{"version":"0.4","data":[{"t":"Demographics","q":[{"name":" CIREDNOP","gend":0,"add":" RELLIM 3112B TPA EVA B","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1979-02-27","age":"","mstatus":"","insh":"86600210*05","cliId":"","pno":"19\/6871588-0","cno":"786\/910-8851","email":"","ename":"","eno":"","pphy":"ZHAO, WEI MD","ppno":"757\/436-7888","pcpadd":"675 N BATTLEFIELD BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"Battlefield Medical Associates","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":["M31.31","D89.89","M31.30","G04.90","R22.1","I10.","R56.9","G40.89","Z01.811","Z01.812","Z20.822","K42.9","R69.","M81.0","Z98.890","Z79.899","A41.9","N17.9","Z79.52","M35.9","F17.210","E66.9","G40.909","E86.0","R79.89","F41.8","E55.9","M25.561","M25.562","M35.8","R73.09","R65.10","R11.2","I95.9","M85.80","G31.84","G47.33","D17.0","K29.60","G40.919","M62.81","R26.89","E09.40","V58.89","M51.36","M47.816","F32.9","F41.9","G51.0","G43.909","D73.4","K59.00","H90.41","H93.11","G43.809","G62.9","R73.03","Z79.82","Z85.841","Z91.81","R41.82","V54.17","Z09.","J34.2","J34.3","J69.0","G92.","R65.21","E87.2","M48.54XA","M48.56XA","R40.2412","K21.9","H90.8","F12.10","G08.","R29.810","J38.01","H90.A31","Q11.1","K42.0","H25.12","H04.122","H40.012","Z90.01"],"date":["2022-09-23","2022-10-05","2022-05-31","2022-03-02","2022-05-16","2022-08-16","2022-05-16","2020-11-30","2021-03-17","2021-03-17","2021-03-17","2021-03-19","2021-08-23","2022-10-05","2022-10-05","2022-10-05","2020-07-02","2020-06-25","2020-11-05","2021-05-13","2020-09-02","2020-06-25","2020-09-02","2020-07-02","2020-07-02","2020-07-02","2021-06-29","2020-09-24","2020-09-24","2020-11-03","2022-08-16","2020-06-28","2020-06-28","2020-06-28","2020-07-10","2021-05-13","2021-05-13","2022-05-16","2022-08-16","2020-06-26","2020-09-02","2020-09-02","2020-09-02","2020-09-02","2020-09-02","2020-09-02","2020-09-02","2020-09-02","2020-09-02","2020-09-02","2020-09-02","2020-09-02","2022-05-31","2020-09-17","2020-09-17","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-01","2020-06-26","2020-07-14","2020-07-14","2022-05-10","2022-05-10","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2020-06-25","2022-05-31","2022-05-31","2022-05-31","2020-09-17","2020-12-03","2021-03-19","2020-11-06","2020-11-06","2020-11-06","2020-11-06"],"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":[["","65862052790","VENLAFAXINE","CAP 37.5 ER","90","Select","Select",""],["","55111057503","IBANDRONATE","TAB 150MG","1","Select","Select",""],["","67877022305","GABAPENTIN","CAP 300MG","180","Select","Select",""],["","68180098003","LISINOPRIL","TAB 10MG","90","Select","Select",""],["","00131248035","VIMPAT","TAB 200MG","60","Select","Select",""],["","68382041205","OMEPRAZOLE","CAP 20MG","90","Select","Select",""],["","54838055550","ONDANSETRON","SOL 4MG\/5ML","150","Select","Select",""],["","53746010905","HYDROCO\/APAP","TAB 5-325MG","21","Select","Select",""],["","67877022005","CEPHALEXIN","CAP 250MG","28","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","20","Select","Select",""],["","62332017460","LACOSAMIDE","TAB 200MG","60","Select","Select",""],["","00781808926","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","60505309702","RISEDRONATE","TAB 150MG","3","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00536106210","STOOL","CAP 100MG","30","Select","Select",""],["","13107004401","OXYCOD\/APAP","TAB 5-325MG","20","Select","Select",""],["","00054472831","PREDNISONE","TAB 5MG","90","Select","Select",""],["","16714047802","AMOX\/K","TAB 875-125","10","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","30","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","69097022476","ALENDRONATE","TAB 70MG","12","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":""}]}]}