{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"WILLIE   M JETER","gend":1,"add":"210 CHOWAN DR APT J","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1955-01-08","age":"","mstatus":"","insh":"20042664*01","cliId":"","pno":"757\/323-8482","cno":"757\/323-8482","email":"","ename":"","eno":"","pphy":"DUMARAN, RAYMOND MD","ppno":"757\/484-5828","pcpadd":"7185 HARBOUR TOWNE PKWY SUITE 206","pcpcity":"SUFFOLK","pcpstate":"VA","pcpzip":23435,"pcpcounty":"","pcpid":162911,"pcpname":"INTERNISTS OF CHURCHLAND","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/484-4933","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I10.","J42.","E66.01","E11.29","E78.5","G89.4","F41.1","Z12.39","Z13.820","Z12.11","M54.5","M25.552","H25.11","H40.013","E11.3292","Z79.4","L23.5","K08.89","E11.65","B37.3","L30.9","K59.00","R19.00","K04.7","R80.9","E88.09","NO DATA","E11.42","B35.1","R60.1","M21.6X9","M20.40","L85.1","K02.9","G47.33","R21.","J45.909","J44.9","E11.9","F41.9","G47.30","Z86.711","Z86.73","Z86.2","Z79.899","Z79.82","Z85.3","Z79.51","Z68.42","R60.0","R10.84","R01.1","N21.9","F03.90","C50.912","Z79.891","Z71.9","M21.6X1","M20.41","I63.9","S09.90XS","L73.9","R42.","I51.7","I35.0","N17.9","U07.1","J96.90","R65.21","J93.0","J96.01","Z51.5","J96.02"],"date":["2021-03-29","2021-03-23","2021-03-29","2021-03-23","2021-03-23","2020-12-12","2021-03-23","2020-08-26","2021-03-23","2020-11-18","2020-12-12","2020-08-26","2021-06-09","2021-06-09","2021-06-09","2021-06-09","2021-02-04","2020-12-13","2020-12-13","2020-12-13","2021-04-26","2021-08-02","2020-01-20","2020-04-21","2021-03-23","2020-11-18","2021-11-01","2021-05-12","2021-05-12","2020-06-26","2020-06-26","2020-06-26","2021-05-12","2020-09-03","2021-03-03","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-03-29","2021-10-28","2020-07-29","2020-07-29","2020-07-29","2020-07-29","2021-03-23","2021-03-23","2021-03-23","2021-04-26","2021-05-12","2021-05-12","2020-12-12","2020-12-12","2021-02-16","2021-02-16","2021-10-27","2021-10-27","2021-10-28","2021-11-01","2021-10-28","2021-10-28","2021-10-28","2021-11-01","2021-10-28","2021-11-01"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","","","","","","","","",null,"","","","","","","","","","","","","","",null,null,null,null,null,null,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":[["","65862067899","ALPRAZOLAM ","1MG","60","Select","Select",""],["","00088221905","LANTUS ","100\/ML","30","Select","Select",""],["","00536333401","VITAMIN ","1000UNIT","30","Select","Select",""],["","08290320122","BD  PEN NEEDL","32GX4MM","100","Select","Select",""],["","42858010301","OXYCOD\/APAP ","7.5-325","120","Select","Select",""],["","68180072103","AMLODIPINE ","10MG","30","Select","Select",""],["","16729003415","LETROZOLE ","2.5MG","30","Select","Select",""],["","70377002911","ATORVASTATIN ","40MG","30","Select","Select",""],["","00002879959","HUMALOG ","100\/ML","15","Select","Select",""],["","50428152314","CVS ","325MG","30","Select","Select",""],["","61314063705","PREDNISOLONE ","1% OP","5","Select","Select",""],["","76385011350","CARVEDILOL ","25MG","60","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","15","Select","Select",""],["","23155010610","HYDROXYZ ","25MG","60","Select","Select",""],["","66733082259","INSULIN ","100\/ML","30","Select","Select",""],["","53885013610","ONETOUCH ","LANCETS","200","Select","Select",""],["","00536123201","ASPIRIN ","325MG EC","90","Select","Select",""],["","65862042005","SMZ\/TMP ","800-160","20","Select","Select",""],["","88827735847","","","100","Select","Select",""],["","49281012065","FLUZONE ","PF 20-21","1","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","20","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21","Select","Select",""],["","67877025115","TRIAMCINOLON ","0.10%","15","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1","Select","Select",""],["","68462010340","FLUCONAZOLE ","150MG","1","Select","Select",""],["","45802086866","POLYETH ","3350 NF","30","Select","Select",""],["","00169406013","VICTOZA ","18MG\/3ML","6","Select","Select",""],["","08290320122","BD PEN NEEDL","32GX4MM","100","Select","Select",""],["","00536333401","VITAMIN","1000UNIT","30","Select","Select",""],["","68180072103","AMLODIPINE","10MG","30","Select","Select",""],["","76385011350","CARVEDILOL","25MG","60","Select","Select",""],["","50428152314","CVS","325MG","30","Select","Select",""],["","16729003415","LETROZOLE","2.5MG","30","Select","Select",""],["","65862067899","ALPRAZOLAM","1MG","60","Select","Select",""],["","00088221905","LANTUS","100\/ML","30","Select","Select",""],["","00002879959","HUMALOG","100\/ML","15","Select","Select",""],["","42858010301","OXYCOD\/APAP","7.5-325","120","Select","Select",""],["","70377002911","ATORVASTATIN","40MG","30","Select","Select",""],["","61314063705","PREDNISOLONE","1% OP","5","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","23155010610","HYDROXYZ","25MG","60","Select","Select",""],["","63304069301","CLINDAMYCIN","300MG","15","Select","Select",""],["","65862042005","SMZ\/TMP","800-160","20","Select","Select",""],["","66733082259","INSULIN","100\/ML","30","Select","Select",""],["","00536123201","ASPIRIN","325MG EC","90","Select","Select",""],["","49281012065","FLUZONE","PF 20-21","1","Select","Select",""],["","53885013610","ONETOUCH","LANCETS","200","Select","Select",""],["","00168000680","TRIAMCINOLON","0.10%","160","Select","Select",""],["","58160082311","SHINGRIX","50\/0.5ML","1","Select","Select",""],["","59746000103","METHYLPRED","4MG","21","Select","Select",""],["","45802086866","POLYETH","3350 NF","30","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","1","Select","Select",""],["","24208050707","LOTEMAX","0.38%","5","Select","Select",""],["","00169406013","VICTOZA","18MG\/3ML","6","Select","Select",""],["","69238110005","DOXYCYCL","100MG","20","Select","Select",""],["","24208050707","LOTEMAX ","GEL 0.0038","5","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":""}]}]}