{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ALLEN   K BRADSHAW","gend":0,"add":"453 WELLON ST APT B","city":"SUFFOLK","state":"VA","zip":"23434-9998","dob":"1990-03-06","age":"","mstatus":"","insh":"1976924*01","cliId":"","pno":"818\/297-2769","cno":"","email":"","ename":"","eno":"","pphy":"ZEV, ZAHAN MD","ppno":"757\/484-0500","pcpadd":"2994 CHURCHLAND BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23321,"pcpcounty":"","pcpid":"","pcpname":"CHURCHLAND INTERNAL MEDICINE ASSOCIATES LTD","plan":"OHP","program":"MEDICAID","lob":"M4","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/686-2805","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F31.81","F41.1","F90.0","N50.89","B20.","L74.510","Z71.9","B00.9","J02.9","R13.12","Z20.822","K61.0","I10.","L29.9","J30.1","J30.89","J30.81","J32.9","H10.45","U07.1","E78.00","Z11.3","Z13.1","F34.0","M25.511","M54.2","M54.5","Z13.220","L91.0","J31.0","H10.33","N20.0","L30.9","R07.89","V49.40XA","Z20.828","Z00.00","E66.9","F32.9","NO DATA","Q66.51","Q66.52","M21.6X1","M21.6X2","M79.671","M79.672","Z20.2","R10.30","R19.7","S39.012A","Z13.31","Z70.8","A51.0","Z23.","A53.9","S39.013A","M54.6","J06.9","Z86.79","N34.2","N48.5","A60.9"],"date":["2022-06-13","2022-06-13","2022-06-13","2021-02-12","2022-06-27","2022-08-30","2021-06-28","2021-09-01","2021-12-20","2021-12-20","2022-07-09","2020-05-08","2022-06-27","2021-05-20","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-06-01","2021-12-22","2020-04-06","2022-01-26","2020-04-06","2022-06-13","2020-12-04","2022-06-15","2021-08-06","2022-01-26","2021-03-15","2021-05-20","2021-05-20","2022-06-30","2020-11-16","2021-12-20","2020-11-02","2021-01-12","2022-06-27","2021-06-16","2021-06-16","2022-06-15","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2020-01-24","2020-09-12","2021-08-06","2021-08-06","2021-08-06","2021-08-25","2021-08-25","2020-11-20","2020-11-20","2020-12-04","2021-08-22","2022-06-15","2020-02-23","2020-02-23","2022-05-05","2022-05-05","2022-06-27"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"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":[]},{"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":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","61958250101","BIKTARVY","TAB ","30","Select","Select",""],["","54092038701","ADDERALL","CAP 20MG","30","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","51224012230","AZITHROMYCIN","TAB 500MG","2","Select","Select",""],["","00228306011","AMPHET\/DEXTR","CAP 20MG ER","30","Select","Select",""],["","63402030430","LATUDA","TAB 40MG","30","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","21","Select","Select",""],["","49483060450","IBUPROFEN","TAB 800MG","30","Select","Select",""],["","42806016005","HYDROXYZ","TAB 25MG","20","Select","Select",""],["","10702002901","PHENTERMINE","CAP 37.5MG","30","Select","Select",""],["","00143122701","DICYCLOMINE","TAB 20MG","28","Select","Select",""],["","59417010510","VYVANSE","CAP 50MG","30","Select","Select",""],["","69584061250","METHOCARBAM","TAB 750MG","30","Select","Select",""],["","65162019050","NAPROXEN","TAB 500MG","20","Select","Select",""],["","33332032101","AFLURIA","INJ 2021-22","0","Select","Select",""],["","49702023113","TRIUMEQ","TAB ","30","Select","Select",""],["","69238110005","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","30","Select","Select",""],["","50458058701","CONCERTA","TAB 54MG","30","Select","Select",""],["","13811071030","METHYLPHENID","TAB 72MG ER","30","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","43386035701","HYDROCO\/APAP","TAB 7.5-325","12","Select","Select",""],["","00093226301","AMOXICILLIN","TAB 500MG","15","Select","Select",""],["","60758011905","PREDNISOLONE","SUS 1% OP","5","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","10","Select","Select",""],["","60758061525","GATIFLOXACIN","SOL 0.005","2","Select","Select",""]]}},{"a":[]},{"a":[]},{"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":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"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":"","a13":""}]}]}