{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"SHERRIE   A BELL","gend":1,"add":"1206 ALGONA ROAD","city":"CHESAPEAKE","state":"VA","zip":"23324-9998","dob":"1982-11-19","age":"","mstatus":"","insh":"9775382*01","cliId":"","pno":"757\/543-2740","cno":"757\/543-2740","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":["E11.3511","Z79.4","E11.3512","S62.639A","V58.89","E11.21","I10.","NO DATA","L02.211","E11.9","Z79.84","R94.4","R00.0","E11.65","E11.49","E11.319","Z01.411","N92.1","R55.","D50.0","N93.9","R79.89","I95.9","D62.","E11.649","N17.9","I95.89","E86.1","I48.0","E11.8","S92.025A","G57.92","R51.9","Z68.41","N18.3","E11.22","E11.40","E78.5","J45.909","Z79.01","K59.00","K21.9","E66.01","E86.0","I12.9","N92.6","J30.9","E87.70","D50.1","Z30.431","S93.402A","E11.42","S61.210A","M54.5","B02.23","I51.7","R42.","I82.513","N92.0","H25.11","H25.12","L85.3","L85.9","L82.0","K76.0","K80.20","E66.9","M79.671","M79.672","M79.674","M79.675","R80.8","N17.8","R82.998","S69.91XA","L70.0","L81.0","L91.0","V54.16","M25.572","M62.81","R26.2","A41.9","L03.311","N28.9"],"date":["2021-01-13","2021-01-13","2021-01-13","2020-12-02","2020-12-02","2021-07-01","2021-07-01","2021-04-12","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2021-07-16","2020-12-23","2020-07-17","2020-07-17","2020-08-13","2020-08-13","2020-09-03","2020-08-31","2020-09-08","2020-08-31","2020-09-01","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-09-03","2020-12-23","2021-06-28","2021-06-28","2021-04-29","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-08-31","2020-07-28","2020-08-24","2020-03-16","2020-03-16","2020-09-03","2020-12-17","2021-04-24","2021-07-01","2020-10-12","2021-01-26","2020-04-16","2020-09-01","2020-09-07","2020-02-07","2020-09-09","2020-09-30","2020-09-30","2020-02-10","2020-02-10","2020-02-10","2020-02-28","2020-02-28","2020-02-28","2020-03-12","2020-03-12","2020-03-12","2020-03-12","2020-07-07","2020-07-07","2020-07-07","2020-10-29","2020-12-09","2020-12-09","2020-12-09","2021-05-18","2021-05-18","2021-05-18","2021-05-18","2021-07-16","2021-07-16","2021-07-16"],"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":[["","00169633910","NOVOLOG ","FLEXPEN","60","Select","Select",""],["","00169406013","VICTOZA ","18MG\/3ML","9","Select","Select",""],["","00378087299","CLONIDINE ","0.2\/24HR","4","Select","Select",""],["","00002771227","HUMALOG ","200\/ML","18","Select","Select",""],["","59310057922","PROAIR ","","8","Select","Select",""],["","00135057604","FLONASE ","50MCG","16","Select","Select",""],["","00597003134","CATAPRES-TTS ","0.1\/24HR","4","Select","Select",""],["","68645049254","PANTOPRAZOLE ","40MG","30","Select","Select",""],["","72205000390","ROSUVASTATIN ","10MG","30","Select","Select",""],["","64380073706","VITAMIN ","50000UNT","4","Select","Select",""],["","68645049554","ATORVASTATIN ","80MG","30","Select","Select",""],["","68382009505","CARVEDILOL ","25MG","60","Select","Select",""],["","00003089421","ELIQUIS ","5MG","60","Select","Select",""],["","53885001110","ONETOUCH ","PLUS 30G","400","Select","Select",""],["","00088221905","LANTUS ","100\/ML","30","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","16","Select","Select",""],["","73070010315","INSULIN ","FLEXPEN","15","Select","Select",""],["","68682010510","NIFEDIPINE ","30MG ER","30","Select","Select",""],["","43547040211","FUROSEMIDE ","40MG","30","Select","Select",""],["","70010075401","METHOCARBAM ","500MG","30","Select","Select",""],["","49035036201","","","16","Select","Select",""],["","00193731150","CONTOUR ","NEXT","180","Select","Select",""],["","67877022310","GABAPENTIN ","300MG","60","Select","Select",""],["","00378001805","METOPROL ","25MG","90","Select","Select",""],["","43598071901","CHLORTHALID ","25MG","30","Select","Select",""],["","00378808320","TRETINOIN ","0.05%","20","Select","Select",""],["","00187516220","RETIN-A ","0.05%","20","Select","Select",""],["","13811071910","NITROFURANTN ","100MG","10","Select","Select",""],["","08290320122","BD  PEN NEEDL","32GX4MM","100","Select","Select",""],["","00904759080","FEROSUL ","325MG","15","Select","Select",""],["","00555087302","MEDROXYPR ","5MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR ","10MG","15","Select","Select",""],["","00023585801","LILETTA ","52MG","1","Select","Select",""],["","11917009215","FERROUS ","325MG","45","Select","Select",""],["","00045083837","TYLENOL ","650MG","120","Select","Select",""],["","67877021905","CEPHALEXIN ","500MG","18","Select","Select",""],["","00169750111","NOVOLOG","100\/ML","30","Select","Select",""],["","00002771227","HUMALOG","200\/ML","18","Select","Select",""],["","00088221905","LANTUS","100\/ML","30","Select","Select",""],["","00169406013","VICTOZA","18MG\/3ML","9","Select","Select",""],["","00378087299","CLONIDINE","0.2\/24HR","4","Select","Select",""],["","59310057922","PROAIR","","8","Select","Select",""],["","68645049254","PANTOPRAZOLE","40MG","30","Select","Select",""],["","64380073706","VITAMIN","50000UNT","4","Select","Select",""],["","72205000390","ROSUVASTATIN","10MG","30","Select","Select",""],["","68382009505","CARVEDILOL","25MG","60","Select","Select",""],["","00597003134","CATAPRES-TTS","0.1\/24HR","4","Select","Select",""],["","00003089421","ELIQUIS","5MG","60","Select","Select",""],["","67877022310","GABAPENTIN","300MG","60","Select","Select",""],["","00054327099","FLUTICASONE","50MCG","16","Select","Select",""],["","00135057604","FLONASE","50MCG","16","Select","Select",""],["","53885027210","ONETOUCH","VERIO","200","Select","Select",""],["","00193731150","CONTOUR","NEXT","180","Select","Select",""],["","43547040211","FUROSEMIDE","40MG","30","Select","Select",""],["","43598071901","CHLORTHALID","25MG","30","Select","Select",""],["","68682010510","NIFEDIPINE","30MG ER","30","Select","Select",""],["","70010075401","METHOCARBAM","500MG","30","Select","Select",""],["","73070010315","INSULIN","FLEXPEN","45","Select","Select",""],["","00185012201","NITROFURANTN","100MG","10","Select","Select",""],["","00904759080","FEROSUL","325MG","15","Select","Select",""],["","57664050658","METOPROL","25MG","30","Select","Select",""],["","00591565810","CYCLOBENZAPR","10MG","15","Select","Select",""],["","00555077902","MEDROXYPR","10MG","6","Select","Select",""],["","11917009215","FERROUS","325MG","75","Select","Select",""],["","00023585801","LILETTA","52MG","1","Select","Select",""],["","00378808320","TRETINOIN","0.05%","20","Select","Select",""],["","00187516220","RETIN-A","0.05%","20","Select","Select",""],["","08290320122","BD PEN NEEDL","32GX4MM","100","Select","Select",""],["","00045083837","TYLENOL","650MG","120","Select","Select",""],["","00093314705","CEPHALEXIN","500MG","18","Select","Select",""],["","69097014260","ALBUTEROL","HFA","7","Select","Select",""],["","68645049554","ATORVASTATIN","80MG","30","Select","Select",""],["","00085113204","PROVENTIL","HFA","7","Select","Select",""],["","69097014260","ALBUTEROL ","AER HFA","7","Select","Select",""],["","42571016242","AMOX\/K ","TAB 875-125","20","Select","Select",""],["","65862042005","SMZ\/TMP ","TAB 800-160","20","Select","Select",""],["","00085113204","PROVENTIL ","AER HFA","7","Select","Select",""],["","53746051501","SPIRONOLACT ","TAB 100MG","30","Select","Select",""],["","00713075737","METRONIDAZOL ","CRE 0.0075","45","Select","Select",""],["","67877032105","IBUPROFEN ","TAB 800MG","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":""}]}]}