{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CARROLL M NICOLLS JR","gend":0,"add":"C\/O KATHERINE NICOLLS 319 MAYCOX AVE","city":"NORFOLK","state":"VA","zip":"23505-9998","dob":"1948-08-23","age":"","mstatus":"","insh":"900041847*01","cliId":"","pno":"757\/623-0289","cno":"","email":"","ename":"","eno":"","pphy":"GALAN DEJESUS, MIRIAM CNP","ppno":"757\/623-8642","pcpadd":"STE 201 400 W BRAMBLETON AVE","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23510,"pcpcounty":"","pcpid":"","pcpname":"Skees Family Practice","plan":"OHP","program":"MEDICARE","lob":"DSNP","region":"TIDEWATER","aligned":"Y","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/623-4640","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L89.152","L89.312","L89.322","G82.50","I10.","J45.909","R13.10","F10.20","Z79.82","Z99.81","Z87.01","Z96.0","Z91.81","Z12.11","J44.9","G47.33","J15.4","G82.53","A41.9","N39.0","N31.9","Z97.8","Z93.0","T83.511A","A41.59","K59.2","K21.9","K59.09","N28.1","Z88.8","Z79.51","Z79.899","Z91.040","A41.89","B96.4","B95.2","G82.51","S14.111S","R33.9","Z74.01","Z45.2","Z79.2","J45.41","Z99.3","G47.36","R14.0","R50.9","R14.3","K59.00","R41.82","Z74.3","L57.0","L98.411","L82.1","L81.4","D22.9","Z85.828","D18.00","L90.5","L57.8","Z12.83","Z71.9","A04.5","Z92.89","R63.3","B99.9","Z00.00","Z46.6","Z87.440","S14.101S","R47.01","K80.20","R78.81","A49.8"],"date":["2021-04-07","2021-04-07","2021-04-07","2021-10-04","2021-11-10","2021-04-07","2021-04-07","2021-04-07","2021-11-10","2021-04-07","2021-04-07","2021-04-07","2021-04-07","2021-05-23","2021-11-10","2021-10-07","2021-07-06","2021-10-07","2021-10-28","2021-10-11","2021-11-10","2021-08-12","2021-11-10","2021-10-11","2021-08-07","2021-11-10","2021-08-07","2021-08-07","2021-08-07","2021-08-07","2021-10-11","2021-08-07","2021-08-07","2021-10-11","2021-10-11","2021-10-11","2021-11-10","2021-11-10","2021-11-10","2021-11-10","2021-10-11","2021-10-11","2021-10-07","2021-10-07","2021-03-04","2021-08-08","2021-08-08","2021-08-08","2021-08-08","2021-08-12","2021-08-12","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-10-28","2021-08-30","2021-08-30","2021-01-07","2021-10-04","2021-10-28","2021-11-10","2021-11-10","2021-01-02","2021-01-02","2021-08-07","2021-08-10","2021-08-10"],"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":[["","49502080693","YUPELRI ","","-90","Select","Select",""],["","50111078810","AZITHROMYCIN ","500MG","36","Select","Select",""],["","65862057490","MONTELUKAST SODIUM ","10MG","30","Select","Select",""],["","68040075240","EPICERAM ","","225","Select","Select",""],["","11822316500","RA COL-RITE ","100MG","30","Select","Select",""],["","00904693176","PEG 3350 ","","30","Select","Select",""],["","61990015001","PIPERACILLIN SODIUM\/TAZOBACTAM ","36-4.5GM","3","Select","Select",""],["","0"," ","","1","Select","Select",""],["","45963043965","CONSTULOSE ","10GM\/15","1800","Select","Select",""],["","00832046560","NYAMYC ","100000","120","Select","Select",""],["","00093417773","CEPHALEXIN ","250\/5ML","300","Select","Select",""],["","00904699860","DOCUSATE SODIUM ","100MG","30","Select","Select",""],["","75834013960","BALSAM PERU & CASTOR OIL ","CASTOR","60","Select","Select",""],["","72578008602","DESONIDE ","0.05%","60","Select","Select",""],["","71351001460","BPCO ","","60","Select","Select",""],["","58980078021","VENELEX ","","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":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"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":""}]}]}