{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"THOMAS GALLARDO","gend":0,"add":"1941 RAVENCROFT LN","city":"VIRGINIA BEACH","state":"VA","zip":"23454-9998","dob":"1982-03-18","age":"","mstatus":"","insh":"20059691*01","cliId":"","pno":"","cno":"","email":"","ename":"","eno":"","pphy":"PATEL, SONAL MD","ppno":"757\/738-1350","pcpadd":"908 EDEN WAY N STE 101","pcpcity":"CHESAPEAKE","pcpstate":"VA","pcpzip":23320,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/413-5450","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F10.20","F10.929","F39.","E87.2","Z63.0","V62.84","F12.20","F32.9","F10.24","L03.115","R78.81","B95.61","M86.9","T14.8XXA","L08.9","F31.4","F41.1","F10.21","F17.200","F11.21","F14.21","N52.9","N48.89","V54.16","V09.9XXD","Z01.810","I34.0","M86.171","R42.","Z98.890","M86.071","U07.1","E83.42","E87.1","E87.6","T84.84XA","M79.89","F33.1","R05.","Z20.828","M79.604","M86.10","Z87.81","M79.671","N52.39","Z87.438","I10.","G47.00","K21.9","Z72.0","L76.32","F17.210","Z88.5","N52.02","R39.9","F31.81","F60.3","M54.5","M54.9","R53.83","S92.001A","S92.254A","V09.9XXA","T81.41XA","S92.011D","S92.251D","S72.401D","V03.90XD","Y92.9","Y93.9","F31.9","Z88.8","F41.9","Z79.899","R60.0","S72.351A","S50.311A","S50.312A","S70.211A","S80.212A","S39.91XA","S29.9XXA","Z45.2","F10.239","S72.301A","S92.011A","T81.49XA","T81.31XA","L02.611","T84.69XA","F10.10","F10.920"],"date":["2021-10-13","2020-10-14","2021-08-03","2020-10-14","2020-10-14","2020-10-14","2021-09-30","2021-07-27","2021-03-29","2021-08-04","2021-09-14","2021-09-14","2021-11-10","2021-11-10","2021-11-10","2022-08-04","2022-08-04","2022-08-04","2022-08-04","2022-06-07","2022-06-07","2022-03-31","2022-03-31","2021-07-30","2021-07-30","2021-07-31","2021-07-31","2021-09-14","2021-07-27","2021-08-04","2021-08-01","2021-08-02","2021-08-01","2021-08-01","2021-08-01","2021-11-12","2021-11-16","2021-01-17","2020-12-15","2020-12-15","2021-11-16","2021-08-04","2021-08-04","2022-02-28","2022-04-13","2022-07-21","2021-11-16","2021-03-05","2021-03-11","2021-03-05","2021-11-16","2021-11-16","2021-11-16","2022-07-21","2022-07-21","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-03-11","2021-06-15","2021-06-15","2021-06-14","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-06-28","2021-11-12","2021-11-12","2021-11-12","2021-11-12","2021-11-16","2021-06-14","2021-06-13","2021-06-13","2021-06-13","2021-06-13","2021-06-13","2021-06-13","2021-08-04","2021-03-04","2021-06-14","2021-06-14","2021-07-28","2021-07-28","2021-07-28","2021-07-28","2020-01-04","2020-01-04"],"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":[["","50111064801","FLUOXETINE","CAP 20MG","30","Select","Select",""],["","00093506201","HYDROXYZ","TAB 50MG","120","Select","Select",""],["","29300011101","LAMOTRIGINE","TAB 25MG","42","Select","Select",""],["","67877024601","QUETIAPINE","TAB 200MG","30","Select","Select",""],["","68180072003","AMLODIPINE","TAB 5MG","30","Select","Select",""],["","42806040021","METHYLPRED","TAB 4MG","21","Select","Select",""],["","64380080707","IBUPROFEN","TAB 800MG","90","Select","Select",""],["","00115165901","PROPRANOLOL","TAB 10MG","90","Select","Select",""],["","11877001140","BINAXNOW","KIT HOME TES","8","Select","Select",""],["","27241000350","RISPERIDONE","TAB 0.5MG","30","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","25","Select","Select",""],["","65757030001","VIVITROL","INJ 380MG","1","Select","Select",""],["","62175011843","OMEPRAZOLE","CAP 20MG","30","Select","Select",""],["","69452015120","VITAMIN","CAP 50000UNT","4","Select","Select",""],["","31722054201","INDOMETHACIN","CAP 25MG","30","Select","Select",""],["","00527133001","BACLOFEN","TAB 10MG","42","Select","Select",""],["","57896020401","ACETAMINOPHE","TAB 500MG","90","Select","Select",""],["","50458058030","XARELTO","TAB 10MG","21","Select","Select",""],["","65162010250","GABAPENTIN","CAP 300MG","240","Select","Select",""],["","71288041083","ENOXAPARIN","INJ 40\/0.4ML","8","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","28","Select","Select",""],["","31722094901","OXYCOD\/APAP","TAB 5-325MG","40","Select","Select",""],["","57896090110","ASPIRIN","TAB 325MG","42","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","28","Select","Select",""],["","68462019005","NAPROXEN","TAB 500MG","60","Select","Select",""],["","00363051908","PAIN","TAB 500MG\/RR","90","Select","Select",""],["","80777027398","MODERNA","INJ COVID-19","0","Select","Select",""],["","65162021210","PHENYTOIN","CAP 100MG","56","Select","Select",""],["","29300012510","MELOXICAM","TAB 15MG","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":""}]}]}