0","N30.01","F90.9","F31.64","R59.0","C85.10","R07.9","J85.1","D64.81","F19.10","Z82.49","Z87.891","F12.90","M25.561","R63.5","L85.3","M25.562","T50.901A","Z12.31","M54.31","R13.13","N10.","G50.1","R41.82","R93.89","F41.0","L98.9","N30.00","G43.909","Z76.0","F31.5","F60.9","G92.","Z91.5","M79.7","N18.9","F12.20","Z88.1","Z91.040","Z91.018","Z88.2","F31.30","M54.32","Z72.0","S39.012A","G43.009","F31.62","F32.9","S01.05XA","W54.0XXA","L03.114","S61.452A","F31.2","R53.81","M54.40","Z68.25","F31.4","F90.1","F23.","R40.1","R03.0"],"date":["2020-03-24","2021-05-19","2020-03-17","2020-03-30","2021-12-22","2020-07-22","2021-06-10","2020-06-20","2021-08-03","2020-06-20","2020-06-20","2020-06-20","2020-06-20","2020-07-25","2020-06-20","2020-08-05","2020-06-15","2020-06-19","2020-06-19","2020-06-23","2020-07-25","2021-04-23","2020-07-25","2021-12-28","2020-06-15","2020-06-15","2020-02-28","2020-06-05","2020-06-05","2020-05-15","2020-06-23","2020-07-22","2020-02-05","2020-06-23","2020-06-23","2020-07-28","2021-08-03","2021-04-23","2020-01-25","2020-02-26","2021-07-14","2020-05-06","2021-06-10","2021-11-15","2021-11-15","2021-11-15","2020-10-29","2021-11-15","2020-03-30","2020-04-13","2020-06-15","2020-06-15","2020-08-09","2020-08-09","2020-08-09","2021-03-05","2021-03-05","2021-03-05","2020-01-15","2020-01-15","2020-03-04","2020-02-03","2020-03-04","2020-04-20","2020-05-16","2020-06-15","2020-06-15","2021-04-12","2020-06-15","2020-06-15","2020-06-15","2021-06-10","2021-03-09","2021-03-09","2021-06-10","2020-01-05","2020-03-18","2020-03-18","2020-03-24","2020-09-24","2020-12-14","2021-04-12","2021-04-12","2021-04-12","2021-04-12","2021-10-06","2021-10-06","2021-11-15","2019-04-18","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2019-08-04","2019-09-26","2019-11-12","2019-02-06","2019-09-10","2019-06-05","2019-12-06","2019-12-06","2019-02-20","2019-04-03","2019-04-03","2019-04-03","2019-04-16","2019-08-03","2019-12-16","2019-12-16","2019-02-11","2019-02-11","2019-04-15","2019-08-03","2019-12-04"],"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":[["","","PREGABALIN","CAP 200MG","","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","70677001301","SM","OIN ANTIBIOT","28","Select","Select",""],["","10702010201","METHYLPHENID","TAB 20MG","90","Select","Select",""],["","","NABUMETONE","TAB 500MG","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","00597002402","COMBIVENT","AER 20-100","4","Select","Select",""],["","00406052301","OXYCOD\/APAP","TAB 10-325MG","10","Select","Select",""],["","","CERAVE","LOT SPF 30","","Select","Select",""],["","43547040711","CLONAZEPAM","TAB 1MG","60","Select","Select",""],["","81131011184","HAIR\/SKIN\/","TAB NAILS","30","Select","Select",""],["","59746017710","CYCLOBENZAPR","TAB 10MG","60","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","16714033002","GABAPENTIN","TAB 600MG","180","Select","Select",""],["","65862019405","FLUOXETINE","CAP 40MG","30","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","66993068530","OLANZAPINE","TAB 20MG","30","Select","Select",""],["","","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","","PANOXYL-4","LIQ CREM WSH","","Select","Select",""],["","","FAMOTIDINE","TAB 20MG","","Select","Select",""],["","00713062231","TRIPLE","OIN PLUS","28","Select","Select",""],["","66993092606","LAVOCLEN-4","LIQ CREM WSH","170","Select","Select",""],["","16714062202","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","00115169449","EPINEPHRINE","INJ 0.3MG","2","Select","Select",""],["","","PANOXYL","LIQ 0.04","","Select","Select",""],["","","ONDANSETRON","TAB 8MG ODT","","Select","Select",""],["","65862078430","ESOMEPRA","CAP 40MG DR","30","Select","Select",""],["","55111018010","TIZANIDINE","TAB 4MG","60","Select","Select",""],["","00299391816","CETAPHIL","LOT MOISTURE","473","Select","Select",""],["","","PHENAZOPYRID","TAB 200MG","","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","33342009441","RIZATRIPTAN","TAB 10MG ODT","10","Select","Select",""],["","52569013905","HM","TAB WOMEN","30","Select","Select",""],["","67877021560","CEFUROXIME","TAB 250MG","20","Select","Select",""],["","49348027472","DOUBLE","OIN ","15","Select","Select",""],["","00487020103","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","80777027399","MODERNA","INJ COVID-19","0","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00002442030","ZYPREXA","TAB 20MG","30","Select","Select",""],["","31722053305","METHOCARBAM","TAB 500MG","60","Select","Select",""],["","00501373005","NEOSPORIN","OIN ORIGINAL","15","Select","Select",""],["","00591079501","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","40","Select","Select",""],["","73796009920","ADULT","MIS ","1","Select","Select",""],["","72140011019","EUCERIN","LOT HEALING","250","Select","Select",""],["","65162055310","METAXALONE","TAB 800MG","60","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","30","Select","Select",""],["","65162046650","IBUPROFEN","TAB 800MG","100","Select","Select",""],["","16571020111","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","20","Select","Select",""],["","","HYDROMORPHON","TAB 2MG","","Select","Select",""],["","","CREAMY","LIQ WASH 4%","","Select","Select",""],["","","BIOTENE","LIQ DRY MTH","","Select","Select",""],["","50383066730","LIDO\/PRILOCN","CRE 2.5-2.5%","30","Select","Select",""],["","00603188016","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","57664037718","TRAMADOL","TAB 50MG","14","Select","Select",""],["","","MORPHINE","TAB 60MG ER","","Select","Select",""],["","","COMP","MIS COMP\/NEB","","Select","Select",""],["","00603254428","BUT\/APAP\/CAF","TAB ","60","Select","Select",""],["","","PROMETHAZINE","TAB 12.5MG","","Select","Select",""],["","00536105022","CALC","CHW 750MG","30","Select","Select",""],["","55111068405","IBU","TAB 800MG","60","Select","Select",""],["","","AMOXICILLIN","TAB 875MG","","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","00591024110","LORAZEPAM","TAB 1MG","42","Select","Select",""],["","","PROCHLORPER","TAB 10MG","","Select","Select",""],["","65862096801","ESZOPICLONE","TAB 2MG","30","Select","Select",""],["","","LINEZOLID","TAB 600MG","","Select","Select",""],["","","ETODOLAC","TAB 400MG","","Select","Select",""],["","","NARCAN","SPR ","","Select","Select",""],["","","ALPRAZOLAM","TAB 1MG","","Select","Select",""],["","","SENNA","TAB 8.6MG","","Select","Select",""],["","00115544513","BUPROPION","TAB 200MG SR","60","Select","Select",""],["","00378044201","PERPHEN\/AMIT","TAB 2-25MG","92","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","16500007410","ONE-A-DAY","TAB WOMENS","30","Select","Select",""],["","51991029201","OXCARBAZEPIN","TAB 150MG","60","Select","Select",""],["","50111043401","TRAZODONE","TAB 100MG","30","Select","Select",""],["","16714083501","ZIPRASIDONE","CAP 20MG","60","Select","Select",""],["","00135024602","TUMS","CHW 750MG","30","Select","Select",""],["","00536589588","NICOTINE","DIS 14MG\/24H","28","Select","Select",""],["","59088081907","LIDOCAINE\/HC","CRE 3%-0.5%","85","Select","Select",""],["","16714061205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","44183044201","NODOLOR","CAP ","60","Select","Select",""],["","50428147651","MOISTURIZING","LOT ","473","Select","Select",""],["","31604004045","MULTI","CAP FOR HER","90","Select","Select",""],["","16714043901","NITROFURANTN","CAP 100MG","6","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":""}]}]}