{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"KIMBERLY   S SHELTON","gend":1,"add":"116 NANCY DR APT W1","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1992-12-19","age":"","mstatus":"","insh":"900039517*01","cliId":"","pno":"757\/264-8189","cno":"","email":"","ename":"","eno":"","pphy":"MUGAISI, HESED N MD","ppno":"757\/738-1375","pcpadd":"148 BURNETTS WAY STE 107","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23434,"pcpcounty":"","pcpid":"","pcpname":"BON SECOURS SUFFOLK PRIMARY CARE","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/934-6935","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z36.89","O16.2","R55.","R00.2","D64.9","Z3A.20","R07.9","Z3A.24","D64.89","R71.8","Z34.90","O16.3","O12.13","Z3A.36","N76.0","B96.89","N73.9","N91.2","F33.1","D50.9","N94.10","E66.01","Z68.41","R10.30","R10.2","S60.212A","Z00.00","I10.","Z71.89","Z13.31","J45.51","Z11.59","R09.81","R73.9","Z33.1","M43.6","R51.9","Z01.89","O34.211","O14.94","Z37.0","R68.89","O32.1XX0","Z3A.29","I51.7","I51.9","H91.93","Z01.110","O36.63X0","Z3A.35","O14.14","O99.52","O99.02","J45.909","Z3A.37","Z20.828","Z34.80","O99.012","O99.89","R03.0","R07.89","R06.02","O14.04","Z30.09","H60.91"],"date":["2020-07-06","2020-08-03","2020-07-10","2020-08-17","2021-04-27","2020-07-10","2020-07-10","2020-08-03","2020-10-07","2020-09-24","2020-10-19","2020-10-26","2020-10-26","2020-10-26","2021-04-27","2021-04-27","2021-04-27","2021-04-27","2021-11-19","2020-10-15","2021-04-27","2021-09-01","2021-09-01","2021-04-27","2021-04-27","2021-05-29","2021-09-01","2021-10-07","2021-09-01","2021-09-01","2021-09-01","2021-10-07","2021-09-01","2021-10-07","2020-09-24","2021-03-02","2021-08-17","2021-10-07","2020-10-30","2020-10-30","2020-10-30","2021-08-17","2020-09-10","2020-09-10","2020-08-31","2020-08-31","2020-11-11","2020-11-11","2020-10-15","2020-10-15","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-10-30","2020-06-01","2020-07-10","2020-07-10","2020-07-10","2020-07-10","2020-08-17","2020-10-30","2021-03-18","2021-06-30"],"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":[]}]},{"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":[["","00406051205","OXYCODONE\/ACETAMINOPHEN                                               ","5-325MG","20","Select","Select",""],["","00904645760","DOK                                                                   ","100MG","60","Select","Select",""],["","68180071909","AMLODIPINE BESYLATE                                                   ","2.5MG","30","Select","Select",""],["","64380080707","IBUPROFEN                                                             ","800MG","30","Select","Select",""],["","00904759080","FEROSUL                                                               ","325MG","90","Select","Select",""],["","68682010810","NIFEDIPINE ER                                                         ","30MG ER","30","Select","Select",""],["","50111033402","METRONIDAZOLE                                                         ","500MG","14","Select","Select",""],["","57237007710","ONDANSETRON ODT                                                       ","4MG ODT","12","Select","Select",""],["","00143980305","DOXYCYCLINE HYCLATE                                                   ","100MG","28","Select","Select",""],["","68382091634","METHYLPREDNISOLONE DOSE PACK                                          ","4MG","21","Select","Select",""],["","65162062711","TRAMADOL HCL                                                          ","50MG","10","Select","Select",""],["","00781185220","AMOXICILLIN\/CLAVULANATE POTASSIUM                                     ","875-125","20","Select","Select",""],["","00143993905","AMOXICILLIN                                                           ","500MG","-28","Select","Select",""],["","00406012405","HYDROCODONE\/ACETAMINOPHEN                                             ","7.5-325","8","Select","Select",""],["","00228285111","GUANFACINE ER                                                         ","2MG ER","30","Select","Select",""],["","60432026415","FLUTICASONE PROPIONATE                                                ","50MCG","16","Select","Select",""],["","31722072690","MONTELUKAST SODIUM                                                    ","10MG","30","Select","Select",""],["","76204020060","ALBUTEROL SULFATE                                                     ","0.08%","-180","Select","Select",""],["","00054032756","FLUTICASONE PROPIONATE\/SALMETEROL                                     ","250\/50","-60","Select","Select",""],["","66993001968","ALBUTEROL SULFATE HFA                                                 ","HFA","-18","Select","Select",""],["","00378932132","WIXELA INHUB                                                          ","250\/50","-60","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":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"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":""}]}]}