{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DEBORAH BAINES","gend":1,"add":"948 SOUTH QUAIL ST APT 2","city":"NORFOLK","state":"VA","zip":"23513-9998","dob":"1959-05-13","age":"","mstatus":"","insh":"20050128*01","cliId":"","pno":"757\/575-2684","cno":"","email":"","ename":"","eno":"","pphy":"TORRY, CHE DO","ppno":"757\/310-6413","pcpadd":"739 THIMBLE SHOALS BLVD SUITE 1008","pcpcity":"NEWPORT NEWS","pcpstate":"VA","pcpzip":23606,"pcpcounty":"","pcpid":"","pcpname":"INVICTUS HEALTH LLC","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/310-6404","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["J44.9","Z99.81","J45.909","G89.4","M50.10","M79.7","M25.312","G43.909","M51.26","M54.16","M54.9","G89.29","J06.9","F41.9","F32.9","N28.89","R09.02","R91.8","D17.22","L57.0","L82.1","Z71.9","J44.1","M54.6","M51.16","E88.2","Z79.891","Z87.891","Z68.24","N28.9","F33.1","F41.1","M50.30","M99.81","R06.02","R07.9","F17.210","J20.9","S20.212A","Z72.0","J44.0","J18.9","J96.11","I10.","G47.30","R91.1","M19.91","Z79.52","Z79.51","M47.812","J96.20","J96.22","J96.21","J18.1","Z86.010","K21.9","E66.9","M19.90","M54.5","F17.200","M54.12","Z68.25","Z80.8","R06.03","J90."],"date":["2021-12-22","2021-12-22","2021-12-22","2021-11-23","2021-11-23","2021-01-04","2021-02-03","2021-11-23","2021-04-02","2021-11-23","2021-09-27","2021-09-27","2020-04-07","2020-04-07","2020-04-07","2021-01-18","2021-01-18","2021-01-18","2020-01-28","2020-01-28","2020-01-28","2020-01-28","2020-09-17","2021-10-27","2021-10-19","2021-10-19","2021-08-30","2020-09-17","2020-09-17","2021-02-03","2021-08-19","2021-08-19","2019-03-07","2019-03-07","2019-09-14","2019-09-14","2019-10-05","2019-02-02","2019-10-05","2019-12-05","2019-07-04","2019-07-04","2019-07-04","2019-07-04","2019-07-04","2019-07-04","2019-07-04","2019-07-04","2019-07-04","2019-04-10","2019-05-27","2019-05-28","2019-05-27","2019-05-27","2019-05-27","2019-05-27","2019-05-27","2019-05-27","2019-05-27","2019-06-05","2019-03-21","2019-03-08","2019-02-26","2019-05-27","2019-05-27"],"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":[["","51991007301","BUT\/APAP\/CAF","CAP CODEINE","60","Select","Select",""],["","55111029398","SUMATRIPTAN","TAB 100MG","9","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","00591565810","CYCLOBENZAPR","TAB 10MG","90","Select","Select",""],["","69097012303","TOPIRAMATE","TAB 50MG","60","Select","Select",""],["","42858010401","OXYCOD\/APAP","TAB 10-325MG","180","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","69097081507","GABAPENTIN","CAP 400MG","180","Select","Select",""],["","","BUDES\/FORMOT","AER 160-4.5","","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","68382050010","OMEPRAZOLE","CAP 40MG","30","Select","Select",""],["","65862001205","SERTRALINE","TAB 50MG","30","Select","Select",""],["","49884022203","DOXEPIN","CAP 150MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","","PROVENTIL","AER HFA","","Select","Select",""],["","00456120130","LINZESS","CAP 145MCG","30","Select","Select",""],["","08290305269","3ML","MIS 25GX5\/8\"","1","Select","Select",""],["","65862085901","FAMOTIDINE","TAB 20MG","60","Select","Select",""],["","24658031205","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","","ADVAIR","AER 230\/21","","Select","Select",""],["","70069000510","CYANOCOBALAM","INJ 1000MCG","4","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","67877057305","BENZONATATE","CAP 100MG","30","Select","Select",""],["","","AZITHROMYCIN","TAB 250MG","","Select","Select",""],["","","METHYLPRED","TAB 4MG","","Select","Select",""],["","70377002811","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00378064110","PREDNISONE","TAB 10MG","30","Select","Select",""],["","","MIRTAZAPINE","TAB 30MG ODT","","Select","Select",""],["","00115168974","BUDESONIDE","SUS 0.5MG\/2","60","Select","Select",""],["","00093742698","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","31722091701","OXYCODONE","TAB 15MG","120","Select","Select",""],["","43598044556","NICOTINE","KIT TRANSDER","56","Select","Select",""],["","16729013716","CLONAZEPAM","TAB 1MG","9","Select","Select",""],["","00186198904","PULMICORT","SUS 0.5MG\/2","60","Select","Select",""],["","51672401801","ETODOLAC","TAB 400MG","20","Select","Select",""],["","60432060816","PROMETHAZINE","SYP 6.25\/5ML","210","Select","Select",""],["","00173060102","FLOVENT","AER 250MCG","60","Select","Select",""],["","65862053820","LEVOFLOXACIN","TAB 750MG","4","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":""}]}]}