{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SARAH JANUCHOWSKI","gend":1,"add":"1336 SEABOARD AVE APT A","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1981-12-16","age":"","mstatus":"","insh":"1857995*01","cliId":"","pno":"757\/543-9858","cno":"757\/543-9858","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":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F90.9","F31.81","F42.9","L03.032","L60.0","M79.675","NO DATA","L40.9","Z71.9","Z01.818","L98.499","F41.1","S91.102A","R00.0","F34.1","M79.672","L97.529","R11.10","R11.2","N92.1","M25.512","R07.89","M25.522","W19.XXXA","V58.89","D50.9","E55.9","L97.522","F31.89","F60.89","F12.21","G47.00","I10.","F17.210","Z79.899","F41.9","S93.412A","M25.572","W18.39XA","N92.0","Z68.41","N83.12","D64.9","K21.9","E66.01","F31.9","G47.30","Z98.51","Z90.79","Z90.721","Z20.822","F31.32","F40.11","F51.04","F12.20","Z72.0","Z65.8","L03.031","L97.512","R50.9","R06.02","B34.9","G62.9","E66.9","F32.9","F43.20","J06.9","J20.8","Z28.21","J18.9","R60.0","G43.909","N73.6","H60.502"],"date":["2021-07-27","2021-08-24","2021-08-24","2021-07-09","2020-05-13","2020-07-10","2020-08-31","2021-04-15","2021-04-15","2021-02-26","2020-10-04","2021-08-24","2020-02-14","2020-04-16","2020-11-25","2020-06-05","2021-02-26","2020-04-16","2020-04-16","2020-08-14","2021-07-28","2021-07-17","2021-07-17","2021-07-17","2020-02-07","2021-01-12","2021-01-12","2021-03-01","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2021-05-12","2020-01-17","2020-01-22","2020-01-17","2020-08-14","2020-08-14","2020-08-14","2021-01-05","2021-01-05","2020-08-14","2020-08-14","2020-08-14","2020-08-14","2020-08-14","2020-08-14","2021-02-26","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-05-11","2021-07-09","2021-07-09","2020-04-16","2020-09-01","2020-04-16","2020-07-01","2021-01-05","2021-01-05","2021-01-07","2020-03-10","2020-03-10","2020-03-17","2020-09-01","2020-09-01","2020-08-06","2020-08-14","2021-05-26"],"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":[["","00378400305","ALPRAZOLAM ","0.5MG","30","Select","Select",""],["","65862015901","ZOLPIDEM ","5MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","00069046856","CHANTIX ","0.5MG","56","Select","Select",""],["","16729013616","CLONAZEPAM ","0.5MG","60","Select","Select",""],["","00093075210","ATENOLOL ","50MG","30","Select","Select",""],["","29300011416","LAMOTRIGINE ","200MG","30","Select","Select",""],["","00074055402","HUMIRA ","40\/0.4ML","2","Select","Select",""],["","43547035410","LISINOPRIL ","20MG","30","Select","Select",""],["","43547026910","ROPINIROLE ","0.5MG","30","Select","Select",""],["","29300015001","QUETIAPINE ","200MG","30","Select","Select",""],["","50383026625","CLOBETASOL ","0.05%","50","Select","Select",""],["","00228306011","AMPHET\/DEXTR ","20MG ER","30","Select","Select",""],["","16714036004","MONO-LINYAH ","0.25-35","28","Select","Select",""],["","65862069790","VENLAFAXINE ","150MG ER","30","Select","Select",""],["","00406012301","HYDROCO\/APAP ","5-325MG","20","Select","Select",""],["","65162027210","SMZ\/TMP ","800-160","14","Select","Select",""],["","54092038701","ADDERALL ","20MG","30","Select","Select",""],["","00173068220","VENTOLIN ","","18","Select","Select",""],["","50228018005","GABAPENTIN ","300MG","60","Select","Select",""],["","10702010101","METHYLPHENID ","10MG","60","Select","Select",""],["","60432027516","BROM\/PSE\/DM ","","180","Select","Select",""],["","59746017306","PREDNISONE ","10MG","48","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","42858010201","OXYCOD\/APAP ","5-325MG","28","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","40","Select","Select",""],["","67877021901","CEPHALEXIN ","500MG","14","Select","Select",""],["","69452014420","BENZONATATE ","200MG","30","Select","Select",""],["","65862064163","AZITHROMYCIN ","250MG","6","Select","Select",""],["","00591352530","LIDOCAINE ","5%","30","Select","Select",""],["","55111015330","ONDANSETRON ","4MG","12","Select","Select",""],["","00078044005","RITALIN ","10MG","60","Select","Select",""],["","00245010811","FERROUS ","325MG EC","60","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","4","Select","Select",""],["","00436067216","DAKINS ","0.13%","473","Select","Select",""],["","50383002505","OFLOXACIN ","0.3%OTIC","5","Select","Select",""],["","42806031250","DOXYCYCL ","100MG","20","Select","Select",""],["","58657067601","CIPROFLOXACN ","500MG","20","Select","Select",""],["","57664037708","TRAMADOL ","50MG","20","Select","Select",""],["","43547034450","RISPERIDONE ","4MG","30","Select","Select",""],["","57237002801","AMOXICILLIN ","500MG","42","Select","Select",""],["","68462046599","RIZATRIPTAN ","5MG","12","Select","Select",""],["","69547035302","NARCAN ","","2","Select","Select",""],["","50484001030","SANTYL ","250\/GM","30","Select","Select",""],["","45802049326","AMMONIUM ","12%","385","Select","Select",""],["","00143924920","AMOX\/K ","875-125","28","Select","Select",""],["","52817033200","CYCLOBENZAPR ","10MG","21","Select","Select",""],["","68462019005","NAPROXEN ","500MG","14","Select","Select",""],["","80777027399","MODERNA ","COVID-19","0","Select","Select",""],["","42571025101","CLINDAMYCIN ","150MG","30","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100","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":""}]}]}