{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA   M SPENCE","gend":1,"add":"1912 MILLVILLE CT","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1960-05-15","age":"","mstatus":"","insh":"20035423*01","cliId":"","pno":"757\/487-4352","cno":"757\/487-4352","email":"","ename":"","eno":"","pphy":"KAPUR, ANAND MD","ppno":"757\/673-5890","pcpadd":"SUITE 250 5818 HARBOUR VIEW BLV","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":131856,"pcpname":"HARBOUR VIEW FAMILY PRACTICE","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"757\/494-7615","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/673-5946","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M43.16","M51.37","M54.16","Z01.419","Z12.39","Z12.4","Z13.820","M81.0","K58.9","R39.81","R11.0","K21.9","Z86.010","K57.90","K64.8","K62.89","H25.13","H52.4","R07.89","J30.2","R05.","R35.0","J40.","J01.00","I10.","J45.40","R30.9","R63.4","E78.00","J30.9","M51.36","L28.2","E87.6","N39.0","E66.9","H04.123"],"date":["2020-06-18","2020-06-25","2021-04-22","2020-12-16","2020-12-16","2020-12-16","2020-12-16","2021-06-14","2021-11-17","2021-11-17","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-09-15","2021-05-28","2021-05-28","2020-08-13","2020-08-13","2020-08-13","2020-08-13","2021-02-18","2021-02-18","2020-05-13","2020-03-04","2020-03-04","2020-03-04","2020-03-04","2020-03-04","2020-03-04","2020-03-04","2020-05-13","2020-05-13","2020-05-13","2021-05-28"],"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":[["","00172572860","FAMOTIDINE ","20MG","60","Select","Select",""],["","66993058697","FLUTIC\/SALME ","500\/50","60","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","30","Select","Select",""],["","64764017130","DEXILANT ","30MG DR","30","Select","Select",""],["","00378932232","WIXELA ","500\/50","60","Select","Select",""],["","60505257809","ATORVASTATIN ","10MG","30","Select","Select",""],["","67877019705","AMLODIPINE ","2.5MG","30","Select","Select",""],["","68382039801","POT  CHLORIDE","20MEQ ER","14","Select","Select",""],["","65862019105","CYCLOBENZAPR ","10MG","15","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","4","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG DR","30","Select","Select",""],["","68382005101","MELOXICAM ","15MG","30","Select","Select",""],["","16714065202","CIPROFLOXACN ","500MG","10","Select","Select",""],["","45802005505","TRIAMCINOLON ","0.10%","454","Select","Select",""],["","69452014420","BENZONATATE ","200MG","21","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","00173069700","ADVAIR ","500\/50","60","Select","Select",""],["","65162067684","AZELASTINE ","0.10%","30","Select","Select",""],["","45802065078","LORATADINE ","10MG","30","Select","Select",""],["","58160088552","FLUARIX ","2020-21","0","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","59676058015","JANSSEN ","COVID-19","0","Select","Select",""],["","64380073706","VITAMIN","50000UNT","4","Select","Select",""],["","66993058697","FLUTIC\/SALME","500\/50","60","Select","Select",""],["","65862019105","CYCLOBENZAPR","10MG","15","Select","Select",""],["","29300012810","HYDROCHLOROT","25MG","30","Select","Select",""],["","60505257809","ATORVASTATIN","10MG","30","Select","Select",""],["","00378932232","WIXELA","500\/50","60","Select","Select",""],["","00172572860","FAMOTIDINE","20MG","60","Select","Select",""],["","64764017130","DEXILANT","30MG DR","30","Select","Select",""],["","16714065202","CIPROFLOXACN","500MG","10","Select","Select",""],["","45802005535","TRIAMCINOLON","0.10%","30","Select","Select",""],["","69452014420","BENZONATATE","200MG","21","Select","Select",""],["","68382039801","POT CHLORIDE","20MEQ ER","14","Select","Select",""],["","68382005101","MELOXICAM","15MG","30","Select","Select",""],["","67877019705","AMLODIPINE","2.5MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG DR","30","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","00173069700","ADVAIR","500\/50","60","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","58160088552","FLUARIX","2020-21","0","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","65162067684","AZELASTINE","0.10%","30","Select","Select",""],["","59676058015","JANSSEN","COVID-19","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":[[["No","Select","","","","","Select","",""],["No","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":""}]}]}