{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"JACKELINE ORTIZ","gend":1,"add":"2511 E PRINCESS ANNE ROAD","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1971-01-15","age":"","mstatus":"","insh":"20041368*01","cliId":"","pno":"757\/237-2823","cno":"","email":"","ename":"","eno":"","pphy":"FRIAS, ANGELINA MD","ppno":"757\/583-2181","pcpadd":"2203 E LITTLE CREEK RD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":"","pcpname":"Roosevelt Family Practice","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/480-6482","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["L73.2","B37.3","R30.0","N76.0","E11.39","E11.3293","H25.13","H04.123","E11.65","E66.01","E55.9","K31.84","Z20.828","F32.9","Z68.41","J45.901","NO DATA","J45.50","J44.9","E11.9","E11.00","K21.9","S52.572A","G56.02","E11.8","Z79.4","E11.40","R52.","G56.01","M47.812","M47.816","M15.3","E78.5","J30.2","R09.82","F41.1","F41.9","F41.0","Z01.411","R32.","S52.592A","M79.675","Z20.822","K75.81","R13.19","Z80.0","K22.70","R14.3","K63.5","G47.30","Z12.11","D12.4","K57.30","K29.50","K64.8","R14.0","K59.09","K58.2","R10.9","R20.0","J30.0","J30.9","Z68.42","E11.3299","E66.9","J41.1","S92.511A","M79.671","S92.504A","R49.0","L03.90","E11.319","E11.49","H10.13","E11.3291","J38.3","V54.16","N93.0","R35.0","Z11.3","K62.5","M79.7","M25.50","J45.909","N95.2","R53.83","J38.7","M79.89","I10.","R94.5","K60.2","K64.4","R10.2","R22.0","R55.","R42.","R10.84","R82.71","R11.0","Z90.710","Z90.49","Z83.3","R60.0","I89.0","J45.991","M25.569","E78.00","R10.30","B37.2","R10.13","R19.5","K76.0","L29.3","R22.43","J03.90","H66.90","R05.1"],"date":["2020-01-10","2022-06-06","2022-06-06","2021-05-10","2020-09-09","2020-09-09","2020-09-09","2020-09-09","2022-10-05","2022-11-01","2022-11-01","2022-03-30","2021-12-13","2022-08-04","2022-11-01","2022-11-08","2022-11-01","2020-08-26","2020-08-26","2022-06-02","2020-08-26","2022-08-04","2021-09-23","2020-12-15","2022-01-24","2022-10-05","2022-10-10","2021-09-23","2021-09-23","2020-01-21","2020-01-21","2020-01-21","2021-11-11","2020-08-26","2020-08-26","2020-03-13","2022-08-04","2020-04-09","2022-07-21","2020-07-08","2020-07-20","2021-06-21","2022-10-24","2021-11-11","2022-05-13","2021-09-21","2022-05-13","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2021-11-11","2020-12-15","2020-05-28","2020-05-28","2020-07-09","2020-09-25","2020-09-25","2020-04-09","2019-01-11","2019-02-15","2019-01-17","2019-09-05","2019-10-03","2019-10-28","2019-02-28","2019-04-24","2019-04-24","2019-08-09","2019-02-15","2019-05-01","2019-04-05","2019-09-12","2019-05-28","2022-08-04","2019-10-31","2022-05-13","2019-05-01","2019-05-30","2019-09-05","2019-10-17","2022-08-04","2019-10-17","2019-01-10","2019-01-10","2019-09-12","2019-01-31","2019-07-16","2019-07-16","2022-06-02","2022-06-02","2022-06-02","2022-06-02","2022-06-02","2022-06-02","2022-10-10","2022-10-10","2022-10-10","2022-10-10","2022-08-04","2022-06-06","2022-06-06","2022-05-13","2022-05-13","2022-05-13","2022-07-21","2022-10-10","2022-10-24","2022-10-24","2022-10-24"],"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":[["","","VITAMIN"," VITAMIN ","10","Select","Select",""],["","","ALBUTEROL"," ALBUTEROL ","18","Select","Select",""],["","","PANTOPRAZOLE"," PANTOPRAZOLE ","60","Select","Select",""],["","","LANTUS"," LANTUS ","18","Select","Select",""],["","16714068403","SIMVASTATIN","TAB 40MG","30","Select","Select",""],["","","BD  PEN NEEDL"," BD  PEN NEEDL","400","Select","Select",""],["","","PHENTERMINE"," PHENTERMINE ","30","Select","Select",""],["","","BUPROPION"," BUPROPION ","30","Select","Select",""],["","","JANUMET"," JANUMET ","60","Select","Select",""],["","","ATORVASTATIN"," ATORVASTATIN ","30","Select","Select",""],["","59267100002","PFIZER","INJ COVID-19","0","Select","Select",""],["","57599080000","FREESTY","KIT 2 SENSOR","2","Select","Select",""],["","","NOVOLOG"," NOVOLOG ","24","Select","Select",""],["","","CLOTRIM\/BETA","CRE DIPROP","","Select","Select",""],["","","INSULIN","INJ FLEXPEN","","Select","Select",""],["","16714020030","ONDANSETRON","TAB 4MG ODT","12","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","15","Select","Select",""],["","43547040211","FUROSEMIDE","TAB 40MG","30","Select","Select",""],["","11877001140","BINAXNOW","KIT HOME TES","8","Select","Select",""],["","","TERCONAZOLE","CRE 0.004","","Select","Select",""],["","42806071401","BENZONATATE","CAP 100MG","90","Select","Select",""],["","59310082206","AIRDUO","INH 232-14","3","Select","Select",""],["","65862050320","AMOX\/K","TAB 875-125","28","Select","Select",""],["","78206012601","DULERA","AER 200-5MCG","13","Select","Select",""],["","","FLUCONAZOLE","TAB 150MG","","Select","Select",""],["","00093360982","FLUTIC\/SALME","INH 232\/14","3","Select","Select",""],["","00121077504","GG\/CODEINE","SOL 100-10\/5","118","Select","Select",""],["","","MONTELUKAST"," MONTELUKAST ","30","Select","Select",""],["","50111078810","AZITHROMYCIN","TAB 500MG","10","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","31722063231","OSELTAMIVIR","CAP 75MG","10","Select","Select",""],["","","ADVAIR"," ADVAIR ","12","Select","Select",""],["","08317236131","PEN  NEEDLES","MIS 31GX6MM","500","Select","Select",""],["","11523716003","CLARITIN","TAB 10MG","90","Select","Select",""],["","68462012605","GABAPENTIN","TAB 600MG","120","Select","Select",""],["","60842002301","AUVI-Q","INJ 0.3MG","2","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","90","Select","Select",""],["","","FAMOTIDINE","TAB 40MG","","Select","Select",""],["","53885065701","ONETOUCH","KIT VERIO","1","Select","Select",""],["","00054004641","IPRATROPIUM","SPR 0.0006","90","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","68382004101","PROMETHAZINE","TAB 25MG","2","Select","Select",""],["","52268020101","SUTAB","TAB ","24","Select","Select",""],["","49035032712","GENTLE","TAB 5MG EC","3","Select","Select",""],["","49035031207","EQ","POW ","510","Select","Select",""],["","45802086802","POLYETH","POW 3350 NF","476","Select","Select",""],["","","DYMISTA","SPR 137-50","","Select","Select",""],["","59651014530","RANITIDINE","CAP 300MG","30","Select","Select",""],["","65862037501","ESCITALOPRAM","TAB 20MG","30","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00597010061","SPIRIVA","SPR 2.5MCG","12","Select","Select",""],["","","LORAZEPAM","TAB 0.5MG","","Select","Select",""],["","","PROVENTIL","AER HFA","","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","10","Select","Select",""],["","","AZEL\/FLUTIC","SPR 137-50","","Select","Select",""],["","","TRIAMCINOLON","CRE 0.001","","Select","Select",""],["","","OXYCOD\/APAP","TAB 5-325MG","","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","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":{"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":""}]}]}