{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"MARJORIE NEAL","gend":1,"add":"1809 SHELLDRAKE CT LOT 16","city":"CHESAPEAKE","state":"VA","zip":"23320-9998","dob":"1953-11-11","age":"","mstatus":"","insh":"20032664*01","cliId":"","pno":"757\/633-9803","cno":"","email":"","ename":"","eno":"","pphy":"ZHAO, WEI MD","ppno":"757\/436-7888","pcpadd":"675 N BATTLEFIELD BLVD","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"Battlefield Medical Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-5669","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F30.2","F33.2","K80.20","K66.0","Z53.31","K55.1","J44.9","H26.491","R05.9","F51.01","R91.8","Z72.0","R06.00","N95.1","E11.9","I10.","E78.5","H26.492","R32.","Z00.00","Z23.","J06.9","NO DATA","H02.412","H02.835","H02.832","K58.1","R63.4","Z80.0","K43.9","I50.9","Z87.19","F32.9","Z88.5","Z88.8","F17.200","I25.10","G40.909","Z79.84","Z79.51","D72.829","E78.00","I25.2","Z86.79","K59.00","Z80.9","R10.84","T18.3XXA","K55.9","N89.8","N94.89","R10.11","K76.0","R10.2","I11.0","M19.90","M79.7","K21.9","G47.30","Z87.442","F17.210","Z83.3","N17.9","Z90.49","D64.9","N39.46","B00.9","I73.9","E03.9","N39.3","N81.6","J11.1","R19.4","R11.0","H04.123","H04.121","H04.122","I77.1","M25.561","M54.9","Z01.818","E87.6","Z20.828","E83.42","E83.51","J43.9","E87.5","M79.89","R60.9","M47.817","M47.812","M17.12","Z01.810","M25.562","R07.2","G89.18","R69.","Z96.652","Z98.890","Z74.09","N32.9","M25.511","R53.83","Z47.1","N10.","E11.65","R31.9","I50.20","Z53.8","F41.8","Z79.899","D62.","F31.9","Z88.6","Z88.0","M20.41","M20.42","M77.41","M77.42","B35.1","M51.36","M54.5","Z79.818","M79.605","R07.9","M17.9","G47.33","Z79.890","R51.","R10.9","R42.","Z09.","H40.013","M70.22","Z12.11","T88.1XXA","L03.113","R93.89","Z20.822","L60.8","M25.512","G89.29","R58.","J40.","J84.9","J20.9","F17.290"],"date":["2021-05-23","2022-07-15","2020-10-16","2020-10-16","2020-10-16","2020-11-17","2022-02-02","2021-11-05","2022-07-22","2021-11-24","2022-08-09","2022-08-31","2022-08-31","2020-03-11","2022-08-09","2022-06-22","2022-06-22","2021-12-03","2020-02-25","2020-05-12","2022-06-22","2020-09-21","2022-08-09","2022-02-11","2022-02-11","2021-12-02","2022-02-02","2021-05-19","2020-09-21","2020-07-17","2022-08-09","2022-02-02","2022-02-02","2020-10-16","2020-10-16","2020-10-16","2022-08-09","2020-10-16","2022-08-09","2020-10-16","2020-10-16","2022-08-09","2022-08-09","2020-10-16","2020-10-16","2020-10-16","2020-12-02","2020-11-17","2020-12-31","2021-02-22","2021-02-22","2020-09-21","2020-09-21","2021-02-22","2022-08-09","2021-02-22","2022-08-09","2022-08-31","2021-02-22","2021-02-22","2022-08-09","2021-02-22","2020-11-17","2020-11-21","2020-12-31","2021-12-07","2021-02-02","2021-06-24","2022-08-09","2021-12-22","2021-12-07","2020-01-29","2020-03-20","2020-11-21","2022-05-09","2021-10-15","2021-10-15","2022-02-02","2020-06-04","2020-06-04","2020-10-06","2020-11-13","2020-11-13","2020-11-13","2020-11-13","2022-08-09","2020-11-13","2020-11-13","2020-11-20","2019-01-18","2019-01-18","2019-09-24","2019-03-25","2019-07-26","2019-03-25","2019-04-26","2019-04-26","2019-09-24","2019-07-26","2019-07-26","2019-08-13","2019-08-13","2019-09-03","2019-04-30","2019-09-03","2019-09-03","2019-09-03","2019-04-26","2019-02-13","2019-02-13","2019-09-01","2019-04-26","2019-04-26","2022-08-09","2019-04-26","2019-07-02","2019-07-02","2019-09-17","2019-09-17","2019-09-17","2019-09-30","2019-09-30","2019-09-30","2019-05-08","2019-03-27","2019-04-27","2022-08-09","2019-09-01","2019-02-06","2019-09-01","2019-09-11","2019-09-11","2022-02-11","2022-06-29","2022-02-02","2022-06-24","2022-06-24","2022-07-22","2022-08-04","2022-06-22","2022-04-26","2022-04-26","2022-04-26","2022-04-26","2022-08-31","2022-08-31","2022-08-09"],"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":[["","59148003713","REXULTI","TAB 1MG","30","Select","Select",""],["","00378180010","LEVOTHYROXIN","TAB 25MCG","30","Select","Select",""],["","16729017001","ESCITALOPRAM","TAB 20MG","60","Select","Select",""],["","68382075810","METFORMIN","TAB 500MG","60","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","68180045001","QUETIAPINE","TAB 400MG","30","Select","Select",""],["","66993006885","PANTOPRAZOLE","TAB 40MG","60","Select","Select",""],["","","CLOPIDOGREL","TAB 75MG","","Select","Select",""],["","62175089146","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","","TOVIAZ","TAB 4MG","","Select","Select",""],["","","LINZESS","CAP 145MCG","","Select","Select",""],["","","LISINOP\/HCTZ","TAB 20-12.5","","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00597015561","STIOLTO","AER 2.5-2.5","4","Select","Select",""],["","00054001825","PREDNISONE","TAB 20MG","10","Select","Select",""],["","00023916360","RESTASIS","EMU 0.05% OP","60","Select","Select",""],["","00378081005","HYDROCHLOROT","CAP 12.5MG","30","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","27808023302","DOXYCYCL","CAP 100MG","20","Select","Select",""],["","66993008096","FLUTICAS","AER 220MCG","12","Select","Select",""],["","00173072020","FLOVENT","AER 220MCG","12","Select","Select",""],["","70461032203","FLUCLVX","INJ 2022-23","0","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","","FLUAD","INJ 0.5ML","","Select","Select",""],["","00093716456","TOLTERODINE","CAP 4MG ER","30","Select","Select",""],["","53885027025","ONETOUCH","TES VERIO","25","Select","Select",""],["","","OXYBUTYNIN","TAB 5MG ER","","Select","Select",""],["","","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","","IBUPROFEN","TAB 400MG","","Select","Select",""],["","","DICYCLOMINE","CAP 10MG","","Select","Select",""],["","","SYMBICORT","AER 160-4.5","","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","","NABUMETONE","TAB 500MG","","Select","Select",""],["","00173069500","ADVAIR","AER 100\/50","60","Select","Select",""],["","31722070530","VALACYCLOVIR","TAB 1GM","14","Select","Select",""],["","63304069301","CLINDAMYCIN","CAP 300MG","28","Select","Select",""],["","","PROAIR","AER ","","Select","Select",""],["","","MONTELUKAST","CHW 4MG","","Select","Select",""],["","66993058497","FLUTIC\/SALME","AER 100\/50","60","Select","Select",""],["","00005197102","PREVNAR","INJ ","0","Select","Select",""],["","00065045407","SYSTANE","DRO 0.4-0.3%","10","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","14","Select","Select",""],["","49281040565","FLUZONE","INJ PF 19-20","0","Select","Select",""],["","70377000812","ROSUVASTATIN","TAB 20MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","68180021509","LOSARTAN\/HCT","TAB 50-12.5","30","Select","Select",""],["","45802014167","CICLOPIROX","SOL 0.08","7","Select","Select",""],["","27241011904","FENOFIBRATE","CAP 134MG","30","Select","Select",""],["","40985027113","B-12","SUB 5000MCG","30","Select","Select",""],["","58160081912","SHINGRIX","INJ 50MCG","1","Select","Select",""],["","","OSELTAMIVIR","CAP 75MG","","Select","Select",""],["","38703000161","BLOOD","MIS WRIST CF","1","Select","Select",""],["","","CVS","DIS 14MG\/24H","","Select","Select",""],["","00603020922","MAG","TAB 400MG","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","","WIXELA","AER 100\/50","","Select","Select",""],["","","NICOTINE","DIS 14MG\/24H","","Select","Select",""],["","","DOK","CAP 100MG","","Select","Select",""],["","","HYDROCO\/APAP","TAB 5-325MG","","Select","Select",""],["","","CODEINE\/GG","SOL 10-100\/5","","Select","Select",""],["","10702001801","OXYCODONE","TAB 5MG","40","Select","Select",""],["","51862045404","CLONIDINE","DIS 0.2\/24HR","4","Select","Select",""],["","68180046907","LOVASTATIN","TAB 40MG","30","Select","Select",""],["","69097084507","CYCLOBENZAPR","TAB 5MG","90","Select","Select",""],["","00597003234","CATAPRES-TTS","DIS 0.2\/24HR","4","Select","Select",""],["","00832105515","BACLOFEN","TAB 20MG","60","Select","Select",""],["","42858030101","HYDROMORPHON","TAB 2MG","30","Select","Select",""],["","00904404360","FISH","CAP 1000MG","120","Select","Select",""],["","00093005805","TRAMADOL","TAB 50MG","20","Select","Select",""],["","00245531911","KLOR-CON","TAB 20MEQ ER","30","Select","Select",""],["","51672300302","HYDROCORT","CRE 0.025","57","Select","Select",""],["","13668003860","RISPERIDONE","TAB 2MG","30","Select","Select",""],["","65862007701","CIPROFLOXACN","TAB 500MG","10","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"comment":[["","","",""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}