{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"VELMA   L MCDONALD","gend":1,"add":"2312 VICTORY BLVD APT B","city":"PORTSMOUTH","state":"VA","zip":"23702-9998","dob":"1966-12-08","age":"","mstatus":"","insh":"20042698*01","cliId":"","pno":"757\/352-1123","cno":"757\/352-1123","email":"","ename":"","eno":"","pphy":"KAPOOR, SONIA MD","ppno":"757\/548-0076","pcpadd":"SUITE 100 725 VOLVO PKWY","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"Family Physicians of Chesapeake","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/548-4652","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["K91.2","Z68.29","R00.0","E86.0","E66.9","Z09.","R42.","R82.4","Z98.84","Z88.0","Z88.2","Z88.8","R09.81","F31.9","F32.3","H93.293","E87.6","R10.13","R11.0","R19.4","K62.5","R74.8","J37.0","E04.1","J30.0","F31.32","N76.0","J30.2","H93.8X3","H93.13","R51.","Z68.24","G47.419","M54.16","K64.9","N90.89","N39.0","A49.1","E16.2","A60.00","E55.9","K76.0","R63.4","R00.2","I10.","E78.5","M54.5","M53.3","F41.1","Z20.822","I49.8","J30.9","K59.00","F31.81","F43.10","B37.3","N95.2","R39.89","R59.9","I49.3","I45.10","Z88.1","Z86.39","R35.0","R53.1","J06.9","E04.2","I08.1","R07.9","G43.809","K58.9","R79.89","F41.9","Z74.1","M54.9","R29.6","R25.1","Z20.2","R30.0","M79.659","N20.0","I47.1","E23.2","Z90.3","F31.77","R06.02","Z98.0","R10.9","R19.7","E86.9","J02.9","K21.9","F31.63","F51.01","R53.83","E04.9","J32.9","R22.32","R22.9","H81.10","Z68.27","R68.89","R23.2","E66.3","Z01.419","Z79.890","E65.","Z12.11","R10.2","N89.8","L25.9","K92.1","E11.9","H16.223","L30.4","N94.10","R10.31","J01.90","NO DATA","N36.2","H52.223","H52.03","H35.033","Z87.442","S80.12XA","M79.89","Z68.26","S05.01XA","J01.10"],"date":["2021-09-24","2020-01-07","2022-04-14","2021-05-21","2020-01-08","2020-01-08","2021-06-24","2020-01-28","2022-03-21","2022-03-21","2022-03-21","2022-03-21","2021-11-08","2021-08-04","2021-01-04","2020-07-01","2020-07-22","2020-09-08","2020-09-08","2020-09-08","2020-09-08","2021-07-13","2022-02-24","2022-02-24","2022-02-24","2022-06-02","2022-07-25","2022-08-29","2020-08-25","2020-08-25","2020-08-25","2022-04-14","2020-11-02","2021-08-23","2020-11-30","2022-07-19","2022-02-24","2021-02-25","2022-05-25","2020-11-17","2021-07-13","2020-09-24","2020-09-24","2022-04-14","2022-01-28","2022-01-28","2021-07-16","2021-08-03","2022-07-13","2022-08-18","2020-01-09","2021-08-27","2020-01-29","2021-06-10","2021-06-10","2022-01-04","2022-01-04","2022-02-24","2022-01-04","2022-01-23","2022-01-23","2022-03-21","2021-09-24","2022-01-08","2022-01-08","2022-01-08","2022-03-21","2022-05-25","2021-08-25","2020-04-30","2020-05-07","2020-06-05","2022-01-21","2021-04-01","2021-04-01","2021-04-01","2021-04-01","2021-11-09","2022-01-10","2022-01-10","2022-02-24","2022-04-14","2022-04-14","2022-04-14","2022-04-14","2022-04-14","2022-04-14","2021-11-08","2021-11-08","2021-11-08","2022-01-21","2022-01-21","2022-07-13","2022-07-13","2022-05-25","2022-05-25","2022-05-25","2022-05-25","2022-05-25","2020-04-16","2020-04-21","2020-06-05","2020-06-05","2020-06-05","2021-06-28","2020-06-15","2020-08-25","2021-06-28","2022-08-09","2020-10-13","2020-10-13","2020-01-21","2020-08-24","2020-08-24","2020-08-25","2021-03-15","2021-03-15","2021-08-27","2021-08-27","2022-02-24","2022-04-04","2022-04-04","2022-04-04","2022-08-09","2022-10-26","2022-10-26","2022-10-26","2022-08-18","2022-09-02"],"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":[]},{"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":[["","00143988750","AMOXICILLIN","SUS 400\/5ML","250","Select","Select",""],["","57237000630","FLUCONAZOLE","TAB 200MG","1","Select","Select",""],["","00046087221","PREMARIN","CRE 0.625MG","30","Select","Select",""],["","59762500901","CLINDAMYCIN","CRE 2% VAG","40","Select","Select",""],["","00378001805","METOPROL","TAB 25MG","60","Select","Select",""],["","00781185220","AMOX\/K","TAB 875-125","14","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","00172572960","FAMOTIDINE","TAB 40MG","60","Select","Select",""],["","51862094205","DIAZEPAM","TAB 5MG","30","Select","Select",""],["","00054004544","IPRATROPIUM","SPR 0.0003","30","Select","Select",""],["","00406051205","OXYCOD\/APAP","TAB 5-325MG","9","Select","Select",""],["","00642746605","NUVESSA","GEL 0.013","5","Select","Select",""],["","51293061201","PHENAZOPYRID","TAB 200MG","15","Select","Select",""],["","51991033301","CARBINOXAMIN","TAB 4MG","60","Select","Select",""],["","61874011520","VRAYLAR","CAP 1.5MG","30","Select","Select",""],["","23155050201","HYDROXYZ","TAB 50MG","30","Select","Select",""],["","50111033402","METRONIDAZOL","TAB 500MG","14","Select","Select",""],["","61314063006","NEO\/POLY\/DEX","SUS 0.1% OP","5","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","31722072690","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","59762312001","AZITHROMYCIN","SUS 200\/5ML","75","Select","Select",""],["","16571020210","DICLOFENAC","TAB 50MG DR","60","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","64011060128","INTRAROSA","SUP 6.5MG","28","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","59267100001","PFIZER","INJ COVID-19","0","Select","Select",""],["","65162006205","SUCRALFATE","SUS 1GM\/10ML","3600","Select","Select",""],["","00378462126","ESTRADIOL","DIS 0.05MG","24","Select","Select",""],["","00378345823","AZEL\/FLUTIC","SPR 137-50","23","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","67877043103","ARIPIPRAZOLE","TAB 5MG","30","Select","Select",""],["","68382009810","PAROXETINE","TAB 20MG","30","Select","Select",""],["","00603533932","PREDNISONE","TAB 20MG","21","Select","Select",""],["","00363011222","WAL-PHED","TAB 30MG","24","Select","Select",""],["","65162010150","GABAPENTIN","CAP 100MG","60","Select","Select",""],["","11917012814","NASAL","AER 0.009","126","Select","Select",""],["","45802065087","LORATADINE","TAB 10MG","90","Select","Select",""],["","00115166101","PROPRANOLOL","TAB 40MG","60","Select","Select",""],["","60505083305","AZELASTINE","SPR 0.001","30","Select","Select",""],["","00363040321","WAL-DRAM","TAB 25MG","30","Select","Select",""],["","59746012106","MECLIZINE","TAB 25MG","30","Select","Select",""],["","00591079510","DICYCLOMINE","TAB 20MG","30","Select","Select",""],["","65862052890","VENLAFAXINE","CAP 75MG ER","30","Select","Select",""],["","00574200802","NYSTOP","POW 100000","120","Select","Select",""],["","68382013805","TOPIRAMATE","TAB 25MG","120","Select","Select",""],["","67877024901","QUETIAPINE","TAB 50MG","30","Select","Select",""],["","53489012002","DOXYCYCL","TAB 100MG","20","Select","Select",""],["","43386009019","GAVILYTE-G","SOL ","4000","Select","Select",""],["","24385090363","GNP","TAB 5MG EC","2","Select","Select",""],["","00093220401","METOCLOPRAM","TAB 5MG","2","Select","Select",""],["","00904674860","BISACODYL","TAB 5MG EC","2","Select","Select",""],["","68462079917","NYSTAT\/TRIAM","OIN ","15","Select","Select",""],["","00316022130","NYSTATIN","CRE 100000","30","Select","Select",""],["","27437005101","SOLOSEC","GRA 2GM","1","Select","Select",""],["","45802006435","TRIAMCINOLON","CRE 0.001","15","Select","Select",""],["","00378427677","VALACYCLOVIR","TAB 1GM","40","Select","Select",""],["","00496079904","ANALPRAM-HC","CRE 1-2.5%","30","Select","Select",""],["","54766079904","ANALPRAM","CRE 2.5-1%","30","Select","Select",""],["","00168034646","TERCONAZOLE","CRE 0.004","45","Select","Select",""],["","75834019701","HC","CRE 2.5-1%","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":[]}},{"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":""}]}]}