{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LOUIS   H BAILEY","gend":0,"add":"572 ASHTON AVE","city":"FRANKLIN","state":"VA","zip":"23851-9998","dob":"1959-10-11","age":"","mstatus":"","insh":"20023452*01","cliId":"","pno":"757\/384-2658","cno":"757\/384-2658","email":"","ename":"","eno":"","pphy":"HASHMI, AFREEDA A MD","ppno":"757\/562-2158","pcpadd":"102 FAIRVIEW DRIVE SUITE B","pcpcity":"FRANKLIN","pcpstate":"VA","pcpzip":23851,"pcpcounty":"","pcpid":161374,"pcpname":"Bayview Hospitalist","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"CENTRAL","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I51.7","Z01.810","I87.2","Z72.0","E66.3","R07.89","R10.32","N52.9","I87.321","I83.811","F17.200","U07.1","I83.813","I73.9","M17.11","M79.89","R97.20","C61.","C79.51","I25.10","I83.891","I87.391","R60.0","I83.11","M25.561","K40.90","I83.90","Z68.37","K21.9","F17.210","M54.9","I10.","R59.9","R68.89","Z09.","M23.51","J05.10","J04.30","C78.7","R07.0","Y71.0","E11.9","J02.9","R60.9","R13.10","Z85.46","Z87.891","Z95.828","Z51.11","Z45.2"],"date":["2020-01-03","2020-08-24","2021-09-07","2020-08-24","2020-08-24","2020-08-03","2020-09-04","2020-09-04","2020-09-16","2020-09-16","2021-02-15","2021-02-15","2020-07-06","2020-01-03","2020-10-19","2021-06-10","2021-08-12","2021-09-23","2021-09-09","2020-01-09","2020-07-06","2020-07-06","2020-07-06","2020-07-29","2020-08-10","2020-08-10","2020-07-01","2020-01-28","2020-01-06","2020-06-29","2020-05-14","2021-08-23","2021-09-07","2021-06-16","2020-07-29","2020-10-19","2021-08-26","2021-08-26","2021-08-12","2021-08-24","2021-08-24","2021-07-29","2021-08-24","2021-09-07","2021-08-23","2021-08-23","2021-08-23","2021-08-23","2021-09-23","2021-08-19"],"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":[["","64380080807","IBUPROFEN ","600MG","15","Select","Select",""],["","68180071909","AMLODIPINE ","2.5MG","30","Select","Select",""],["","00069047103","CHANTIX ","0.5& 1MG","53","Select","Select",""],["","00406012305","HYDROCO\/APAP ","5-325MG","6","Select","Select",""],["","65162010250","GABAPENTIN ","300MG","90","Select","Select",""],["","52817033010","CYCLOBENZAPR ","5MG","30","Select","Select",""],["","69543013611","TRAMADOL ","50MG","60","Select","Select",""],["","00006483703","PNEUMOVAX ","25\/0.5","1","Select","Select",""],["","00781185220","AMOX\/K ","875-125","14","Select","Select",""],["","00115164501","NITROFUR ","100MG","20","Select","Select",""],["","57237007830","ONDANSETRON ","8MG ODT","30","Select","Select",""],["","00054418425","DEXAMETHASON ","4MG","6","Select","Select",""],["","67877024201","QUETIAPINE ","25MG","60","Select","Select",""],["","00378047705","DIAZEPAM ","10MG","1","Select","Select",""],["","19515081852","FLULAVAL ","2021-22","0","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","59267100001","PFIZER ","COVID-19","0","Select","Select",""],["","64380080807","IBUPROFEN","600MG","15","Select","Select",""],["","00069047103","CHANTIX","0.5& 1MG","53","Select","Select",""],["","00406012305","HYDROCO\/APAP","5-325MG","6","Select","Select",""],["","68180071909","AMLODIPINE","2.5MG","30","Select","Select",""],["","52817033010","CYCLOBENZAPR","5MG","30","Select","Select",""],["","65162010250","GABAPENTIN","300MG","90","Select","Select",""],["","69543013611","TRAMADOL","50MG","28","Select","Select",""],["","67877024201","QUETIAPINE","25MG","60","Select","Select",""],["","00378047705","DIAZEPAM","10MG","1","Select","Select",""],["","65862050320","AMOX\/K","875-125","14","Select","Select",""],["","00006483703","PNEUMOVAX","25\/0.5","1","Select","Select",""],["","59267100001","PFIZER","COVID-19","0","Select","Select",""],["","00054418425","DEXAMETHASON","4MG","6","Select","Select",""],["","19515081852","FLULAVAL","2021-22","0","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","00115164501","NITROFUR","100MG","20","Select","Select",""],["","57237007830","ONDANSETRON","8MG ODT","30","Select","Select",""],["","00054429931","FUROSEMIDE ","TAB 40MG","7","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","",""],["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":""}]}]}