{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEWIS SIMON","gend":0,"add":"2601 RODGERS ST","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1965-06-02","age":"","mstatus":"","insh":"1603300*01","cliId":"","pno":"757\/576-9552","cno":"757\/576-9552","email":"","ename":"","eno":"","pphy":"MUSSELMANI, ZATTAM MD","ppno":"757\/543-3557","pcpadd":"1422 POINDEXTER ST","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23324,"pcpcounty":"","pcpid":119860,"pcpname":"","plan":"OHP","program":"ACA","lob":"Individual","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/543-0053","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M51.26","M54.16","M48.061","E11.40","E78.00","M51.16","Z79.899","Z79.84","Z87.891","Z79.1","M47.26","M47.812","M54.2","G56.03","G56.22","E11.42","M47.816","M47.817","M54.5","R10.33","K43.9","I95.9","R20.8","G89.29","M54.41","M54.42","I95.1","E78.5","M79.2","Z01.818","Z20.828","F32.0","N28.1","N39.0","M72.2","G40.909","E66.01","E11.9","A41.9","N30.01","D72.829","R33.9","K42.9","N40.1","R39.14","Z00.00","K51.919","Z68.41","Z12.5","N31.9","I10.","R63.4","R20.2","N20.0","H35.363","R31.9","R52.","M65.331","E11.65","T38.3X6A","Z68.32","R73.9","Z79.4","E29.1","Z23.","E65.","M79.10","K43.6","K40.90","K66.0","Z68.34","Z87.19","R31.0","Z53.8","Z87.448","K52.9","R10.32","K59.00","M76.821","M21.41","M62.40","M76.822","M21.42","Z01.810","R94.31","M50.323","M50.322","K51.90","Z87.442","R42.","K63.5","K51.50","Z86.010","K64.8","D12.4","N13.30","N13.4","M79.671","M79.672","G47.9","M25.571","M25.572","S90.212A"],"date":["2020-08-19","2020-05-14","2020-08-19","2021-09-13","2021-01-13","2020-05-14","2021-01-13","2021-01-13","2021-01-13","2020-08-10","2020-06-25","2020-06-25","2020-11-10","2021-05-18","2020-07-01","2020-07-01","2020-11-19","2020-08-19","2021-01-06","2020-10-09","2021-01-15","2020-11-24","2020-11-23","2021-01-06","2020-12-01","2020-12-01","2020-12-09","2021-09-13","2021-09-13","2021-01-11","2021-01-11","2021-05-05","2021-03-10","2021-03-10","2021-11-15","2020-07-29","2021-01-13","2020-08-19","2020-09-19","2020-09-19","2020-09-19","2021-06-04","2020-12-29","2021-06-04","2021-06-04","2021-03-09","2021-03-09","2021-09-13","2021-03-09","2021-06-04","2021-06-09","2020-05-27","2020-05-27","2020-06-18","2020-07-27","2020-10-29","2021-03-29","2021-03-29","2020-05-28","2020-05-28","2020-05-28","2020-05-28","2020-07-14","2020-07-29","2020-09-10","2021-01-13","2020-11-10","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-01-13","2021-02-12","2020-07-20","2020-08-10","2020-08-28","2020-08-28","2020-08-28","2021-11-15","2021-04-28","2021-04-28","2021-11-15","2021-04-28","2021-01-06","2021-01-06","2020-06-25","2020-06-25","2020-07-02","2020-09-19","2020-09-19","2020-06-03","2020-07-20","2020-07-21","2020-07-21","2020-07-21","2020-09-19","2020-09-19","2021-06-09","2021-04-28","2021-06-09","2021-07-01","2021-07-01","2021-06-07"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","",null,"","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"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":[]}]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","65702040710","ACCU-CHEK","AVIVA PL","50","Select","Select",""],["","50924097110","SOFTCLIX","LANCETS","100","Select","Select",""],["","53885004401","ONE","VERIO FL","1","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","12","Select","Select",""],["","53885027025","ONETOUCH","VERIO","50","Select","Select",""],["","00781148801","AMITRIPTYLIN","50MG","-30","Select","Select",""],["","00591367001","NABUMETONE","500MG","60","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","70377002811","ATORVASTATIN","20MG","30","Select","Select",""],["","58160081912","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","68382013201","TAMSULOSIN","0.4MG","-90","Select","Select",""],["","33342002208","LEVOFLOXACIN","500MG","7","Select","Select",""],["","00115174801","METAXALONE","800MG","60","Select","Select",""],["","68180012202","CEPHALEXIN","500MG","40","Select","Select",""],["","65862000801","METFORMIN","500MG","60","Select","Select",""],["","67877046990","PREGABALIN","300MG","60","Select","Select",""],["","27241006903","SILDENAFIL","100MG","20","Select","Select",""],["","16729000301","GLIMEPIRIDE","4MG","90","Select","Select",""],["","29300012501","MELOXICAM","15MG","-30","Select","Select",""],["","65862058301","AMLOD\/BENAZP","5-10MG","30","Select","Select",""],["","00115703301","FLUDROCORT","0.1MG","-30","Select","Select",""],["","52268001201","SUPREP","PREP KIT","354","Select","Select",""],["","00143980350","DOXYCYCL","100MG","20","Select","Select",""],["","69097081307","GABAPENTIN","100MG","90","Select","Select",""],["","42858010250","OXYCOD\/APAP","5-325MG","30","Select","Select",""],["","13811071910","NITROFURANTN","100MG","14","Select","Select",""],["","61442010301","DICLOFENAC","75MG DR","60","Select","Select",""],["","00115174801","METAXALONE ","800MG","-60","Select","Select",""],["","00591367001","NABUMETONE ","500MG","60","Select","Select",""],["","65702040710","ACCU-CHEK ","AVIVA PL","50","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","50924097110","SOFTCLIX ","LANCETS","100","Select","Select",""],["","53885027150","ONETOUCH ","VERIO","-50","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","12","Select","Select",""],["","00781148801","AMITRIPTYLIN ","50MG","30","Select","Select",""],["","65862058301","AMLOD\/BENAZP ","5-10MG","30","Select","Select",""],["","68382013201","TAMSULOSIN ","0.4MG","-90","Select","Select",""],["","53885004401","ONE ","VERIO FL","1","Select","Select",""],["","52268001201","SUPREP ","PREP KIT","354","Select","Select",""],["","69097081307","GABAPENTIN ","100MG","90","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","40","Select","Select",""],["","00143980350","DOXYCYCL ","100MG","20","Select","Select",""],["","16729000301","GLIMEPIRIDE ","4MG","30","Select","Select",""],["","70377002811","ATORVASTATIN ","20MG","30","Select","Select",""],["","58160081912","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","67877046690","PREGABALIN ","150MG","60","Select","Select",""],["","33342002208","LEVOFLOXACIN ","500MG","7","Select","Select",""],["","00115703301","FLUDROCORT ","0.1MG","-30","Select","Select",""],["","65862000801","METFORMIN ","500MG","60","Select","Select",""],["","42858010250","OXYCOD\/APAP ","5-325MG","30","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","14","Select","Select",""],["","27241006903","SILDENAFIL ","100MG","20","Select","Select",""],["","68382005101","MELOXICAM ","15MG","30","Select","Select",""],["","61442010301","DICLOFENAC ","75MG DR","60","Select","Select",""],["","08627005303","DEXCOM","SENSOR","3","Select","Select",""],["","49281072110","FLUBLOK","2021-22","0","Select","Select",""],["","59267100003","PFIZER","COVID-19","0","Select","Select",""],["","59267100003","PFIZER ","INJ COVID-19","0","Select","Select",""],["","08627009111","DEXCOM ","MIS RECEIVER","1","Select","Select",""],["","49281072110","FLUBLOK ","INJ 2021-22","0","Select","Select",""]]}},{"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":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[[["Yes","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""]]]},{"t":"Mini-Cog","q":[{"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":""}]}]}