{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ECIRTAKTTOCS ","gend":1,"add":" LANAC 1031G5 TPA EVA","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1974-12-24","age":"","mstatus":"","insh":"7975210*32","cliId":"","pno":"99\/7578951-8","cno":"757\/998-1598","email":"","ename":"","eno":"","pphy":"WHITEHURST, CANDACE MD","ppno":"757\/622-8358","pcpadd":"930 W 21ST ST STE 100","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS GHENT STATION 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":["R05.","N30.01","R07.89","L29.2","Z11.3","J02.9","R09.89","Z20.822","N64.4","R63.5","N94.10","J06.9","B97.89","R91.1","J45.909","G56.03","C50.911","Z79.810","G89.4","Z68.33","R60.0","M25.522","F41.9","F32.9","M79.7","E66.9","G47.00","E55.9","Z76.0","G89.29","Z68.32","R12.","K21.9","D50.9","D64.9","M77.12","Z08.","Z85.3","Z86.2","B34.9","K59.00","Z80.0","J45.40","R13.10","Z12.11","K43.9","R39.15","R11.0","R10.11","J30.2","L72.0","M26.621","N76.4","S50.02XA","C80.1","D72.819","Z68.31","Z01.419","R52.","Z17.0","R14.0","J45.41","B37.3","Z23.","E78.5","M79.2","R20.2","R53.83","J01.01","B96.89","M25.552","M25.512","R41.89","Z68.30","Z79.899","J01.20"],"date":["2021-09-25","2020-09-23","2020-12-01","2021-02-12","2022-09-12","2021-09-22","2021-09-22","2021-09-22","2022-03-30","2022-03-30","2022-09-30","2020-03-24","2020-03-24","2022-06-15","2020-05-12","2021-08-20","2021-07-15","2021-07-15","2021-07-15","2021-07-15","2021-07-29","2021-08-20","2022-07-14","2021-07-29","2021-07-29","2022-07-14","2022-07-14","2022-07-14","2021-07-29","2021-07-29","2021-08-26","2020-04-23","2021-09-25","2021-01-21","2022-07-14","2021-08-29","2022-06-15","2022-06-15","2022-06-15","2020-02-12","2021-08-26","2020-08-07","2021-07-29","2021-10-13","2021-10-13","2022-08-05","2022-09-12","2020-06-01","2020-06-01","2021-03-12","2021-03-12","2021-03-12","2021-10-26","2022-05-15","2020-03-16","2020-03-16","2020-03-16","2020-09-03","2021-01-21","2021-01-21","2021-08-26","2020-05-06","2020-07-30","2020-12-15","2022-07-14","2020-12-15","2021-01-18","2021-05-13","2021-05-24","2021-05-24","2022-05-18","2022-05-18","2022-07-14","2022-07-14","2022-07-14","2022-07-23"],"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":[["","10702002501","PHENTERMINE","TAB 37.5MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","69238110002","DOXYCYCL","CAP 100MG","14","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00456120230","LINZESS","CAP 290MCG","30","Select","Select",""],["","66993058697","FLUTIC\/SALME","AER 500\/50","60","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","17","Select","Select",""],["","00173069600","ADVAIR","AER 250\/50","60","Select","Select",""],["","57237007710","ONDANSETRON","TAB 4MG ODT","10","Select","Select",""],["","10702000709","CYCLOBENZAPR","TAB 10MG","20","Select","Select",""],["","55111015810","OMEPRAZOLE","CAP 20MG","60","Select","Select",""],["","10370010150","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","00254101196","SUCRALFATE","SUS 1GM\/10ML","560","Select","Select",""],["","68382005105","MELOXICAM","TAB 15MG","30","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","49281042150","FLUZONE","INJ 2021-22","0","Select","Select",""],["","00591247330","TAMOXIFEN","TAB 20MG","30","Select","Select",""],["","52565004215","NYSTAT\/TRIAM","OIN ","30","Select","Select",""],["","70710111108","TIZANIDINE","CAP 2MG","21","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","90","Select","Select",""],["","67877022210","GABAPENTIN","CAP 100MG","90","Select","Select",""],["","64380071306","BENZONATATE","CAP 200MG","30","Select","Select",""],["","50111078710","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","00054418625","DEXAMETHASON","TAB 6MG","5","Select","Select",""],["","10572010001","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","50383077504","LIDOCAINE","SOL 2% VISC","100","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","300","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","1","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","65162047810","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","65649040001","PLENVU","SOL ","3","Select","Select",""],["","00378932132","WIXELA","AER 250\/50","60","Select","Select",""],["","45802057178","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","20","Select","Select",""],["","68180012201","CEPHALEXIN","CAP 500MG","40","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","14","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":""}]}]}