{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BRENDA NASH","gend":1,"add":"843 POST AVE","city":"CHESAPEAKE","state":"VA","zip":23324,"dob":"1963-01-20","age":"","mstatus":"","insh":"20032648*01","cliId":"","pno":"757\/779-3343","cno":"","email":"","ename":"","eno":"","pphy":"Route,  barbara","ppno":"757\/410-4488","pcpadd":"5424 Discovery Park Blvd BLDB A STE 201","pcpcity":"WILLIAMSBURG","pcpstate":"VA","pcpzip":23324,"pcpcounty":"","pcpid":"","pcpname":"Princess Anne Family Medicine","plan":"OHP","program":"Medicaid","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/410-4450","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["N12.","J06.9","J20.9","E86.0","E11.65","N10.","R07.9","I10.","R07.89","F41.8","E78.5","Z20.822","J04.0","Z11.59","E11.9","E11.40","E78.2","R11.2","F41.9","G62.9","N39.0","B96.20","F32.9","Z79.899","Z79.4","K21.9","Z90.49","E78.00","Z90.711","Z98.51","Z88.5","Z91.040","K76.0","R10.84","R11.0","R06.00","J00.","U07.1","NO DATA","R06.02","D72.825","E53.8","R11.10","K59.1","R94.31","N30.01","R41.82","R79.89","I63.9","M54.16","F33.2","Z09.","F13.239","V62.84","E55.9","E11.49","R22.31","L03.011","H81.10","E83.42","E66.9","G47.00","Z68.39","Z28.21","I63.339","I69.351","I69.352","I69.321","G43.109","R47.01","R51.","R42.","R26.81","M79.671","D21.21","D21.22","I63.331","R27.0","I63.50","R53.1","I51.7","N30.00","K52.9","R19.7","F41.1","F51.01","Z63.32","S93.601A","S39.012A","S80.01XA","S80.02XA","R35.0","K59.00","Z87.440","Z86.16","Z90.710","S89.92XA","R55.","N28.9","M79.604","S91.201A","Z53.21","Z12.11","R39.89"],"date":["2022-10-13","2021-12-15","2022-03-29","2021-06-30","2022-06-25","2021-05-21","2022-03-16","2022-08-21","2021-05-20","2021-05-21","2021-05-21","2022-08-21","2020-03-19","2020-03-19","2022-08-21","2022-02-22","2022-02-22","2021-12-20","2022-02-22","2021-05-12","2022-10-26","2020-03-23","2020-03-23","2020-03-23","2022-08-21","2020-03-23","2022-08-21","2020-03-23","2020-03-23","2020-03-23","2022-03-16","2022-08-21","2021-06-30","2021-06-30","2022-08-21","2021-12-20","2021-12-19","2021-12-20","2022-10-26","2021-12-20","2021-12-20","2020-05-08","2021-12-20","2021-12-20","2020-01-30","2021-05-18","2020-09-29","2021-05-21","2019-04-23","2019-11-08","2019-11-15","2019-06-07","2019-11-08","2019-11-08","2019-11-08","2019-11-06","2019-03-27","2019-03-27","2019-04-20","2019-04-23","2019-04-23","2019-04-20","2019-04-20","2019-04-20","2019-04-21","2019-04-21","2019-04-21","2019-04-21","2019-04-23","2019-04-23","2019-04-23","2019-04-23","2019-04-23","2019-10-03","2019-10-03","2019-10-03","2019-04-20","2019-04-22","2019-04-22","2019-04-23","2019-04-22","2022-03-29","2022-06-25","2022-06-25","2022-03-16","2022-03-16","2022-03-16","2022-02-16","2022-08-21","2022-02-16","2022-02-16","2022-08-21","2022-08-21","2022-08-21","2022-08-21","2022-08-21","2022-02-16","2022-02-22","2022-02-22","2022-07-12","2022-07-12","2022-07-12","2022-10-20","2022-10-26"],"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":{"indx":[false,false],"comment":["",""],"score":["",""]}},{"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":[["","68180029503","DULOXETINE","CAP 30MG","42","Select","Select",""],["","65862006399","METOPROL","TAB 50MG","60","Select","Select",""],["","70377002911","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","57599080300","FREESTY","MIS 2 READER","1","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","64380073706","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","46122052978","GNP","TAB 5MG EC","2","Select","Select",""],["","69097094312","GABAPENTIN","CAP 300MG","60","Select","Select",""],["","00169633910","NOVOLOG","INJ FLEXPEN","15","Select","Select",""],["","","INSULIN","INJ FLEXPEN","","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","13703010391","3ML","MIS 25GX1\"","4","Select","Select",""],["","67877015905","METFORMIN","TAB 500MG ER","120","Select","Select",""],["","00006027731","JANUVIA","TAB 100MG","30","Select","Select",""],["","00088221905","LANTUS","INJ 100\/ML","15","Select","Select",""],["","68001033308","LISINOPRIL","TAB 5MG","90","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","00169406013","VICTOZA","INJ 18MG\/3ML","9","Select","Select",""],["","70069000510","CYANOCOBALAM","INJ 1000MCG","4","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","14","Select","Select",""],["","58657050916","GUAIFENESIN","LIQ 100\/5ML","118","Select","Select",""],["","","BENZONATATE","CAP 200MG","","Select","Select",""],["","54838011740","SILTUSSIN","SYP 100\/5ML","118","Select","Select",""],["","","TRULICITY","INJ 0.75\/0.5","","Select","Select",""],["","00172208380","HYDROCHLOROT","TAB 25MG","30","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","15187000604","SCOT-TUSSIN","LIQ EXPCT SF","118","Select","Select",""],["","00185012201","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","","CYCLOBENZAPR","TAB 10MG","","Select","Select",""],["","08290320122","BD  PEN NEEDL","MIS 32GX4MM","100","Select","Select",""],["","00904693176","PEG","POW ","30","Select","Select",""],["","00143992801","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","82607066026","FLOWFLEX","KIT TEST","8","Select","Select",""],["","57896048930","POLYETH","POW 3350 NF","510","Select","Select",""],["","65862042001","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","64380076621","PEG-3350","SOL ELECTROL","4000","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","2","Select","Select",""],["","50111078751","AZITHROMYCIN","TAB 250MG","6","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","90","Select","Select",""],["","","ALPRAZOLAM","TAB 1MG","","Select","Select",""],["","53885019401","ONETOUCH","KIT VERIO FL","1","Select","Select",""],["","","OMEPRAZOLE","CAP 40MG","","Select","Select",""],["","53885004401","ONE","KIT VERIO FL","1","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00406051201","OXYCOD\/APAP","TAB 5-325MG","10","Select","Select",""],["","61442010305","DICLOFENAC","TAB 75MG DR","60","Select","Select",""],["","","NAPROXEN","TAB 500MG","","Select","Select",""],["","55111018015","TIZANIDINE","TAB 4MG","90","Select","Select",""],["","00093227534","AMOX\/K","TAB 875-125","14","Select","Select",""],["","00172392670","DIAZEPAM","TAB 5MG","30","Select","Select",""],["","","VENTOLIN","AER ","","Select","Select",""],["","27808006502","PROMETH\/COD","SOL 6.25-10","120","Select","Select",""],["","00002879959","HUMALOG","INJ 100\/ML","15","Select","Select",""],["","00299382060","METROGEL","GEL 0.01","60","Select","Select",""],["","16729013600","CLONAZEPAM","TAB 0.5MG","7","Select","Select",""],["","00169185189","NOVOFINE","MIS 32GX6MM","100","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","30","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","00536114941","ASPIRIN","TAB 81MG EC","34","Select","Select",""],["","51645078508","MAG","TAB 400MG","30","Select","Select",""],["","68382013905","TOPIRAMATE","TAB 50MG","30","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":""}]}]}