{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"RICHARD HARRIS","gend":0,"add":"1401 DEEP CREEK BLVD LOT 68","city":"CHESAPEAKE","state":"VA","zip":"23323-9998","dob":"1969-02-07","age":"","mstatus":"","insh":"20056956*01","cliId":"","pno":"757\/949-6919","cno":"757\/949-6919","email":"","ename":"","eno":"","pphy":"ANGLIN, VICTOR TEODORO MD","ppno":"757\/738-1225","pcpadd":"3537 AIRLINE BLVD STE 1","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23701,"pcpcounty":"","pcpid":"","pcpname":"AIRLINE BOULEVARD MEDICAL ASSOCIATES","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/448-1037","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F33.2","I21.4","V62.84","I25.10","E11.65","Z79.4","Z68.25","R07.9","F39.","NO DATA","F33.1","F12.10","F11.20","J69.0","J96.01","J96.02","S22.43XA","Z20.822","J44.9","F17.210","I10.","I45.10","E78.5","F31.30","F41.9","K21.9","Z88.0","Z88.2","R09.2","S22.42XA","T40.601A","Z68.28","V58.89","D72.829","V54.19","F32.9","M54.5","F31.9","F10.99","F11.90","F12.20","F17.200","K59.00","Z13.89","Z51.81","E11.9","Z11.59","Z23.","Z13.220","E04.1","Z68.26","F33.9","F14.20","I31.3","E65.","R07.2","R46.4","M54.89","G89.29","I25.118","I11.9","R79.89","Z12.11","Z12.5","R63.4","I20.0","I24.9","Z20.828","R45.1","F12.90","F13.10","F14.10","F41.1","R41.0","T46.904A","E87.6","R29.6","Z53.20","Z56.0","Z59.00","Z79.899","Z82.49","M54.12","M54.9","F31.4","F15.10","F10.20","J45.909","M54.2","Z91.14","R55.","R07.81","Z79.82","Z79.84","F31.10","S22.41XA","X58.XXXA","R00.0","F32.89","R07.89","R77.8"],"date":["2021-11-20","2021-10-24","2021-10-26","2021-10-24","2021-10-24","2021-10-24","2021-11-01","2021-10-27","2020-01-31","2021-11-12","2021-03-25","2020-01-31","2021-03-29","2021-03-17","2021-03-16","2021-03-16","2021-03-13","2021-03-13","2021-10-24","2021-10-24","2021-10-24","2021-03-13","2021-10-24","2021-03-13","2021-06-19","2021-10-24","2021-03-13","2021-03-13","2021-03-13","2021-03-16","2021-06-17","2021-03-17","2021-03-23","2021-03-15","2021-03-23","2021-07-02","2021-04-17","2021-10-25","2021-07-01","2021-07-01","2021-02-16","2021-03-25","2021-02-16","2021-03-25","2021-03-25","2021-10-24","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-03-23","2021-10-31","2021-02-16","2021-03-14","2021-03-14","2021-06-17","2021-06-17","2021-10-04","2021-11-12","2020-10-05","2020-10-05","2020-05-22","2020-10-06","2020-05-22","2020-05-22","2020-10-16","2020-10-06","2020-10-14","2020-12-08","2021-10-24","2021-03-25","2021-03-25","2021-03-25","2021-06-17","2021-06-17","2021-10-24","2021-10-24","2021-10-24","2021-10-24","2021-10-24","2021-10-24","2021-10-24","2020-05-21","2020-05-21","2020-12-19","2020-12-19","2020-12-19","2020-12-19","2020-12-19","2020-12-19","2021-03-13","2021-03-16","2021-10-04","2021-10-04","2021-10-10","2021-03-13","2021-03-13","2021-06-17","2021-06-19","2021-06-19","2021-10-24"],"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":[]},{"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":[["","00088222033","LANTUS","INJ 100\/ML","10","Select","Select",""],["","50228017705","GABAPENTIN","TAB 600MG","30","Select","Select",""],["","62175089143","ATORVASTATIN","TAB 20MG","30","Select","Select",""],["","00904679480","ASPIRIN","CHW 81MG","30","Select","Select",""],["","23155010210","METFORMIN","TAB 500MG","60","Select","Select",""],["","62175012841","ISOSORB","TAB 30MG ER","30","Select","Select",""],["","29300024205","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","08290320109","BD  PEN NEEDL","MIS 31GX8MM","100","Select","Select",""],["","08290324911","INSULIN","MIS 0.5\/31G","100","Select","Select",""],["","16729021816","CLOPIDOGREL","TAB 75MG","30","Select","Select",""],["","70512003350","HALOBETASOL","OIN 0.0005","100","Select","Select",""],["","49035029812","NAT","TAB 8.6MG","30","Select","Select",""],["","69547035302","NARCAN","SPR ","2","Select","Select",""],["","00002751001","HUMALOG","INJ 100\/ML","10","Select","Select",""],["","54629409760","NAC","CAP 600MG","112","Select","Select",""],["","00781711783","CALCIPOTRIEN","CRE 0.00005","240","Select","Select",""],["","00093005405","BUSPIRONE","TAB 10MG","60","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","30","Select","Select",""],["","60505317007","OMEGA-3-ACID","CAP 1GM","360","Select","Select",""],["","55111028130","LEVOFLOXACIN","TAB 750MG","5","Select","Select",""],["","29300013501","CLONIDINE","TAB 0.1MG","60","Select","Select",""],["","51079099120","TRAMADOL","TAB 50MG","28","Select","Select",""],["","11523726803","MIRALAX","POW 3350 NF","10","Select","Select",""],["","42858010201","OXYCOD\/APAP","TAB 5-325MG","12","Select","Select",""],["","31722071390","PANTOPRAZOLE","TAB 40MG","10","Select","Select",""],["","80681000300","THEREMS","TAB MULTIVIT","30","Select","Select",""],["","43598049401","NAPROXEN","TAB 275MG","10","Select","Select",""],["","13668021830","ARIPIPRAZOLE","TAB 10MG","30","Select","Select",""],["","42806034805","BUPROPN","TAB 150MG XL","30","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00093317431","ALBUTEROL","AER HFA","8","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","00781723864","BUPREN\/NALOX","MIS 8-2MG","8","Select","Select",""],["","69336012410","FENOPROFEN","CAP 200MG","100","Select","Select",""],["","68001018408","QUETIAPINE","TAB 100MG","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00603533932","PREDNISONE","TAB 20MG","5","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","46122044078","GNP","CAP 25MG","5","Select","Select",""],["","62332000191","FAMOTIDINE","TAB 20MG","5","Select","Select",""],["","68462063945","NITROGLYCERN","SUB 0.4MG","1","Select","Select",""],["","60505082901","FLUTICASONE","SPR 50MCG","16","Select","Select",""],["","70010075405","METHOCARBAM","TAB 500MG","16","Select","Select",""],["","70954008510","CHLORZOXAZON","TAB 500MG","42","Select","Select",""],["","62175013643","OMEPRAZOLE","CAP 40MG","14","Select","Select",""],["","00406012305","HYDROCO\/APAP","TAB 5-325MG","12","Select","Select",""],["","49035053112","EQ","TAB 500MG","42","Select","Select",""],["","81131007173","COMPLE","TAB ADLT 50+","14","Select","Select",""],["","43598075205","BUPROPION","TAB 150MG SR","28","Select","Select",""],["","49035030882","PAIN","TAB 500MG","42","Select","Select",""],["","43547026910","ROPINIROLE","TAB 0.5MG","28","Select","Select",""],["","68382080601","TRAZODONE","TAB 100MG","14","Select","Select",""],["","37864074301","MULTIVITAMIN","TAB DAILY","14","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":""}]}]}