{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" AIRETTELCEGAVAS M ","gend":1,"add":"SNNA 94242DAOR EVOC ","city":"BLOXOM","state":"VA","zip":23308,"dob":"1985-06-29","age":"","mstatus":"","insh":"8221210*38","cliId":"","pno":"66\/7576975-5","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"757\/824-5676","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23308,"pcpcounty":"","pcpid":"","pcpname":"EASTERN SHORE RURAL HEALTH SYSTEM INC","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":["I10.","J01.00","H61.21","F17.210","S64.01XA","Z87.39","V58.89","N92.0","R39.15","Z71.3","E66.09","Z68.35","G56.01","M22.2X2","M62.81","Z74.09","G44.209","R52.","R22.31","M67.431","G56.02","F31.81","N92.4","M25.631","Z30.013","M25.462","Z23.","Z20.822","J02.0","J44.1","R59.0","B00.9","M25.531","M54.5","G56.03","M79.644","M47.816","L28.2","J02.9","G56.21","J01.90","J30.2","J45.909","R05.","J11.1","E66.9","Z68.33","G56.13","G56.22","K52.9","Z98.51","R20.0","R20.2","NO DATA","R53.82","J06.9","Z30.42","Z00.00","F41.1","M25.562","G89.29","L30.9","J40.","M62.838","S54.01XA","G89.18","Z92.29","Z01.419","E11.65","N39.0","E11.9","J10.1","J44.9","Z79.84","Z79.899","R53.1","N64.4","Z03.818","R05.9","J45.20","R63.5","M54.6"],"date":["2022-10-23","2020-02-03","2020-02-03","2022-10-23","2021-02-01","2021-01-05","2021-04-20","2022-10-18","2021-02-08","2022-09-13","2021-02-08","2021-02-08","2021-04-20","2021-09-10","2021-09-10","2021-09-10","2021-10-26","2021-10-26","2021-10-26","2019-04-23","2020-09-03","2021-01-06","2020-11-17","2021-02-17","2021-04-12","2021-04-12","2021-05-10","2022-10-23","2022-10-14","2019-05-30","2019-06-17","2022-06-17","2021-01-26","2019-01-16","2020-04-27","2019-02-22","2022-03-24","2019-06-06","2021-05-21","2021-02-11","2021-07-07","2022-07-29","2021-07-07","2020-02-05","2020-02-05","2020-02-05","2020-02-05","2020-01-23","2020-01-23","2020-04-01","2020-04-01","2021-01-26","2021-01-26","2022-10-23","2021-11-08","2022-10-14","2022-02-04","2020-09-18","2020-09-18","2021-09-10","2021-09-10","2019-05-24","2019-05-24","2019-07-09","2020-09-28","2020-09-28","2021-05-10","2022-07-29","2022-10-18","2022-09-13","2022-10-23","2022-10-23","2022-10-23","2022-10-23","2022-10-23","2022-10-23","2022-06-17","2022-10-14","2022-10-14","2022-02-04","2022-07-19","2022-03-24"],"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":[["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","45802065078","LORATADINE","TAB 10MG","30","Select","Select",""],["","53885059501","ONETOUCH","MIS 30G","200","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","90","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","00054327099","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","70710113908","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","68382079201","ACYCLOVIR","TAB 800MG","34","Select","Select",""],["","57237016199","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","56151147002","TRUE","KIT METER","1","Select","Select",""],["","70010049110","METFORMIN","TAB 500MG ER","180","Select","Select",""],["","00378064205","PREDNISONE","TAB 20MG","10","Select","Select",""],["","64980028001","GLIPIZIDE","TAB 5MG","30","Select","Select",""],["","53885004401","ONE","KIT VERIO FL","1","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","20","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","69452015020","VALPROIC","CAP 250MG","90","Select","Select",""],["","10370010150","BUPROPN","TAB 150MG XL","90","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","10","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","60","Select","Select",""],["","42571016201","AMOX\/K","TAB 875-125","14","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","180","Select","Select",""],["","65162083366","DICLOFENAC","GEL 0.01","100","Select","Select",""],["","51991074790","DULOXETINE","CAP 30MG","14","Select","Select",""],["","00093117410","PENICILLN","TAB 500MG","20","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","68462010530","ONDANSETRON","TAB 4MG","9","Select","Select",""],["","45802048678","DOCUSATE","CAP 100MG","60","Select","Select",""],["","50428028552","ACETAMINOPHN","TAB 500MG","90","Select","Select",""],["","67877032105","IBUPROFEN","TAB 800MG","60","Select","Select",""],["","50428043004","VITAMIN","TAB 500MG","100","Select","Select",""],["","00172392570","DIAZEPAM","TAB 2MG","12","Select","Select",""],["","53746010901","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","69547035302","NARCAN","SPR ","2","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":""}]}]}