{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"CELLIA   D WILSON","gend":1,"add":"1042 BRYCE LN APT 2","city":"VIRGINIA BEACH","state":"VA","zip":"23464-9998","dob":"1976-02-27","age":"","mstatus":"","insh":"3201732*01","cliId":"","pno":"757\/383-1055","cno":"757\/383-1055","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":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/543-0053","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J30.9","K58.2","K31.84","E10.21","K59.00","D50.9","R10.12","K21.9","L21.8","L85.3","F41.9","F51.01","E11.40","N76.0","D64.9","N64.4","E11.3551","E11.3312","H16.142","K92.2","Z20.822","R10.13","E11.65","R82.4","R81.","R80.9","K29.70","K20.9","E11.9","Z79.4","K64.9","N39.0","K52.9","R10.9","H35.033","Z01.419","N92.0","D25.1","E11.3511","K92.0","K31.89","NO DATA","I50.9","E87.70","M79.2","Z86.69","G60.9","G47.33","R11.2","F12.90","F43.20","D62.","K44.9","R06.02","R60.0","M79.605","M79.604","M79.89","E86.0","K22.11","N17.9","K25.4","E11.22","E11.43","I12.9","F51.04","E78.2","R77.8","I44.0","I10.","R07.9","K29.50","N92.1","E66.9","I11.0","E78.5","F17.200","I37.1","I07.1","I50.30","E01.0","K21.0","F33.1","E11.21"],"date":["2020-04-27","2020-04-27","2021-02-18","2020-04-27","2020-05-06","2021-02-21","2020-05-21","2020-05-06","2020-07-01","2021-03-16","2021-07-21","2020-09-22","2020-10-20","2020-09-22","2021-07-08","2020-10-20","2020-11-16","2021-02-05","2021-02-02","2021-02-23","2021-02-18","2020-12-01","2021-02-18","2020-04-15","2020-04-15","2020-04-15","2020-05-20","2020-05-20","2021-07-14","2020-05-20","2020-08-11","2021-02-09","2020-09-09","2020-09-09","2021-03-25","2020-10-29","2021-02-18","2020-10-29","2021-03-25","2021-02-23","2021-03-05","2021-03-16","2021-05-25","2021-07-15","2020-07-22","2020-07-22","2021-08-10","2021-08-10","2020-12-01","2020-12-01","2021-01-26","2021-02-22","2021-02-22","2021-03-05","2021-03-05","2021-03-17","2021-03-17","2021-03-17","2020-09-09","2021-02-18","2021-07-08","2021-02-18","2021-02-18","2021-02-18","2021-02-18","2021-08-10","2021-02-18","2021-02-18","2020-04-15","2021-07-15","2020-09-09","2020-09-09","2021-02-18","2021-02-18","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2021-07-14","2020-03-16","2020-03-16","2020-11-23","2021-07-08"],"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":[["","31722058230","DULOXETINE ","30MG","30","Select","Select",""],["","31722070110","LOSARTAN ","50MG","30","Select","Select",""],["","60505014601","OMEPRAZOLE ","40MG","30","Select","Select",""],["","00378021601","FUROSEMIDE ","40MG","30","Select","Select",""],["","08290324703","INSULIN ","0.5\/29G","100","Select","Select",""],["","68382039801","POT  CHLORIDE","20MEQ ER","30","Select","Select",""],["","00904671760","CETIRIZINE ","10MG","30","Select","Select",""],["","00088221905","LANTUS ","100\/ML","15","Select","Select",""],["","16729017101","AMITRIPTYLIN ","10MG","60","Select","Select",""],["","27241001890","MONTELUKAST ","10MG","30","Select","Select",""],["","69680012035","LIDOCAINE ","5%","213","Select","Select",""],["","65162063709","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","59762040101","SUCRALFATE ","1GM","120","Select","Select",""],["","53885027210","ONETOUCH ","VERIO","100","Select","Select",""],["","43598029490","PREGABALIN ","100MG","120","Select","Select",""],["","00002751001","HUMALOG ","100\/ML","10","Select","Select",""],["","68382004101","PROMETHAZINE ","25MG","12","Select","Select",""],["","50383070016","FLUTICASONE ","50MCG","48","Select","Select",""],["","49035045895","ALLERGY ","10MG","30","Select","Select",""],["","45802096126","CLOBETASOL ","0.05%","118","Select","Select",""],["","69452015120","VITAMIN ","50000UNT","4","Select","Select",""],["","16729020201","BUSPIRONE ","10MG","60","Select","Select",""],["","51224000150","BENZONATATE ","200MG","21","Select","Select",""],["","70710134403","RAMELTEON ","8MG","30","Select","Select",""],["","10572010001","PEG-3350 ","ELECTROL","4000","Select","Select",""],["","57896044101","BISACODYL ","5MG EC","4","Select","Select",""],["","68001036500","METRONIDAZOL ","500MG","14","Select","Select",""],["","60258017101","MAG ","400MG","30","Select","Select",""],["","81131007179","MAGNESIUM ","400MG","30","Select","Select",""],["","00185061501","HYDROXYZ ","50MG","30","Select","Select",""],["","43199001101","HYOSCYAMINE ","0.125MG","60","Select","Select",""],["","63646001004","KETOCONAZOLE ","2%","120","Select","Select",""],["","45802000403","HYDROCORT ","2.50%","28","Select","Select",""],["","59746012106","MECLIZINE ","25MG","30","Select","Select",""],["","00228202996","ALPRAZOLAM ","0.5MG","20","Select","Select",""],["","67877021520","CEFUROXIME ","250MG","14","Select","Select",""],["","08290320109","BD  PEN NEEDL","31GX8MM","100","Select","Select",""],["","45802041926","AMMONIUM ","12%","400","Select","Select",""],["","71093014005","METHOCARBAM ","500MG","60","Select","Select",""],["","00093227534","AMOX\/K ","875-125","14","Select","Select",""],["","68382080501","TRAZODONE ","50MG","30","Select","Select",""],["","60505265605","TRIAMT\/HCTZ ","37.5-25","30","Select","Select",""],["","68001025320","FLUCONAZOLE ","150MG","3","Select","Select",""],["","58657045101","PHENAZOPYRID ","200MG","9","Select","Select",""],["","70010004401","BUT\/APAP\/CAF ","","30","Select","Select",""],["","00185012201","NITROFURANTN ","100MG","14","Select","Select",""],["","00093220401","METOCLOPRAM ","5MG","90","Select","Select",""],["","51672400202","NORTRIPTYLIN ","25MG","60","Select","Select",""],["","50111032701","HYDRALAZINE ","25MG","90","Select","Select",""],["","31722058330","DULOXETINE","60MG","30","Select","Select",""],["","60505014601","OMEPRAZOLE","40MG","30","Select","Select",""],["","00378021601","FUROSEMIDE","40MG","30","Select","Select",""],["","16729017101","AMITRIPTYLIN","10MG","60","Select","Select",""],["","27241001890","MONTELUKAST","10MG","30","Select","Select",""],["","49035045895","ALLERGY","10MG","30","Select","Select",""],["","69452015120","VITAMIN","50000UNT","4","Select","Select",""],["","57237000511","FLUCONAZOLE","150MG","1","Select","Select",""],["","68382080601","TRAZODONE","100MG","30","Select","Select",""],["","69680012035","LIDOCAINE","5%","236","Select","Select",""],["","00002751001","HUMALOG","100\/ML","10","Select","Select",""],["","43598029490","PREGABALIN","100MG","120","Select","Select",""],["","68382039801","POT CHLORIDE","20MEQ ER","30","Select","Select",""],["","00904671760","CETIRIZINE","10MG","30","Select","Select",""],["","68180037703","LOSARTAN","50MG","30","Select","Select",""],["","00088221905","LANTUS","100\/ML","15","Select","Select",""],["","68382004101","PROMETHAZINE","25MG","12","Select","Select",""],["","59762040101","SUCRALFATE","1GM","120","Select","Select",""],["","65162063709","PANTOPRAZOLE","40MG","30","Select","Select",""],["","53885000810","ONETOUCH","PLUS 33G","400","Select","Select",""],["","08290324703","INSULIN","0.5\/29G","100","Select","Select",""],["","50383070016","FLUTICASONE","50MCG","48","Select","Select",""],["","60258017101","MAG","400MG","30","Select","Select",""],["","81131007179","MAGNESIUM","400MG","30","Select","Select",""],["","43199001101","HYOSCYAMINE","0.125MG","60","Select","Select",""],["","59746012106","MECLIZINE","25MG","30","Select","Select",""],["","45802000402","HYDROCORT","2.50%","30","Select","Select",""],["","45802096126","CLOBETASOL","0.05%","118","Select","Select",""],["","63646001004","KETOCONAZOLE","2%","120","Select","Select",""],["","45802041926","AMMONIUM","12%","400","Select","Select",""],["","08290320109","BD PEN NEEDL","31GX8MM","100","Select","Select",""],["","71093014005","METHOCARBAM","500MG","60","Select","Select",""],["","16729020201","BUSPIRONE","10MG","60","Select","Select",""],["","51224000150","BENZONATATE","200MG","21","Select","Select",""],["","00093227534","AMOX\/K","875-125","14","Select","Select",""],["","68001036500","METRONIDAZOL","500MG","15","Select","Select",""],["","70710134403","RAMELTEON","8MG","30","Select","Select",""],["","70010004401","BUT\/APAP\/CAF","","30","Select","Select",""],["","00185012201","NITROFURANTN","100MG","14","Select","Select",""],["","58657045101","PHENAZOPYRID","200MG","9","Select","Select",""],["","00185061501","HYDROXYZ","50MG","30","Select","Select",""],["","67877021520","CEFUROXIME","250MG","14","Select","Select",""],["","00093220401","METOCLOPRAM","5MG","90","Select","Select",""],["","00228202996","ALPRAZOLAM","0.5MG","20","Select","Select",""],["","50111032701","HYDRALAZINE","25MG","90","Select","Select",""],["","60505265605","TRIAMT\/HCTZ","37.5-25","30","Select","Select",""],["","51672400202","NORTRIPTYLIN","25MG","60","Select","Select",""],["","68001035600","METOPROL","25MG ER","30","Select","Select",""],["","10572010001","PEG-3350","ELECTROL","4000","Select","Select",""],["","57896044101","BISACODYL","5MG EC","4","Select","Select",""],["","68382056401","METOPROL ","TAB 25MG ER","30","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","",""],["N\/A","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":""}]}]}