{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"TINA   M HORNER","gend":1,"add":"110 E BAY AVE","city":"NORFOLK","state":"VA","zip":"23503-9998","dob":"1969-05-18","age":"","mstatus":"","insh":"20051791*01","cliId":"","pno":"757\/857-7541","cno":"757\/857-7541","email":"","ename":"","eno":"","pphy":"FEE, ERIC MD","ppno":"757\/587-0157","pcpadd":"7924 CHESAPEAKE BLVD","pcpcity":"NORFOLK","pcpstate":"VA","pcpzip":23518,"pcpcounty":"","pcpid":"","pcpname":"Bayview Medical Center","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/587-0074","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["T14.90XA","S62.616A","S22.39XA","S32.9XXA","S32.10XA","V20.5XXA","S32.432A","S22.43XA","S32.811A","S32.021A","N28.1","F17.210","F40.240","R40.2413","Z20.828","M54.9","S32.029A","V54.17","V89.2XXA","T07.XXXA","S22.49XA","S32.82XA","S32.810K","S32.402A","S32.599A","S00.01XA","S50.312A","S29.8XXA","I10.","F32.9","F41.1","G47.00","R10.2","M25.559","R26.9","NO DATA","R91.8","L04.9","H10.89","V87.7XXA","R52.","V54.19","V54.12","V03.10XD","Z79.01","S32.811K","D64.9","V58.89","F10.10","Z79.899","Z98.51","Z23.","R06.00"],"date":["2020-11-08","2020-11-08","2020-08-03","2020-08-03","2020-08-08","2020-08-01","2020-08-01","2020-08-01","2020-08-03","2020-09-30","2022-04-04","2020-09-28","2020-08-01","2020-08-01","2020-08-01","2020-08-01","2020-08-03","2020-09-28","2020-08-05","2020-08-04","2020-08-08","2020-12-17","2020-09-28","2020-08-01","2020-08-01","2020-08-01","2020-08-01","2020-08-05","2022-09-19","2022-09-19","2022-09-19","2022-04-04","2022-04-04","2022-04-04","2021-10-12","2022-04-04","2022-04-04","2022-04-04","2022-04-04","2020-12-17","2020-08-08","2020-10-08","2020-09-10","2020-09-10","2020-09-10","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2020-09-28","2022-09-19"],"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":[["","50228018005","GABAPENTIN","CAP 300MG","90","Select","Select",""],["","62332007990","VALSART\/HCTZ","TAB 80-12.5","30","Select","Select",""],["","13668000805","ZOLPIDEM","TAB 10MG","30","Select","Select",""],["","00093342601","LORAZEPAM","TAB 1MG","60","Select","Select",""],["","57237001760","DULOXETINE","CAP 20MG","90","Select","Select",""],["","00173071620","ADVAIR","AER 115\/21","12","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","68180096301","ALBUTEROL","AER HFA","8","Select","Select",""],["","70436001004","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","29300024601","BUSPIRONE","TAB 15MG","60","Select","Select",""],["","33342006310","VALSARTAN","TAB 80MG","30","Select","Select",""],["","62332025118","AZITHROMYCIN","TAB 250MG","1","Select","Select",""],["","61314062810","POLYMYXIN","SOL TRIMETHP","10","Select","Select",""],["","69543038810","KETOROLAC","TAB 10MG","15","Select","Select",""],["","13811071910","NITROFURANTN","CAP 100MG","14","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","65162004710","OXYCODONE","TAB 5MG","28","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","63824000850","MUCINEX","TAB 600MG ER","60","Select","Select",""],["","41167005840","ASPERCREME","PAD LIDO 4%","20","Select","Select",""],["","00548560100","ENOXAPARIN","INJ 30\/0.3ML","13","Select","Select",""],["","00904698640","MUCUS","TAB 600MG ER","60","Select","Select",""],["","49348014392","SM","POW ","510","Select","Select",""],["","59746017710","CYCLOBENZAPR","TAB 10MG","10","Select","Select",""],["","70677005901","SENNA\/DSS","TAB 8.6-50MG","30","Select","Select",""],["","00904052361","VITAMIN","TAB 500MG","60","Select","Select",""],["","00904549213","THERA-M","TAB ","30","Select","Select",""],["","50458058030","XARELTO","TAB 10MG","21","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":{"indx":[["","","",""],[""],[""],[""],[""],[""]],"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":""}]}]}