{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"APRIL   M COLEMAN","gend":1,"add":"1011 KEEL ST APT 3032","city":"CHESAPEAKE","state":"VA","zip":23324,"dob":"1982-04-17","age":"","mstatus":"","insh":"6293875*01","cliId":"","pno":"757\/907-3413","cno":"757\/907-3413","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":"907-3413","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":["I10.","R06.83","R07.9","Z00.01","I51.7","I16.1","R07.89","I50.21","F32.9","G61.9","G56.02","M54.32","J45.909","G89.4","M54.9","M54.5","R10.9","F41.9","Z01.419","Z12.4","Z12.39","R30.9","B37.3","G57.92","E55.9","R31.9","J30.9","G47.33","M79.629","R41.82","R20.2","M54.16","M54.12","F33.2","F41.1","N89.8","R31.21","R79.89","I50.32","I50.9","R10.13","R11.2","E66.3","F43.12","I21.4","I50.31","I11.0","E66.01","Z68.35","F17.210","Z79.899","Z86.73","Z88.8","Z98.51","Z83.3","I61.1","E87.70","I16.0","Z68.41","R51.9","R20.0","R42.","M54.2","I11.9","F06.2","K59.09","R14.0","R04.0","N39.0","N76.0","D50.9","R74.8","Z72.0","R77.8","Z95.0","I16.9","E66.9","G50.0","I63.9","M50.30"],"date":["2021-09-18","2020-08-27","2021-09-17","2020-08-27","2021-04-20","2020-11-23","2021-04-20","2020-11-23","2021-09-18","2020-12-02","2020-12-14","2020-12-14","2020-12-16","2021-06-17","2021-03-16","2021-03-16","2021-04-14","2021-09-18","2021-03-26","2021-03-26","2020-02-14","2020-02-14","2020-02-14","2020-08-09","2020-09-30","2020-09-30","2020-09-30","2020-09-30","2020-11-22","2021-09-15","2021-09-18","2021-09-10","2021-09-16","2021-06-02","2021-06-02","2020-09-01","2020-10-28","2021-09-17","2021-04-21","2020-11-21","2021-05-04","2021-03-24","2021-03-24","2021-05-26","2020-11-19","2020-11-24","2020-11-24","2021-04-20","2020-11-19","2021-04-20","2021-04-20","2021-09-18","2020-11-19","2020-11-19","2020-11-19","2020-11-19","2021-02-01","2021-09-17","2021-04-20","2021-09-18","2021-04-20","2021-04-20","2021-04-20","2021-04-20","2021-04-29","2021-05-04","2021-05-04","2020-08-28","2021-01-05","2021-03-26","2021-04-01","2021-04-20","2021-04-20","2021-04-22","2021-04-22","2020-11-19","2021-07-28","2021-09-10","2021-09-17","2021-09-18"],"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":[["","68462010340","FLUCONAZOLE ","150MG","2","Select","Select",""],["","65862044930","VALACYCLOVIR ","1GM","30","Select","Select",""],["","67877019805","AMLODIPINE ","5MG","30","Select","Select",""],["","51660093901","CETIRIZINE ","10MG","30","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","4","Select","Select",""],["","60432026415","FLUTICASONE ","50MCG","16","Select","Select",""],["","29300013501","CLONIDINE ","0.1MG","30","Select","Select",""],["","59762070702","DICLOFENAC ","1.30%","60","Select","Select",""],["","68645019159","METOPROL ","100MG","60","Select","Select",""],["","65862001230","SERTRALINE ","50MG","30","Select","Select",""],["","65862016001","ZOLPIDEM ","10MG","30","Select","Select",""],["","11822393550","RA ","","238","Select","Select",""],["","29300012810","HYDROCHLOROT ","25MG","30","Select","Select",""],["","69097081307","GABAPENTIN ","100MG","90","Select","Select",""],["","70010077005","METHOCARBAM ","750MG","20","Select","Select",""],["","50111032801","HYDRALAZINE ","50MG","90","Select","Select",""],["","11822042030","SALINE ","0.65%","45","Select","Select",""],["","00487950125","ALBUTEROL ","0.08%","75","Select","Select",""],["","60219106901","POT  CHLORIDE","20MEQ ER","30","Select","Select",""],["","59746021601","SPIRONOLACT ","25MG","30","Select","Select",""],["","62332013330","OLMESA ","40MG","30","Select","Select",""],["","00310737020","BUDES\/FORMOT ","160-4.5","10","Select","Select",""],["","42632000303","BP ","AUTOMATI","1","Select","Select",""],["","57237001830","DULOXETINE ","30MG","30","Select","Select",""],["","59310057922","PROAIR ","","26","Select","Select",""],["","16729017101","AMITRIPTYLIN ","10MG","90","Select","Select",""],["","69238131109","PREGABALIN ","50MG","90","Select","Select",""],["","60793013230","FLECTOR ","1.30%","60","Select","Select",""],["","10135012301","ACETAMIN ","325MG","60","Select","Select",""],["","00186037020","SYMBICORT ","160-4.5","10","Select","Select",""],["","23155072401","LABETALOL ","200MG","60","Select","Select",""],["","68462029817","CLOTRIM\/BETA ","DIPROP","120","Select","Select",""],["","31722099601","HYDROCO\/APAP ","5-325MG","15","Select","Select",""],["","50268053315","MELATONIN ","MAX ST","30","Select","Select",""],["","00591352530","LIDOCAINE ","5%","60","Select","Select",""],["","67877021901","CEPHALEXIN ","500MG","21","Select","Select",""],["","00781107705","ALPRAZOLAM ","0.5MG","60","Select","Select",""],["","16729017001","ESCITALOPRAM ","20MG","30","Select","Select",""],["","00054429931","FUROSEMIDE ","40MG","30","Select","Select",""],["","00085113201","PROVENTIL ","HFA","20","Select","Select",""],["","00781286810","OMEPRAZOLE ","20MG","30","Select","Select",""],["","51660033301","ARTHRTS ","650MG","120","Select","Select",""],["","00904759080","FEROSUL ","325MG","60","Select","Select",""],["","45802086802","POLYETH ","3350 NF","238","Select","Select",""],["","29300022701","METRONIDAZOL ","500MG","14","Select","Select",""],["","16714007104","BACLOFEN ","10MG","30","Select","Select",""],["","60505265705","TRIAMT\/HCTZ ","75-50MG","30","Select","Select",""],["","00173088210","BREO ","200-25","60","Select","Select",""],["","59267100003","PFIZER ","COVID-19","0","Select","Select",""],["","65862044930","VALACYCLOVIR","1GM","30","Select","Select",""],["","68462010340","FLUCONAZOLE","150MG","2","Select","Select",""],["","67877019805","AMLODIPINE","5MG","30","Select","Select",""],["","70010077005","METHOCARBAM","750MG","20","Select","Select",""],["","51660093901","CETIRIZINE","10MG","30","Select","Select",""],["","64380073706","VITAMIN","50000UNT","4","Select","Select",""],["","68645051054","HYDROCHLOROT","25MG","30","Select","Select",""],["","57237010101","METOPROL","50MG","60","Select","Select",""],["","50111032801","HYDRALAZINE","50MG","90","Select","Select",""],["","11822042030","SALINE","0.65%","45","Select","Select",""],["","69097081307","GABAPENTIN","100MG","90","Select","Select",""],["","62332013330","OLMESA","40MG","30","Select","Select",""],["","60432026415","FLUTICASONE","50MCG","16","Select","Select",""],["","60219106901","POT CHLORIDE","20MEQ ER","30","Select","Select",""],["","69238131109","PREGABALIN","50MG","90","Select","Select",""],["","57237001830","DULOXETINE","30MG","30","Select","Select",""],["","42632000303","BP","AUTOMATI","1","Select","Select",""],["","29300013501","CLONIDINE","0.1MG","30","Select","Select",""],["","10135012301","ACETAMIN","325MG","60","Select","Select",""],["","23155072401","LABETALOL","200MG","60","Select","Select",""],["","69097014260","ALBUTEROL","HFA","20","Select","Select",""],["","68462029817","CLOTRIM\/BETA","DIPROP","120","Select","Select",""],["","00186037020","SYMBICORT","160-4.5","10","Select","Select",""],["","59746021601","SPIRONOLACT","25MG","30","Select","Select",""],["","50268053315","MELATONIN","MAX ST","30","Select","Select",""],["","67877021901","CEPHALEXIN","500MG","21","Select","Select",""],["","00781107705","ALPRAZOLAM","0.5MG","60","Select","Select",""],["","16729017001","ESCITALOPRAM","20MG","30","Select","Select",""],["","59310057922","PROAIR","","26","Select","Select",""],["","16729017101","AMITRIPTYLIN","10MG","90","Select","Select",""],["","59762070702","DICLOFENAC","1.30%","60","Select","Select",""],["","00085113201","PROVENTIL","HFA","20","Select","Select",""],["","51660033301","ARTHRTS","650MG","120","Select","Select",""],["","00054429931","FUROSEMIDE","40MG","30","Select","Select",""],["","00781286810","OMEPRAZOLE","20MG","30","Select","Select",""],["","00591352530","LIDOCAINE","5%","60","Select","Select",""],["","29300022701","METRONIDAZOL","500MG","14","Select","Select",""],["","00904759080","FEROSUL","325MG","60","Select","Select",""],["","11822393550","RA","","238","Select","Select",""],["","68645052254","SERTRALINE","50MG","30","Select","Select",""],["","45802086802","POLYETH","3350 NF","238","Select","Select",""],["","65862016001","ZOLPIDEM","10MG","30","Select","Select",""],["","16714007104","BACLOFEN","10MG","30","Select","Select",""],["","60505265705","TRIAMT\/HCTZ","75-50MG","30","Select","Select",""],["","00173088210","BREO","200-25","60","Select","Select",""],["","59267100003","PFIZER","COVID-19","0","Select","Select",""],["","00310737020","BUDES\/FORMOT","160-4.5","10","Select","Select",""],["","00527169501","BUT\/APAP\/CAF","","60","Select","Select",""],["","49035015712","EQ","325MG","100","Select","Select",""],["","00832532511","POT CL MICRO","20MEQ ER","30","Select","Select",""],["","16714008210","HYDROXYZ","25MG","60","Select","Select",""],["","60793013230","FLECTOR","1.30%","60","Select","Select",""],["","31722099601","HYDROCO\/APAP","5-325MG","15","Select","Select",""],["","62756018388","OXCARBAZEPIN","150MG","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","",""],["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":""}]}]}