{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"YECARTWORUB ","gend":1,"add":"YAB E 121DVLB WEIV","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1973-11-15","age":"","mstatus":"","insh":"8783210*42","cliId":"","pno":"69\/7578996-5","cno":"","email":"","ename":"","eno":"","pphy":"FEE, ERIC MD","ppno":"757\/587-0157","pcpadd":"7924 CHESAPEAKE BLVD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":"","pcpname":"Bayview Medical Center","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":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["U07.1","Z03.89","M53.3","M79.7","R76.8","M54.5","G89.29","M70.62","M51.36","G62.9","G43.909","I10.","D12.6","F32.9","R89.9","J06.9","Z20.828","R06.02","Z00.00","Z11.59","G89.4","N30.01","M25.552","NO DATA","K76.0","Z87.891","Z82.49","Z82.61","Z82.3","R10.2","N94.10","Z03.818","R19.7","R11.0","R05.","R51.","G43.009","R20.2","H53.9","G47.00","G44.40","T39.95XA","G43.709","Z51.81","R51.9","J02.0","J02.9","M10.9","M47.816","N39.0","R73.02","Z01.419","Z12.39","Z12.12","R53.83","R06.83","M70.61","E78.00","Z20.822","R07.9","F41.9","Z79.899","M51.26","S39.012A","M77.31","M24.571","M24.572","M79.672","M72.2","M79.671","M54.2","M50.30","M79.2","M62.89","E66.9","B34.9","Z11.52","R00.2","Z23.","Z80.0","D12.5","K29.50","R10.13","R42.","R00.1","B00.1","J32.9","R07.89","K58.0","K29.70","K63.5","J01.90","K52.9","J40.","Z62.810","R05.1","B02.9","K11.5","R68.89","M25.562","M77.12"],"date":["2022-01-27","2020-07-31","2022-09-29","2022-09-22","2022-09-22","2021-07-09","2022-09-29","2022-06-20","2022-09-29","2021-12-20","2021-12-08","2022-03-22","2021-12-08","2021-12-08","2021-12-08","2021-12-20","2022-08-28","2020-08-05","2021-10-27","2020-08-12","2022-03-22","2021-05-24","2022-06-20","2022-09-29","2021-12-28","2022-03-22","2021-12-28","2021-12-28","2021-12-28","2020-03-30","2020-03-30","2020-08-12","2020-07-06","2020-07-06","2020-07-31","2020-07-31","2022-10-06","2021-03-29","2020-12-09","2022-10-06","2020-12-09","2020-12-09","2022-11-10","2022-09-22","2022-10-06","2021-10-27","2022-08-28","2021-10-27","2022-09-29","2021-10-27","2021-10-27","2022-04-15","2020-03-09","2022-04-15","2021-03-29","2021-03-29","2021-05-04","2021-07-20","2022-02-01","2020-07-31","2022-10-06","2022-03-22","2020-08-28","2020-08-28","2021-05-06","2021-04-08","2021-05-06","2021-04-08","2021-05-06","2021-10-19","2022-09-29","2022-09-29","2022-09-29","2022-09-29","2022-09-29","2021-06-18","2021-11-21","2019-07-15","2019-01-29","2019-07-17","2019-07-17","2019-07-17","2019-07-17","2019-07-15","2019-07-15","2019-03-21","2019-09-13","2019-04-05","2019-06-13","2019-07-17","2019-07-17","2022-08-28","2019-01-15","2019-09-13","2022-06-09","2022-02-05","2022-07-09","2022-07-26","2022-01-25","2022-10-11","2022-02-28"],"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":[["","50228046601","NABUMETONE","TAB 750MG","60","Select","Select",""],["","00002143611","EMGALITY","INJ 120MG\/ML","1","Select","Select",""],["","68462043630","OLMESA","TAB 5MG","30","Select","Select",""],["","00591264001","BUT\/APAP\/CAF","CAP ","14","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","72618300002","NURTEC","TAB 75MG ODT","8","Select","Select",""],["","65862052790","VENLAFAXINE","CAP 37.5 ER","30","Select","Select",""],["","68462010805","TOPIRAMATE","TAB 25MG","270","Select","Select",""],["","59762500005","SULFASALAZIN","TAB 500MG","60","Select","Select",""],["","00074709430","QULIPTA","TAB 60MG","30","Select","Select",""],["","70954008510","CHLORZOXAZON","TAB 500MG","30","Select","Select",""],["","68180072103","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","00378632377","VALSART\/HCTZ","TAB 160-25MG","90","Select","Select",""],["","29300012810","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","00781577626","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","","AMOXICILLIN","CAP 500MG","","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","43598029390","PREGABALIN","CAP 75MG","60","Select","Select",""],["","65862044990","VALACYCLOVIR","TAB 1GM","24","Select","Select",""],["","","TRAMADOL","TAB 50MG","","Select","Select",""],["","57237004105","PENICILLN","TAB 500MG","20","Select","Select",""],["","11877001140","BINAXNOW","KIT HOME TES","2","Select","Select",""],["","00574110404","BROM\/PSE\/DM","SYP ","120","Select","Select",""],["","00023650116","UBRELVY","TAB 100MG","16","Select","Select",""],["","","METHOCARBAM","TAB 500MG","","Select","Select",""],["","16571020150","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","3","Select","Select",""],["","23155050201","HYDROXYZ","TAB 50MG","60","Select","Select",""],["","00093031401","KETOROLAC","TAB 10MG","15","Select","Select",""],["","00002150680","MOUNJARO","INJ 2.5\/0.5","2","Select","Select",""],["","51759020210","AJOVY","INJ 225\/1.5","2","Select","Select",""],["","42806001101","SULINDAC","TAB 200MG","60","Select","Select",""],["","","TIZANIDINE","TAB 4MG","","Select","Select",""],["","","RIZATRIPTAN","TAB 10MG","","Select","Select",""],["","","MELOXICAM","TAB 15MG","","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","12","Select","Select",""],["","","AMITRIPTYLIN","TAB 25MG","","Select","Select",""],["","58657050016","CODEINE\/GG","SOL 10-100\/5","180","Select","Select",""],["","27241009803","DULOXETINE","CAP 30MG","60","Select","Select",""],["","","NORTRIPTYLIN","CAP 10MG","","Select","Select",""],["","","GABAPENTIN","CAP 300MG","","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","59651018201","METHOTREXATE","TAB 2.5MG","20","Select","Select",""],["","","CLINDAMYCIN","CAP 150MG","","Select","Select",""],["","00527133001","BACLOFEN","TAB 10MG","60","Select","Select",""],["","60846050101","PYRIDIUM","TAB 100MG","6","Select","Select",""],["","51293081001","PHENAZOPYRID","TAB 100MG","6","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","55513084101","AIMOVIG","INJ 70MG\/ML","1","Select","Select",""],["","69230030030","ALLERGY","TAB 180MG","30","Select","Select",""],["","57237000511","FLUCONAZOLE","TAB 150MG","2","Select","Select",""],["","","IBUPROFEN","TAB 800MG","","Select","Select",""],["","55111029309","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","","DIAZEPAM","TAB 5MG","","Select","Select",""],["","","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","","ETODOLAC","TAB 400MG","","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","","DULERA","AER 200-5MCG","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","LORAZEPAM","TAB 1MG","","Select","Select",""],["","00378548610","MECLIZINE","TAB 25MG","20","Select","Select",""],["","00004080085","TAMIFLU","CAP 75MG","10","Select","Select",""],["","69238126601","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","51672136001","ACYCLOVIR","OIN 0.05","15","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","2","Select","Select",""],["","43598081115","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","69543025216","VIRTUSSIN","SOL 100-10\/5","180","Select","Select",""],["","43598021055","SSD","CRE 0.01","50","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","67877012405","SILVER","CRE 0.01","50","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":""}]}]}