{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AHLAM   K YOUSUF","gend":1,"add":"109 BONITA DR","city":"NEWPORT NEWS","state":"VA","zip":"23602-9998","dob":"1949-07-01","age":"","mstatus":"","insh":"20038064*01","cliId":"","pno":"757\/884-8602","cno":"","email":"","ename":"","eno":"","pphy":"ABDELAAL, EBTEHAL A MD","ppno":"757\/223-4992","pcpadd":"SUITE 100 6 MANHATTAN SQUARE","pcpcity":"HAMPTON","pcpstate":"VA","pcpzip":23666,"pcpcounty":"","pcpid":"","pcpname":"TPMG PENINSULA MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["M54.2","Z23.","M62.838","Z71.89","M47.22","R42.","E78.2","I10.","Z13.220","Z12.11","R73.03","K75.81","Z79.899","K63.5","Z98.890","Z71.3","Z00.00","E55.9","K21.9","L72.0","R51.9","L72.9","L08.9","Z78.9","Z20.822","M54.42","M85.80","M25.552","E78.5","G47.00","F41.9","Z68.26","M54.12","K58.1","I49.3","R55.","R00.2","R52.","M47.812","R10.9","G89.29","Z86.010","D12.5","D12.4","D12.3","R69.","G44.209","F51.04","F41.8","L02.91","Z12.31","Z87.440","Z76.89","R53.83","H72.03","B36.9","H62.40","H92.12","L29.9","H90.2","J01.90","J02.9","R07.9","R50.9","K52.9","K92.2","R93.3","K52.89","R10.31","R10.32","K31.84","R11.0","K62.5","R15.2","R14.3","D72.89","K04.7","L02.93","Z12.4","Z11.59","Z28.21","H92.02","Z68.27","K76.0","K29.50","R10.13","R07.2","R06.09","R10.2"],"date":["2021-07-06","2020-10-27","2020-10-27","2020-10-27","2021-04-14","2021-10-26","2021-03-04","2021-05-10","2020-10-02","2020-02-21","2021-03-04","2020-02-21","2021-04-14","2020-07-28","2020-07-28","2020-07-28","2021-05-10","2021-03-04","2021-05-10","2021-05-14","2021-05-19","2021-04-23","2021-04-23","2021-07-12","2021-08-16","2020-12-02","2020-12-02","2020-12-02","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-05-10","2021-10-26","2021-05-26","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2020-06-04","2020-07-24","2020-07-24","2020-07-24","2020-07-24","2020-08-03","2021-04-14","2021-04-14","2021-04-14","2021-04-14","2020-10-02","2020-10-02","2019-09-12","2019-09-12","2019-08-07","2019-08-07","2019-08-07","2019-08-07","2019-08-07","2019-08-07","2019-12-26","2019-12-26","2019-11-07","2019-03-01","2019-05-29","2019-05-21","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-06-05","2019-02-06","2019-02-06","2019-07-22","2019-11-20","2019-11-20","2019-11-20","2019-01-02","2019-01-02","2019-05-21","2019-03-27","2019-03-27","2019-10-11","2019-10-15","2019-11-01"],"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":[["","62332013130","OLMESA","TAB 5MG","60","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","30","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","14","Select","Select",""],["","55111012205","ATORVASTATIN","TAB 20MG","90","Select","Select",""],["","29300013010","HYDROCHLOROT","CAP 12.5MG","30","Select","Select",""],["","00093005301","BUSPIRONE","TAB 5MG","30","Select","Select",""],["","69097084705","ESCITALOPRAM","TAB 5MG","30","Select","Select",""],["","69238110305","IBUPROFEN","TAB 800MG","20","Select","Select",""],["","65862001705","AMOXICILLIN","CAP 500MG","30","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","59651000205","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","62037083101","METOPROL","TAB 50MG ER","30","Select","Select",""],["","","PEG-3350\/KCL","SOL \/SODIUM","","Select","Select",""],["","","AMITIZA","CAP 8MCG","","Select","Select",""],["","","DOK","CAP 100MG","","Select","Select",""],["","","CEFDINIR","CAP 300MG","","Select","Select",""],["","","GAVILYTE-N","SOL FLAV PK","","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","","STOOL","CAP 100MG","","Select","Select",""],["","","DICLOFENAC","GEL 0.01","","Select","Select",""],["","45802088094","NYSTAT\/TRIAM","CRE ","30","Select","Select",""],["","13668025230","OLM","TAB 40-12.5","30","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","15","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","30","Select","Select",""],["","00186038230","ESOMEPRA","CAP 20MG DR","30","Select","Select",""],["","00065853302","CIPRODEX","SUS 0.3-0.1%","8","Select","Select",""],["","68462015713","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","43598043611","NITROGLYCERN","SUB 0.4MG","50","Select","Select",""],["","64380071206","BENZONATATE","CAP 100MG","30","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","21","Select","Select",""],["","55111012701","CIPROFLOXACN","TAB 500MG","14","Select","Select",""],["","65862042005","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","00093314705","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","65862018601","CLINDAMYCIN","CAP 300MG","40","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":""}]}]}