{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHARON PICKETT","gend":1,"add":"804 OLE TOWNE CT","city":"CHESAPEAKE","state":"VA","zip":23320,"dob":"1965-06-20","age":"","mstatus":"","insh":"20033423*01","cliId":"","pno":"757\/323-2823","cno":"757\/323-2823","email":"","ename":"","eno":"","pphy":"BUGARIN, LOPITO B MD","ppno":"757\/547-0588","pcpadd":"200 MEDICAL PARKWAY SUITE 315","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":193441,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/785-8297","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-8572","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["R10.13","I10.","F17.200","F22.","F41.1","F29.","R69.","F17.210","F25.0","R41.82","E87.6","R44.3","F28.","Z59.0","V62.84","F10.920","F20.9","R45.1","Z53.20","J43.9","E89.0","Z79.899","Z90.49","Z90.710","Z90.721","Z88.1","Z88.6","Z88.8","Z82.49","F25.1","Z91.14","E55.9","K21.9","I25.10","E78.5","E03.9","J44.9","F60.9","F90.9","T14.8XXD","F32.2","K86.1","K27.9","Z91.19","K29.70","Z71.9","Z76.0","F41.9","R41.0","L72.3","T07.XXXS","G44.52","R11.2","Z71.89","H60.392","J02.9","R45.86","T38.1X6D","Z86.59","R68.89","K58.9","J32.9","K59.00","R10.9","R07.89","R30.0","R46.2","R45.851","H66.92","N39.0","Z86.19","Z86.73","L25.9","B35.3","H60.502","K31.84","F32.9","J01.90","S20.211A","S20.212A","S39.012A","S40.022A","Z11.59","S90.822A","S80.02XA","F19.10","F33.2","F90.0","Z51.81","F41.0","F10.10","M79.7","R51.9","F19.94","F13.10","F15.959","Z87.891","F15.10","F31.81","F51.01","R19.7","L25.5","B18.2","H60.92"],"date":["2020-03-15","2021-08-11","2020-03-15","2020-07-21","2021-03-04","2021-06-22","2020-03-16","2021-06-19","2020-09-21","2020-09-29","2020-09-26","2021-08-05","2020-10-09","2021-08-05","2021-08-05","2021-06-22","2021-07-08","2021-06-19","2020-07-20","2021-06-19","2021-06-19","2021-06-19","2020-07-20","2020-07-20","2020-07-20","2021-06-19","2021-06-19","2021-06-19","2020-07-20","2021-08-13","2021-08-05","2021-08-05","2021-08-11","2021-08-05","2021-08-06","2021-08-06","2021-08-05","2021-08-18","2020-07-23","2020-07-23","2020-09-11","2021-08-11","2020-09-10","2020-09-10","2020-09-10","2020-01-20","2020-01-20","2020-07-09","2020-03-16","2020-07-25","2020-07-25","2020-09-08","2020-09-08","2020-09-08","2021-06-19","2021-06-19","2021-06-19","2021-06-19","2021-08-18","2021-06-19","2020-03-18","2020-03-18","2020-03-24","2020-03-22","2021-06-27","2021-08-10","2021-06-21","2021-06-21","2021-06-25","2021-08-11","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2021-06-25","2021-08-05","2020-01-08","2020-03-19","2020-07-06","2020-07-06","2020-07-06","2020-07-06","2020-10-04","2020-07-22","2020-10-08","2020-10-08","2021-08-30","2021-08-30","2021-03-04","2021-08-05","2021-08-05","2021-08-05","2021-08-06","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-18","2021-08-30","2021-08-30","2021-06-24","2021-06-24","2021-06-27","2021-06-26"],"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":[["","65862014405","CARVEDILOL ","12.5MG","60","Select","Select",""],["","58914017014","CARAFATE ","1GM\/10ML","1200","Select","Select",""],["","00093221001","SUCRALFATE ","1GM","150","Select","Select",""],["","16729017501","AMITRIPTYLIN ","100MG","60","Select","Select",""],["","69238183801","LEVOTHYROXIN ","150MCG","30","Select","Select",""],["","68382018201","BUSPIRONE ","15MG","60","Select","Select",""],["","00555097402","AMPHET\/DEXTR ","30MG","60","Select","Select",""],["","65862049501","QUETIAPINE ","400MG","30","Select","Select",""],["","43547035210","LISINOPRIL ","5MG","30","Select","Select",""],["","11822317640","RA ","325MG","84","Select","Select",""],["","65862056090","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","60505258009","ATORVASTATIN ","40MG","30","Select","Select",""],["","00228203150","ALPRAZOLAM ","1MG","90","Select","Select",""],["","10702000709","CYCLOBENZAPR ","10MG","10","Select","Select",""],["","65862052890","VENLAFAXINE ","75MG ER","14","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","6","Select","Select",""],["","00032121201","CREON ","12000UNT","42","Select","Select",""],["","00456120130","LINZESS ","145MCG","30","Select","Select",""],["","50228018005","GABAPENTIN ","300MG","45","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00254100752","ALBUTEROL ","HFA","7","Select","Select",""],["","00185061501","HYDROXYZ ","50MG","42","Select","Select",""],["","00143924920","AMOX\/K ","875-125","10","Select","Select",""],["","59417010510","VYVANSE ","50MG","30","Select","Select",""],["","00378398093","PALIPERIDONE ","ER 6MG","14","Select","Select",""],["","68382080501","TRAZODONE ","50MG","240","Select","Select",""],["","00085113204","PROVENTIL ","HFA","7","Select","Select",""],["","57237000930","MIRTAZAPINE ","30MG","14","Select","Select",""],["","65162019011","NAPROXEN ","500MG","20","Select","Select",""],["","16714012302","OMEPRAZOLE ","40MG","30","Select","Select",""],["","00143314250","DOXYCYCL ","100MG","28","Select","Select",""],["","00143992701","CIPROFLOXACN ","250MG","10","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","43598016630","OLANZAPINE ","10MG","30","Select","Select",""],["","31722071390","PANTOPRAZOLE","40MG","30","Select","Select",""],["","58914017014","CARAFATE","1GM\/10ML","1200","Select","Select",""],["","00093221001","SUCRALFATE","1GM","150","Select","Select",""],["","43547035210","LISINOPRIL","5MG","30","Select","Select",""],["","68180097301","LEVOTHYROXIN","150MCG","14","Select","Select",""],["","16729017501","AMITRIPTYLIN","100MG","60","Select","Select",""],["","60505258009","ATORVASTATIN","40MG","30","Select","Select",""],["","68382009401","CARVEDILOL","12.5MG","60","Select","Select",""],["","00093100301","BUSPIRONE","15MG","60","Select","Select",""],["","65862049501","QUETIAPINE","400MG","30","Select","Select",""],["","00228203150","ALPRAZOLAM","1MG","90","Select","Select",""],["","00555097402","AMPHET\/DEXTR","30MG","60","Select","Select",""],["","00143924920","AMOX\/K","875-125","10","Select","Select",""],["","00456120130","LINZESS","145MCG","30","Select","Select",""],["","00254100752","ALBUTEROL","HFA","7","Select","Select",""],["","59417010510","VYVANSE","50MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00032121201","CREON","12000UNT","42","Select","Select",""],["","50228018005","GABAPENTIN","300MG","45","Select","Select",""],["","64380073706","VITAMIN","50000UNT","4","Select","Select",""],["","11822317640","RA","325MG","84","Select","Select",""],["","10702000709","CYCLOBENZAPR","10MG","10","Select","Select",""],["","65162019011","NAPROXEN","500MG","20","Select","Select",""],["","65862052890","VENLAFAXINE","75MG ER","14","Select","Select",""],["","00185061501","HYDROXYZ","50MG","42","Select","Select",""],["","00143314250","DOXYCYCL","100MG","28","Select","Select",""],["","00378398093","PALIPERIDONE","ER 6MG","14","Select","Select",""],["","16714012302","OMEPRAZOLE","40MG","30","Select","Select",""],["","68382080501","TRAZODONE","50MG","240","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","57237000930","MIRTAZAPINE","30MG","14","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","43598016630","OLANZAPINE","10MG","30","Select","Select",""],["","00143992701","CIPROFLOXACN","250MG","10","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":""}]}]}