{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"BARBARA BULLOCK","gend":1,"add":"1049 WEST 49TH ST APT 201","city":"NORFOLK","state":"VA","zip":"23508-9998","dob":"1965-11-09","age":"","mstatus":"","insh":"20037875*01","cliId":"","pno":"757\/322-7895","cno":"757\/452-8186","email":"","ename":"","eno":"","pphy":"FEE, ERIC MD","ppno":"757\/587-0157","pcpadd":"7924 CHESAPEAKE BLVD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":"","pcpname":"Bayview Medical Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/587-0074","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z95.810","I50.42","I42.8","I10.","E78.5","I51.89","I34.0","M17.0","I50.22","I42.0","Z86.010","K64.9","K64.8","Z45.02","H53.143","H35.033","H04.123","H16.213","H52.13","Z53.21","E87.5","Z20.828","J01.40","M76.50","J30.9","J02.9","M25.561","E11.9","I50.9","I63.9","K63.5","M51.37","R80.9","E78.00","E03.9","I42.9","J01.90","N89.8","N94.10","N95.2","Z68.29","Z12.11","I51.7","I11.0","M70.21","L03.113","Z76.82","Z01.419","Z68.28","L30.9","Z86.73","M25.521","L03.119","M70.20","L03.90","I50.1","E66.3","R53.83","Z51.89","I11.9","E78.9","M19.90","I08.1","M13.849"],"date":["2021-10-27","2021-11-17","2021-11-17","2021-11-17","2021-11-17","2020-08-10","2021-05-10","2020-02-12","2021-05-10","2020-08-17","2020-10-28","2020-10-28","2020-10-28","2021-10-26","2021-04-07","2021-04-07","2021-04-07","2021-04-07","2021-04-07","2020-08-11","2020-08-17","2021-02-13","2021-02-13","2021-09-15","2021-05-07","2021-05-07","2021-12-07","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2021-11-24","2020-03-05","2021-02-18","2020-02-28","2020-02-28","2020-02-28","2020-02-28","2020-10-28","2021-05-10","2020-02-19","2019-03-05","2019-02-28","2019-02-21","2019-09-20","2019-09-20","2019-08-05","2019-02-04","2019-02-28","2019-02-28","2019-12-04","2019-03-13","2019-06-26","2019-06-26","2019-06-26","2019-03-05","2019-12-16","2019-12-16","2019-12-16","2019-09-18","2019-12-04"],"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":[["","","IBUPROFEN"," IBUPROFEN ","90","Select","Select",""],["","","CLONIDINE"," CLONIDINE ","60","Select","Select",""],["","","FUROSEMIDE"," FUROSEMIDE ","30","Select","Select",""],["","23900001051","VICKS","OIN VAPORUB","50","Select","Select",""],["","","MAG"," MAG ","60","Select","Select",""],["","00031871920","ROBIT","CAP 10-200MG","20","Select","Select",""],["","","RA"," RA ","30","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","30","Select","Select",""],["","","AMLODIPINE"," AMLODIPINE ","30","Select","Select",""],["","","VITAMIN"," VITAMIN ","4","Select","Select",""],["","","ENTRESTO","TAB 24-26MG","","Select","Select",""],["","","FARXIGA","TAB 10MG","","Select","Select",""],["","72647033104","METHYLPRED","TAB 4MG","21","Select","Select",""],["","68382005101","MELOXICAM","TAB 15MG","30","Select","Select",""],["","","METFORMIN"," METFORMIN ","60","Select","Select",""],["","11523715802","CORICIDIN","CAP CONG\/CGH","20","Select","Select",""],["","00904671146","FEXOFENADINE","TAB 180MG","30","Select","Select",""],["","60432026415","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","","CARVEDILOL"," CARVEDILOL ","60","Select","Select",""],["","11822068181","ALLERGY","TAB 180MG","30","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","11822350640","VAP","LIQ 0.062","118","Select","Select",""],["","51660093901","CETIRIZINE","TAB 10MG","30","Select","Select",""],["","","POLYETH"," POLYETH ","527","Select","Select",""],["","","CYCLOBENZAPR"," CYCLOBENZAPR ","30","Select","Select",""],["","49483048112","ASPIRIN","TAB 81MG EC","90","Select","Select",""],["","58160088752","FLUARIX","INJ 2021-22","0","Select","Select",""],["","28785010105","VAPORIZER","MIS 1 GALLON","1","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","","PROAIR"," PROAIR ","8","Select","Select",""],["","","LISINOPRIL"," LISINOPRIL ","30","Select","Select",""],["","","HYDROCO\/APAP"," HYDROCO\/APAP ","18","Select","Select",""],["","","TAMIFLU"," TAMIFLU ","10","Select","Select",""],["","","KETOROLAC"," KETOROLAC ","12","Select","Select",""],["","","GABAPENTIN"," GABAPENTIN ","180","Select","Select",""],["","","AFLURIA"," AFLURIA ","0","Select","Select",""],["","","OSELTAMIVIR"," OSELTAMIVIR ","10","Select","Select",""],["","","SMZ\/TMP"," SMZ\/TMP ","28","Select","Select",""],["","","SM"," SM ","510","Select","Select",""],["","","AMOXICILLIN"," AMOXICILLIN ","20","Select","Select",""],["","","INDOMETHACIN"," INDOMETHACIN ","30","Select","Select",""],["","","HC"," HC ","60","Select","Select",""],["","","8"," 8","30","Select","Select",""],["","","APAP\/CODEINE","TAB 300-30MG","","Select","Select",""],["","","SPIRONOLACT","TAB 25MG","","Select","Select",""],["","","ALBUTEROL","AER HFA","","Select","Select",""],["","","PNEUMOVAX","INJ 25\/0.5","","Select","Select",""],["","","PREMARIN","CRE 0.625MG","","Select","Select",""],["","","FLUCLVX","INJ 2020-21","","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":""}]}]}