{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"  AMEEKAHSENROBSO S","gend":1,"add":"EKAL 412RIC DOOW","city":"SOUTH HILL","state":"VA","zip":"23970-9998","dob":"1986-07-26","age":"","mstatus":"","insh":"0218610*66","cliId":"","pno":"7443406237","cno":4344773260,"email":"","ename":"","eno":"","pphy":"POWERS, LINDA P MD","ppno":4345842025,"pcpadd":"514 W ATLANTIC ST,","pcpcity":"SOUTH HILL","pcpstate":"VA","pcpzip":"23970-9998","pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"CENTRAL","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":["L03.319","Z88.0","S90.112A","L03.032","Z68.42","I10.","Z30.431","N92.1","N84.0","A41.89","U07.1","J96.01","NO DATA","E66.01","E83.42","E11.65","E87.1","Z68.43","E87.6","T38.0X5A","Z79.4","Z79.84","Z79.899","Z82.49","Z83.3","L02.92","E11.9","Z13.29","Z13.6","Z11.4","Z11.59","I11.0","T50.905A","R51.9","R06.9","R06.02","R09.02","R06.89","A41.9","J12.81","R06.03","Z97.5","N76.0","J30.2","J01.10","H60.501","L21.9","N64.9","B37.3"],"date":["2022-08-19","2022-08-19","2022-01-13","2022-01-13","2022-01-13","2023-04-25","2022-03-04","2022-03-04","2022-03-04","2021-12-27","2022-06-03","2021-12-28","2021-12-27","2021-12-27","2021-12-27","2023-04-25","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2023-04-25","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2023-02-07","2021-12-28","2021-06-07","2021-06-07","2021-06-07","2021-06-07","2022-01-23","2022-01-23","2021-06-23","2021-12-27","2021-12-27","2021-12-27","2021-12-27","2021-12-28","2021-12-27","2021-12-27","2021-03-10","2021-07-12","2022-05-05","2022-05-05","2022-06-28","2022-06-28","2021-06-07","2021-07-08"],"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":[["","90166063132","PEN NEEDLES","MIS 31GX5MM","100","Select","Select",""],["","00169643810","LEVEMIR","INJ FLEXTOUC","15","Select","Select",""],["","65862001905","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","00228212750","CLONIDINE","TAB 0.1MG","1","Select","Select",""],["","00603533715","PREDNISONE","PAK 5MG","21","Select","Select",""],["","45802022211","FLUTICASONE","CRE 0.0005","30","Select","Select",""],["","51224012230","AZITHROMYCIN","TAB 500MG","6","Select","Select",""],["","55111046705","METOPROL SUC","TAB 50MG ER","30","Select","Select",""],["","00299550004","CAPEX","SHA 0.0001","120","Select","Select",""],["","68462038537","MOMETASONE","SOL 0.001","30","Select","Select",""],["","57664037718","TRAMADOL HCL","TAB 50MG","7","Select","Select",""],["","00713022460","FLUOCIN ACET","OIN 0.00025","60","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","14","Select","Select",""],["","65862001501","AMOXICILLIN","TAB 875MG","20","Select","Select",""],["","61314064610","NEO\/POLY\/HC","SOL 1% OTIC","10","Select","Select",""],["","57237023301","SMZ-TMP DS","TAB 800-160","20","Select","Select",""],["","68645058259","METFORMIN HCL","500 MG","60","Select","Select",""],["","65702073110","ACCU-CHEK GUIDE ME GLUCOSE MTR","","1","Select","Select",""],["","00169643210","LEVEMIR FLEXPEN","100\/ML (3)","15","Select","Select",""],["","65702071110","ACCU-CHEK GUIDE TEST STRIP","","100","Select","Select",""],["","65702072910","ACCU-CHEK GUIDE MONITOR SYSTEM","","1","Select","Select",""],["","68382056510","METOPROLOL SUCCINATE","50 MG","30","Select","Select",""],["","00310621030","FARXIGA","10 MG","30","Select","Select",""],["","65702028810","ACCU-CHEK FASTCLIX LANCET DRUM","","102","Select","Select",""],["","67877069601","CHLORTHALIDONE","25 MG","30","Select","Select",""],["","45802000910","FLUOCINOLONE ACETONIDE OIL","0.01 %","20","Select","Select",""],["","27808023301","DOXYCYCLINE HYCLATE","100 MG","20","Select","Select",""],["","65162047810","NITROFURANTOIN MONO-MACRO","100 MG","10","Select","Select",""],["","53885004601","ONETOUCH ULTRA","2","1","Select","Select",""],["","53885000810","ONETOUCH DELICA PLUS LANCET","33 GAUGE","100","Select","Select",""],["","53885024510","ONETOUCH ULTRA TEST STRIP","","100","Select","Select",""],["","00406012301","HYDROCODONE-ACETAMINOPHEN","5 MG-325MG","12","Select","Select",""],["","08290320550","NANO","2ND GEN PEN NEEDLE 32GX 5\/32\"","100","Select","Select",""],["","67877032105","IBUPROFEN","800 MG","30","Select","Select",""],["","70010014805","POTASSIUM CHLORIDE","10 MEQ","6","Select","Select",""],["","31722070190","LOSARTAN POTASSIUM","50 MG","30","Select","Select",""],["","90166063132","PEN NEEDLES MIS","31GX5MM","100","Select","Select",""],["","00169643810","LEVEMIR INJ FLEXTOUC","","15","Select","Select",""],["","65862001905","CEPHALEXIN CAP","500MG","30","Select","Select",""],["","00603533715","PREDNISONE PAK","5MG","21","Select","Select",""],["","00228212750","CLONIDINE TAB","0.1MG","1","Select","Select",""],["","50383070016","FLUTICASONE SPR","50MCG","16","Select","Select",""],["","51224012230","AZITHROMYCIN TAB","500MG","6","Select","Select",""],["","55111046705","METOPROL SUC TAB","50MG ER","30","Select","Select",""],["","65862001501","AMOXICILLIN TAB","875MG","20","Select","Select",""],["","61314064610","NEO\/POLY\/HC SOL","1% OTIC","10","Select","Select",""],["","45802048526","FLUOCIN ACET OIL","0.01% SC","120","Select","Select",""],["","00713022460","FLUOCIN ACET OIN","0.025%","60","Select","Select",""],["","29300012510","MELOXICAM TAB","15MG","14","Select","Select",""],["","00299550004","CAPEX SHA","0.01%","120","Select","Select",""],["","45802011859","MOMETASONE SOL","0.1%","30","Select","Select",""],["","57237023301","SMZ-TMP DS TAB","800-160","20","Select","Select",""],["","57664037718","TRAMADOL HCL TAB","50MG","7","Select","Select",""],["","45802022211","FLUTICASONE CRE","0.05%","30","Select","Select",""],["","45802006435","TRIAMCINOLONE ACETONIDE","0.1 %","30","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":""}]}]}