{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LISA   M WOOD","gend":1,"add":"2020 JESSICA LN","city":"VIRGINIA BEACH","state":"VA","zip":"23456-9998","dob":"1983-01-04","age":"","mstatus":"","insh":"1505436*01","cliId":"","pno":"919\/820-2959","cno":"919\/820-2959","email":"","ename":"","eno":"","pphy":"DESAI, MAULIN MD","ppno":"800\/527-2335","pcpadd":"HPT RDS-CONTRACT REP 5000 COX RD ST","pcpcity":"GLEN ALLEN","pcpstate":"VA","pcpzip":23060,"pcpcounty":"","pcpid":125384,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"804\/968-5739","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F41.1","F51.9","F42.2","R07.9","R07.89","K04.7","H93.8X1","H93.11","H92.01","H73.001","G43.809","R42.","Z01.419","R92.8","G44.89","M25.561","S92.424A","R40.0","R06.4","E66.9","E78.00","J40.","H69.80","H90.11","J34.2","R13.10","F45.8","J34.3","H69.83","H93.293","J30.1","J30.89","R56.9","R06.83","G47.33","R63.4","R10.30","R14.0","R09.89","R29.6","R20.2","Z99.89","H72.01","J30.9","Z86.69","K62.1","K63.5","K57.30","K31.89","G44.319","F51.3","S69.91XA","R00.2","R06.00","R06.02","J34.1","S80.01XA","M79.641","NO DATA","Z68.42","R25.2","E78.5","E78.2","R07.0","H90.A21","G47.52","F43.10","V58.89","J45.909","K21.9","E66.01","G43.009","J02.0","J02.9","R00.0","E03.9","E78.1","Z00.00","K59.00"],"date":["2020-02-05","2020-02-05","2020-02-05","2020-04-24","2020-05-20","2020-05-07","2020-06-16","2020-06-16","2020-07-08","2020-06-16","2020-07-08","2020-07-08","2021-02-09","2021-02-09","2021-03-24","2020-01-14","2020-01-14","2020-02-17","2020-02-17","2020-07-28","2020-02-17","2020-04-16","2020-07-08","2020-07-08","2020-09-01","2020-08-04","2020-09-01","2020-09-01","2021-01-12","2021-01-12","2021-01-12","2021-01-12","2020-02-17","2020-01-24","2021-07-30","2021-06-11","2021-06-11","2021-04-26","2021-06-11","2020-02-17","2020-05-20","2020-05-20","2020-07-08","2020-07-08","2020-07-08","2021-06-11","2021-06-11","2021-06-11","2021-06-11","2020-01-21","2020-01-21","2020-01-22","2020-04-25","2020-04-23","2020-05-13","2020-07-20","2020-01-14","2020-02-13","2020-02-13","2020-02-13","2020-07-28","2020-07-28","2020-07-30","2020-01-07","2020-01-07","2020-01-09","2020-01-09","2020-02-06","2020-02-18","2020-09-08","2020-02-18","2020-11-20","2020-01-06","2020-01-06","2020-04-23","2020-04-23","2020-04-23","2020-04-23","2020-09-08"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"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":[["","00378034505","DIAZEPAM ","5MG","120","Select","Select",""],["","70710122700","AMITRIPTYLIN ","50MG","90","Select","Select",""],["","64380080707","IBUPROFEN ","800MG","30","Select","Select",""],["","68382050010","OMEPRAZOLE ","40MG","30","Select","Select",""],["","45802008801","ALBUTEROL ","HFA","8","Select","Select",""],["","00781808926","AZITHROMYCIN ","250MG","6","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","00781635587","MOMETASONE ","50MCG","17","Select","Select",""],["","68382013805","TOPIRAMATE ","25MG","120","Select","Select",""],["","31722072690","MONTELUKAST ","10MG","30","Select","Select",""],["","76204060060","IPRATROPIUM\/ ","ALBUTER","180","Select","Select",""],["","16571040250","CETIRIZINE ","10MG","90","Select","Select",""],["","45802010401","OLOPATADINE ","0.60%","30","Select","Select",""],["","66685100100","AMOX\/K ","875-125","20","Select","Select",""],["","69238183207","LEVOTHYROXIN ","75MCG","90","Select","Select",""],["","00065853302","CIPRODEX ","0.3-0.1%","8","Select","Select",""],["","31722088390","ROSUVASTATIN ","10MG","90","Select","Select",""],["","33342008745","RIZATRIPTAN ","5MG","12","Select","Select",""],["","00456120230","LINZESS ","290MCG","30","Select","Select",""],["","00378161001","DICYCLOMINE ","10MG","60","Select","Select",""],["","80777027315","MODERNA ","COVID-19","0","Select","Select",""],["","00115165901","PROPRANOLOL ","10MG","120","Select","Select",""],["","65862069790","VENLAFAXINE ","150MG ER","60","Select","Select",""],["","70710122700","AMITRIPTYLIN","50MG","90","Select","Select",""],["","65862069790","VENLAFAXINE","150MG ER","60","Select","Select",""],["","00115165901","PROPRANOLOL","10MG","120","Select","Select",""],["","66685100100","AMOX\/K","875-125","20","Select","Select",""],["","68382050010","OMEPRAZOLE","40MG","30","Select","Select",""],["","64380080707","IBUPROFEN","800MG","30","Select","Select",""],["","68382013805","TOPIRAMATE","25MG","120","Select","Select",""],["","31722072690","MONTELUKAST","10MG","30","Select","Select",""],["","60505083001","MOMETASONE","50MCG","17","Select","Select",""],["","60505057501","OLOPATADINE","0.10%","5","Select","Select",""],["","00093317431","ALBUTEROL","HFA","8","Select","Select",""],["","76204060060","IPRATROPIUM\/","ALBUTER","180","Select","Select",""],["","00781808926","AZITHROMYCIN","250MG","6","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","69238183207","LEVOTHYROXIN","75MCG","90","Select","Select",""],["","00065853302","CIPRODEX","0.3-0.1%","8","Select","Select",""],["","43598081115","CETIRIZINE","10MG","90","Select","Select",""],["","31722088390","ROSUVASTATIN","10MG","90","Select","Select",""],["","33342008745","RIZATRIPTAN","5MG","12","Select","Select",""],["","00456120230","LINZESS","290MCG","30","Select","Select",""],["","00378161001","DICYCLOMINE","10MG","60","Select","Select",""],["","80777027315","MODERNA","COVID-19","0","Select","Select",""],["","00378034505","DIAZEPAM","5MG","120","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["Yes","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":""}]}]}