{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" NONGIMYELGNAL","gend":1,"add":"L EERTEKOMS 689SOMAR ANIREV N","city":"VIRGINIA BEACH","state":"VA","zip":"23452-9998","dob":"1977-06-18","age":"","mstatus":"","insh":"80300210*48","cliId":"","pno":"57\/7575227-4","cno":"","email":"","ename":"","eno":"","pphy":"LEUZZI, REBECCA A NP","ppno":"757\/352-2020","pcpadd":"1168 FIRST COLONIAL RD","pcpcity":"VIRGINIA BEACH","pcpstate":"VA","pcpzip":23454,"pcpcounty":"","pcpid":"","pcpname":"Endocrinology Consultants Chesapeake","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":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N39.41","N39.3","T87.89","L84.","C50.411","G35.","I13.0","I50.9","E11.22","N18.3","I69.351","E11.42","E11.3291","D63.1","Z79.4","Z89.422","Z91.81","Z79.82","G60.3","E11.69","M86.471","Z47.81","I82.622","NO DATA","M10.9","E11.3293","I25.2","E78.2","E66.01","M86.9","L97.512","E11.3292","Z79.01","Z79.52","Z17.0","Z00.00","I10.","E66.9","E11.9","E78.5","R79.9","J30.9","K21.9","R04.0","Z71.9","Z76.0","E11.621","L97.509","L97.919","Z12.11","K59.00","I25.10","L97.511","L97.521","G51.0","L03.90","U07.1","I21.4","I12.9","R40.2410","R00.1","R74.8","E08.621","L97.421","L97.411","N18.31","K21.00","M54.17","Z48.3","Z89.411","Z51.0","L02.612","B35.1","H40.1112","Z20.828","Z80.0","L03.116","L97.522","M20.10","M14.671","M79.671","M79.605","Z01.818","M86.171","L97.523","E11.628","S98.111A","L08.9","I82.B12","I82.612","T82.9XXA","E11.40","R10.9","R11.0","N39.0","R82.90","E55.9","D64.9","M54.5","R00.0","R77.8","S81.809A","J12.89","N32.81","Z04.9","T81.42XA","Z45.2","M79.89","B99.9","L53.9","L97.529","T82.524A","E87.6","M76.821","M72.2","H40.1122","K59.09","Z23.","I34.0","L97.401","L97.501","M86.272","T81.49XA","Z68.42","E11.319","Z20.822","Z88.8","Z89.421","Z86.73","Z86.14","E11.622","T14.8XXA","Z68.43","Z09.","B37.0","Z01.810","I51.7","H40.1131","H25.013","Z79.84","L97.516","E61.1","I82.A12","E03.9","R35.8","I50.22","B37.81","M21.6X1","I87.2","R60.0","E78.9","L21.0","B35.0","Z89.419","R69.","R60.9","M79.672","M25.571","C50.919","N17.9","Z90.49","S98.132A","D63.8","Z91.11","M79.606","E11.65","E11.36","R53.1","R26.81","R54.","C50.911","D05.11","R01.1","D05.91","E11.618","J30.1","R26.9","G62.9","L25.9","E11.21","L70.0","L81.0","I73.9","M79.604","Z91.19","R92.1","I50.30","C44.501"],"date":["2021-02-24","2021-02-17","2020-09-03","2021-08-24","2021-03-22","2021-11-02","2021-11-02","2021-11-02","2021-11-02","2020-09-03","2021-02-01","2021-11-02","2021-02-01","2021-11-02","2021-11-02","2021-02-26","2020-07-03","2021-11-02","2021-08-24","2021-09-03","2021-09-22","2021-09-03","2021-09-03","2021-11-02","2021-11-02","2021-09-03","2021-11-02","2021-11-02","2021-11-02","2021-09-02","2021-08-18","2021-11-02","2021-11-02","2021-11-02","2020-08-17","2020-10-26","2021-09-02","2020-10-26","2021-09-02","2021-09-02","2020-10-26","2020-02-17","2021-06-13","2020-02-17","2021-03-12","2021-03-12","2021-11-22","2020-12-01","2020-05-22","2020-12-16","2020-12-16","2020-11-03","2021-04-29","2021-04-26","2021-02-01","2021-01-18","2021-02-19","2021-02-19","2021-02-19","2021-02-01","2021-02-03","2021-02-04","2021-04-29","2021-04-29","2021-04-29","2021-07-16","2021-07-16","2021-08-24","2020-01-06","2020-01-06","2020-01-20","2020-06-30","2021-03-30","2020-09-24","2020-12-12","2020-12-16","2021-02-01","2021-06-02","2021-08-31","2021-08-31","2021-10-28","2021-04-13","2021-04-13","2021-06-15","2021-06-13","2021-06-13","2021-06-10","2021-06-15","2021-07-08","2021-07-08","2021-07-08","2021-10-13","2020-08-17","2020-08-17","2020-08-17","2020-08-17","2020-10-26","2021-04-22","2020-10-26","2021-02-06","2021-04-15","2021-02-06","2021-02-19","2021-02-24","2021-02-24","2021-06-08","2021-07-01","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2021-06-30","2021-06-30","2021-08-18","2021-08-18","2020-09-03","2020-09-10","2020-10-15","2021-02-03","2021-03-30","2021-08-31","2021-06-09","2021-06-09","2021-06-09","2021-06-09","2021-06-09","2021-06-09","2021-06-09","2021-06-09","2021-06-09","2021-06-15","2021-06-15","2021-07-08","2021-07-02","2021-09-02","2021-04-22","2021-04-10","2021-05-28","2021-05-28","2021-05-28","2021-06-02","2021-09-02","2021-09-02","2021-09-02","2020-07-06","2021-02-01","2021-02-12","2020-04-06","2020-05-22","2020-05-22","2021-03-12","2021-03-12","2021-03-12","2021-04-13","2021-07-16","2021-10-28","2021-10-28","2020-04-06","2021-01-13","2021-01-13","2021-01-13","2021-07-02","2021-07-02","2019-01-21","2019-02-12","2019-03-27","2019-03-22","2019-08-14","2019-08-14","2019-08-14","2019-11-06","2019-11-06","2019-11-12","2019-11-12","2019-09-20","2019-11-01","2019-01-19","2019-01-19","2019-01-19","2019-03-27","2019-06-20","2019-06-20","2019-06-21","2019-02-12","2019-04-19","2019-07-12","2019-07-17","2019-07-17"],"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":[["","65862001001","METFORMIN","TAB 1000MG","60","Select","Select",""],["","68180052001","LISINOP\/HCTZ","TAB 20-25MG","30","Select","Select",""],["","49884098501","NATEGLINIDE","TAB 120MG","90","Select","Select",""],["","68462011944","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","67877041984","LINEZOLID","TAB 600MG","24","Select","Select",""],["","66993006885","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","08290324912","INSULIN","MIS 1ML\/31G","200","Select","Select",""],["","00054414622","CLOTRIMAZOLE","TRO 10MG","70","Select","Select",""],["","","TAMOXIFEN","TAB 20MG","","Select","Select",""],["","","ONETOUCH","TES ULTRA","","Select","Select",""],["","65862019901","GABAPENTIN","CAP 300MG","120","Select","Select",""],["","00002871501","HUMULIN","INJ 70\/30","30","Select","Select",""],["","61314054701","LATANOPROST","SOL 0.00005","2","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","","PREDNISONE","TAB 10MG","","Select","Select",""],["","66689000802","NYSTATIN","SUS 100000","120","Select","Select",""],["","69097012805","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","00143980305","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","28","Select","Select",""],["","44087334401","REBIF","INJ 44\/0.5","6","Select","Select",""],["","45802046564","KETOCONAZOLE","SHA 0.02","120","Select","Select",""],["","00378020810","FUROSEMIDE","TAB 20MG","30","Select","Select",""],["","68462026430","ROSUVASTATIN","TAB 40MG","30","Select","Select",""],["","","CIPROFLOXACN","TAB 500MG","","Select","Select",""],["","65862042001","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","57664047758","METOPROL","TAB 50MG","60","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","30","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","74","Select","Select",""],["","","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","08627001601","DEXCOM","MIS TRANSMIT","1","Select","Select",""],["","27241009803","DULOXETINE","CAP 30MG","60","Select","Select",""],["","68382052860","CHOLESTYRAM","POW 4GM","10","Select","Select",""],["","00310621030","FARXIGA","TAB 10MG","90","Select","Select",""],["","72065012112","GVOKE","INJ 1MG\/.2ML","0","Select","Select",""],["","00169183711","NOVOLIN","INJ 70\/30","40","Select","Select",""],["","00054050823","ICOSAPENT","CAP 1GM","360","Select","Select",""],["","69238183007","LEVOTHYROXIN","TAB 25MCG","90","Select","Select",""],["","","ASPIRIN","TAB 81MG EC","","Select","Select",""],["","11523716005","CLARITIN","TAB 10MG","90","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","00536100901","FERROUS","TAB 325MG","90","Select","Select",""],["","49348098053","SM","TAB 81MG EC","30","Select","Select",""],["","00904759060","FEROSUL","TAB 325MG","90","Select","Select",""],["","16729013401","ALLOPURINOL","TAB 100MG","30","Select","Select",""],["","","PREDNISOLONE","SUS 1% OP","","Select","Select",""],["","","DEPEND","MIS X-LARGE","","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","","DOK","CAP 250MG","","Select","Select",""],["","","OXYBUTYNIN","TAB 5MG","","Select","Select",""],["","51672130009","AMMONIUM","LOT 0.12","400","Select","Select",""],["","45802006405","TRIAMCINOLON","CRE 0.001","454","Select","Select",""],["","","STOOL","CAP 240MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","00023916360","RESTASIS","EMU 0.0005","60","Select","Select",""],["","10702001150","HYDROXYZ","TAB 25MG","30","Select","Select",""],["","24208048510","DORZOLAMIDE","SOL 2% OP","10","Select","Select",""],["","68462024801","RANITIDINE","TAB 150MG","60","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","18","Select","Select",""],["","00299391816","CETAPHIL","LOT MOISTURE","473","Select","Select",""],["","00145098505","PANOXYL","LIQ 0.1","156","Select","Select",""],["","70461031903","FLUCLVX","INJ 2019-20","0","Select","Select",""],["","57896070301","IRON","TAB 325MG","90","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}