{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MINNIE   L ROSCOE","gend":1,"add":"2020 TIMBER LN APT A","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1962-11-08","age":"","mstatus":"","insh":"20043343*01","cliId":"","pno":"757\/793-9756","cno":"757\/793-9756","email":"","ename":"","eno":"","pphy":"MUSSELMANI, ZATTAM MD","ppno":"757\/543-3557","pcpadd":"1422 POINDEXTER ST","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23324,"pcpcounty":"","pcpid":119860,"pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","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":["J45.902","R06.03","J44.9","I10.","J96.12","Z99.81","K21.9","F17.200","J96.20","J44.1","J45.40","J20.9","J15.212","J96.21","J96.22","J45.901","F17.210","E55.9","D64.9","J96.90","Z99.11","T78.3XXA","R06.02","J69.0","B95.62","J96.11","E44.0","Z79.890","N39.0","J80.","J96.01","E46.","Z20.828","Z03.818","J45.909","R13.13","J95.00","Z93.0","J96.00","J18.9","J44.0","Z23.","J45.42","J30.9","J96.10","R13.10","J96.02","Z09.","Z43.1","Z43.0","E78.5","Z79.51","Z79.899","Z20.822","J98.01","E87.2","Z68.1","J32.9","E87.5","T46.1X5A","D72.829","R13.12","J02.9","I49.3","R47.02","N92.4","R50.9","J03.90","H25.13","H52.13","H52.223","H52.4","Z01.419","R45.1","R06.00","N76.0","Z11.3"],"date":["2020-04-29","2020-04-05","2021-07-31","2020-06-18","2020-06-11","2020-04-15","2020-06-18","2020-04-26","2020-04-26","2021-08-17","2020-04-22","2020-04-12","2020-04-26","2020-07-05","2020-04-30","2020-04-29","2020-06-18","2020-04-30","2020-04-30","2020-04-26","2020-04-26","2020-04-26","2021-08-06","2020-04-15","2020-04-15","2020-06-11","2020-04-30","2020-10-01","2020-10-01","2020-04-03","2020-04-06","2020-04-25","2020-08-05","2020-04-27","2020-04-26","2020-04-30","2020-05-29","2020-06-18","2020-06-02","2020-05-11","2020-05-11","2020-05-11","2020-04-05","2020-04-05","2020-04-05","2020-04-21","2020-05-04","2020-06-05","2020-06-05","2020-06-18","2020-06-18","2020-06-18","2020-06-18","2021-01-24","2021-01-24","2020-04-03","2020-04-03","2020-04-03","2020-04-03","2020-04-03","2020-04-03","2020-06-02","2020-08-05","2020-04-03","2020-04-22","2020-07-14","2020-08-05","2020-08-05","2021-05-28","2021-05-28","2021-05-28","2021-05-28","2021-05-20","2021-08-17","2021-08-17","2021-09-14","2021-09-14"],"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":[["","76204020025","ALBUTEROL ","0.08%","375","Select","Select",""],["","67877032105","IBUPROFEN ","800MG","90","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00310737220","BUDES\/FORMOT ","80-4.5","10","Select","Select",""],["","00186037220","SYMBICORT ","80-4.5","10","Select","Select",""],["","65862057490","MONTELUKAST ","10MG","90","Select","Select",""],["","00310009530","DALIRESP ","500MCG","90","Select","Select",""],["","00046110511","PREMPRO ","0.3-1.5","28","Select","Select",""],["","67877019805","AMLODIPINE ","5MG","30","Select","Select",""],["","55111015901","OMEPRAZOLE ","40MG","30","Select","Select",""],["","65862019105","CYCLOBENZAPR ","10MG","90","Select","Select",""],["","00597007541","SPIRIVA ","HANDIHLR","30","Select","Select",""],["","68382085601","TRIAMT\/HCTZ ","37.5-25","30","Select","Select",""],["","00904645760","DOK ","100MG","60","Select","Select",""],["","11822003960","RA ","100MG","60","Select","Select",""],["","69238110005","DOXYCYCL ","100MG","14","Select","Select",""],["","47781030301","NITROFURANTN ","100MG","14","Select","Select",""],["","59746017506","PREDNISONE ","20MG","10","Select","Select",""],["","80777027398","MODERNA ","COVID-19","0","Select","Select",""],["","00186037220","SYMBICORT","80-4.5","10","Select","Select",""],["","00310009530","DALIRESP","500MCG","30","Select","Select",""],["","67877032105","IBUPROFEN","800MG","90","Select","Select",""],["","65862019105","CYCLOBENZAPR","10MG","90","Select","Select",""],["","67877019805","AMLODIPINE","5MG","30","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","55111015901","OMEPRAZOLE","40MG","30","Select","Select",""],["","65862057490","MONTELUKAST","10MG","90","Select","Select",""],["","68382085601","TRIAMT\/HCTZ","37.5-25","30","Select","Select",""],["","00597007541","SPIRIVA","HANDIHLR","30","Select","Select",""],["","00310737220","BUDES\/FORMOT","80-4.5","10","Select","Select",""],["","00046110511","PREMPRO","0.3-1.5","28","Select","Select",""],["","76204020025","ALBUTEROL","0.08%","375","Select","Select",""],["","11822003960","RA","100MG","60","Select","Select",""],["","00904645760","DOK","100MG","60","Select","Select",""],["","69238110005","DOXYCYCL","100MG","14","Select","Select",""],["","59746017506","PREDNISONE","20MG","10","Select","Select",""],["","68462031417","NYSTAT\/TRIAM","","15","Select","Select",""],["","80777027398","MODERNA","COVID-19","0","Select","Select",""],["","47781030301","NITROFURANTN","100MG","14","Select","Select",""],["","68462031417","NYSTAT\/TRIAM ","CRE ","15","Select","Select",""],["","45802006435","TRIAMCINOLON ","CRE 0.001","60","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":""}]}]}