{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"ROBERT WOOD","gend":0,"add":"825 GOFF ST APT 333","city":"NORFOLK","state":"VA","zip":"23504-9998","dob":"1958-05-03","age":"","mstatus":"","insh":"20041498*01","cliId":"","pno":"757\/769-2058","cno":"","email":"","ename":"","eno":"","pphy":"BEVERLY, VERNIS MD","ppno":"757\/623-0095","pcpadd":"SUITE 1 1401 TIDEWATER DR","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23504,"pcpcounty":"","pcpid":"","pcpname":"Adult and Pediatric Medical Associates","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/623-1203","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z12.11","I50.9","J44.9","I10.","N28.9","I50.22","I50.23","R79.89","E78.5","F14.10","I11.0","R06.02","J44.1","R55.","Z95.810","Z45.02","I42.8","I77.810","I08.3","I25.5","J45.901","F17.200","Z71.6","G47.33","Z01.812","Z20.822","R94.31","I50.42","Z72.0","N18.31","I13.0","NO DATA","J90.","J43.9","F17.210","N18.9","N18.3","S40.012A","W01.0XXA","T14.90XA","I51.89","Z86.79","S93.491A","R07.9","K31.89","K22.8","K29.70","I34.0","I50.33","E86.9","N17.9","Z45.89","R60.1","I85.00","B18.2","Z95.0","R42.","B19.20","F10.10","Z79.51","Z79.899","Z88.8","K29.80","I42.9","F19.10","I50.20","R06.01","R10.9","Z87.19","Z87.448","R06.09","R60.0","I50.1","K74.60","F10.20","R11.11","I50.21","Z87.898","J06.9","I51.7","I35.8","N19.","R73.03","M10.9","M79.645","M79.89"],"date":["2020-05-19","2021-07-14","2022-08-11","2022-08-11","2020-05-19","2022-10-05","2021-07-13","2021-07-12","2021-07-12","2021-12-23","2021-07-12","2022-10-05","2021-07-13","2021-07-14","2022-09-30","2021-12-23","2022-10-05","2021-02-15","2020-07-28","2020-10-08","2020-11-23","2020-11-23","2021-02-15","2021-03-18","2021-05-04","2021-05-04","2021-12-20","2020-10-09","2020-10-09","2021-07-14","2022-09-30","2022-10-05","2021-07-12","2022-09-30","2022-09-30","2022-01-20","2020-07-28","2020-08-23","2020-08-23","2020-09-26","2020-07-28","2020-08-19","2020-09-26","2020-09-26","2021-05-06","2021-05-06","2021-05-06","2021-02-15","2021-02-15","2021-07-12","2021-07-14","2021-10-12","2020-01-20","2021-04-07","2021-04-07","2021-04-07","2021-05-20","2021-12-23","2021-12-23","2021-12-23","2021-12-23","2022-09-30","2021-05-06","2021-07-14","2021-07-14","2022-09-30","2022-10-05","2019-07-30","2019-07-30","2019-07-30","2019-10-21","2019-04-29","2019-04-29","2019-03-20","2019-12-04","2019-01-22","2019-10-21","2019-04-02","2019-01-22","2022-10-05","2022-10-05","2022-05-05","2022-05-05","2022-09-30","2022-09-30","2022-09-30"],"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":[["","00093729605","CARVEDILOL","TAB 25MG","60","Select","Select",""],["","63304082905","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","00591354105","BUPROPION","TAB 150MG SR","30","Select","Select",""],["","00185012901","BUMETANIDE","TAB 1MG","60","Select","Select",""],["","53489014310","SPIRONOLACT","TAB 25MG","30","Select","Select",""],["","31722070290","LOSARTAN","TAB 100MG","30","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","00310621030","FARXIGA","TAB 10MG","30","Select","Select",""],["","","PREDNISONE","TAB 10MG","","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","60432060416","PROMETHAZINE","SYP DM","180","Select","Select",""],["","00597015561","STIOLTO","AER 2.5-2.5","4","Select","Select",""],["","00713055593","DOXYCYC","CAP 100MG","6","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00173071820","FLOVENT","AER 44MCG","11","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","70677003101","SM","DIS 14MG\/24H","30","Select","Select",""],["","00487020160","IPRATROPIUM\/","SOL ALBUTER","360","Select","Select",""],["","42858010250","OXYCOD\/APAP","TAB 5-325MG","10","Select","Select",""],["","","BENZONATATE","CAP 100MG","","Select","Select",""],["","","AMOX\/K","TAB 875-125","","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","","LIDOCAINE","PAD 0.05","","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":""}]}]}