{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MATTHEW STANLEY","gend":0,"add":"809 E VIRGINIA BEACH BLVD","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1976-12-08","age":"","mstatus":"","insh":"20038870*01","cliId":"","pno":"757\/383-0445","cno":"757\/383-0445","email":"","ename":"","eno":"","pphy":"WHITEHURST, CANDACE MD","ppno":"757\/622-8358","pcpadd":"930 W 21ST ST STE 100","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23517,"pcpcounty":"","pcpid":207883,"pcpname":"BON SECOURS GHENT STATION MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/622-9662","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I67.89","E66.01","M17.0","Z99.3","F31.81","K92.1","D12.2","K21.0","K29.70","L98.492","M25.561","G89.29","Z68.44","G89.4","M47.816","M25.569","F33.41","F41.1","R60.0","K21.9","E66.8","K62.5","R63.4","K62.89","K60.2","K64.0","M17.11","M25.562","M54.16","R74.0","Z86.010","R06.00","J44.9","G47.33","J45.20","R06.2","R94.2","I11.9","E78.5","M25.50","R25.1","Z23.","Z76.0","A41.9","L03.314","R60.1","N50.89"],"date":["2020-11-04","2021-06-01","2020-11-04","2020-11-04","2020-11-22","2020-08-12","2020-08-12","2020-08-12","2020-08-12","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2020-04-29","2020-01-27","2020-11-04","2021-08-16","2021-08-16","2020-11-13","2020-08-12","2020-01-22","2020-09-14","2020-01-22","2020-01-22","2020-08-12","2020-08-12","2020-02-18","2020-04-29","2020-04-29","2020-09-14","2020-09-14","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-12-01","2020-11-04","2020-07-28","2020-07-28","2020-07-28","2020-11-04","2020-11-04","2021-11-04","2021-11-04","2021-11-04","2021-11-03"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",null,null,null,null]}},{"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":[["","43547030703","ARIPIPRAZOLE ","30MG","30","Select","Select",""],["","16729020201","BUSPIRONE ","10MG","180","Select","Select",""],["","65162089129","MOMETASONE ","50MCG","17","Select","Select",""],["","24510010010","NUCYNTA ","100MG","120","Select","Select",""],["","00172572860","FAMOTIDINE ","20MG","30","Select","Select",""],["","70377000315","SIMVASTATIN ","20MG","30","Select","Select",""],["","45802065078","LORATADINE ","10MG","30","Select","Select",""],["","00093742698","MONTELUKAST ","10MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","90","Select","Select",""],["","00603188016","LIDOCAINE ","5%","30","Select","Select",""],["","50111043401","TRAZODONE ","100MG","30","Select","Select",""],["","68180052001","LISINOP\/HCTZ ","20-25MG","30","Select","Select",""],["","51991029401","OXCARBAZEPIN ","600MG","60","Select","Select",""],["","65162019050","NAPROXEN ","500MG","20","Select","Select",""],["","65862019405","FLUOXETINE ","40MG","60","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","30","Select","Select",""],["","00085461001","DULERA ","200-5MCG","13","Select","Select",""],["","00591367001","NABUMETONE ","500MG","60","Select","Select",""],["","00378021610","FUROSEMIDE ","40MG","30","Select","Select",""],["","64764073030","TRINTELLIX ","10MG","30","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","10370010150","BUPROPN ","150MG XL","30","Select","Select",""],["","00173088710","TRELEGY ","ELLIPTA","60","Select","Select",""],["","64380080307","RANITIDINE ","150MG","180","Select","Select",""],["","00832054211","BUMETANIDE ","2MG","30","Select","Select",""],["","00378827052","ALBUTEROL ","0.08%","150","Select","Select",""],["","69097015907","MELOXICAM ","15MG","30","Select","Select",""],["","59148001113","ABILIFY ","30MG","30","Select","Select",""],["","00378064110","PREDNISONE ","10MG","30","Select","Select",""],["","59779061288","ALLERGY ","10MG","30","Select","Select",""],["","00173071920","FLOVENT ","110MCG","36","Select","Select",""],["","00173086910","ANORO ","62.5-25","180","Select","Select",""],["","65862019405","FLUOXETINE","40MG","60","Select","Select",""],["","45802065078","LORATADINE","10MG","30","Select","Select",""],["","00093742698","MONTELUKAST","10MG","30","Select","Select",""],["","50111043401","TRAZODONE","100MG","30","Select","Select",""],["","16729020201","BUSPIRONE","10MG","180","Select","Select",""],["","65162089129","MOMETASONE","50MCG","17","Select","Select",""],["","43547030703","ARIPIPRAZOLE","30MG","30","Select","Select",""],["","68180052001","LISINOP\/HCTZ","20-25MG","30","Select","Select",""],["","70377000315","SIMVASTATIN","20MG","30","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","24510010010","NUCYNTA","100MG","60","Select","Select",""],["","65862085901","FAMOTIDINE","20MG","30","Select","Select",""],["","51991029401","OXCARBAZEPIN","600MG","60","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","90","Select","Select",""],["","00603188016","LIDOCAINE","5%","30","Select","Select",""],["","65162019050","NAPROXEN","500MG","20","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","00085461001","DULERA","200-5MCG","13","Select","Select",""],["","64380080307","RANITIDINE","150MG","180","Select","Select",""],["","00591367001","NABUMETONE","500MG","60","Select","Select",""],["","00378021610","FUROSEMIDE","40MG","30","Select","Select",""],["","64764073030","TRINTELLIX","10MG","30","Select","Select",""],["","59148001113","ABILIFY","30MG","30","Select","Select",""],["","10370010150","BUPROPN","150MG XL","30","Select","Select",""],["","00378064110","PREDNISONE","10MG","30","Select","Select",""],["","00832054211","BUMETANIDE","2MG","30","Select","Select",""],["","00173088710","TRELEGY","ELLIPTA","60","Select","Select",""],["","00173071920","FLOVENT","110MCG","36","Select","Select",""],["","00378827052","ALBUTEROL","0.08%","150","Select","Select",""],["","59779061288","ALLERGY","10MG","30","Select","Select",""],["","00173086910","ANORO","62.5-25","180","Select","Select",""],["","69097015907","MELOXICAM","15MG","30","Select","Select",""],["","69097094312","GABAPENTIN","300MG","28","Select","Select",""],["","69097094312","GABAPENTIN ","CAP 300MG","28","Select","Select",""],["","65162027250","SMZ\/TMP ","TAB 800-160","10","Select","Select",""],["","58160088752","FLUARIX ","INJ 2021-22","0","Select","Select",""],["","76282066339","DICLOFENAC ","GEL 0.01","100","Select","Select",""],["","69238110005","DOXYCYCL ","CAP 100MG","14","Select","Select",""],["","65162046650","IBUPROFEN ","TAB 800MG","60","Select","Select",""],["","68462029855","CLOTRIM\/BETA ","CRE DIPROP","45","Select","Select",""],["","59267100002","PFIZER ","INJ COVID-19","0","Select","Select",""],["","68462011944","FLUCONAZOLE ","TAB 150MG","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":[[["No","Select","","","","","Select","",""],["No","Select","","","","","Select","",""],["N\/A","Select","","","","","Select","",""],["No","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":""}]}]}