{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"LEOTIS   S WATKINS","gend":0,"add":"4666 GREENWOOD DR","city":"PORTSMOUTH","state":"VA","zip":"23701-9998","dob":"1980-07-27","age":"","mstatus":"","insh":"20060765*01","cliId":"","pno":"757\/392-5535","cno":"757\/392-5535","email":"","ename":"","eno":"","pphy":"BHOWMIK, NIHAR MD","ppno":"757\/399-0701","pcpadd":"301 GOODE WAY #103","pcpcity":"PORTSMOUTH","pcpstate":"VA","pcpzip":23704,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"OHCC","region":"TIDEWATER","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"757\/399-3731","pcpnpi":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["G47.33","J96.01","J44.9","J96.11","Z93.0","I50.9","J45.909","J96.12","Z68.44","Z01.810","I48.0","I50.32","I10.","E66.01","Z68.45","NO DATA","J47.9","Z98.890","Z87.891","M25.531","G47.30","I48.91","Z79.01","Z79.51","Z79.899","S69.91XA","E66.9","S63.501A","M79.641","R09.81","I49.9","I82.5Y3","Z99.89","S93.402A","M25.572","S93.402S","E66.2","J95.09","U07.1","H00.014","Z68.43","H57.12","J95.00","R06.02","S63.8X1A","V58.89"],"date":["2022-10-20","2022-10-20","2022-10-20","2020-07-01","2020-07-01","2020-07-01","2020-07-01","2021-09-08","2020-07-01","2020-12-30","2021-06-21","2021-06-21","2021-12-13","2021-12-16","2022-02-09","2021-12-12","2021-09-08","2021-09-08","2021-12-13","2022-02-21","2021-12-13","2021-12-16","2021-12-16","2021-12-12","2021-12-12","2021-12-13","2021-12-13","2021-12-16","2022-02-21","2020-03-19","2020-09-03","2020-12-03","2020-12-03","2022-08-13","2022-08-13","2022-08-13","2020-03-09","2020-06-01","2020-10-05","2020-11-10","2020-11-10","2020-11-10","2021-01-04","2021-11-16","2021-12-29","2022-02-09"],"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":[["","00904759080","FEROSUL","TAB 325MG","60","Select","Select",""],["","65162027250","SMZ\/TMP","TAB 800-160","20","Select","Select",""],["","62037059905","CARTIA","CAP 240\/24HR","30","Select","Select",""],["","00406012301","HYDROCO\/APAP","TAB 5-325MG","30","Select","Select",""],["","00597007541","SPIRIVA","CAP HANDIHLR","30","Select","Select",""],["","00003089421","ELIQUIS","TAB 5MG","60","Select","Select",""],["","29300022019","MONTELUKAST","TAB 10MG","30","Select","Select",""],["","68682099798","DILTIAZEM","CAP 240MG ER","30","Select","Select",""],["","69238149001","BUMETANIDE","TAB 1MG","30","Select","Select",""],["","68645056259","IBUPROFEN","TAB 600MG","20","Select","Select",""],["","00591352530","LIDOCAINE","PAD 0.05","30","Select","Select",""],["","00781261305","AMOXICILLIN","CAP 500MG","21","Select","Select",""],["","69452014430","BENZONATATE","CAP 200MG","30","Select","Select",""],["","00054001925","PREDNISONE","TAB 50MG","5","Select","Select",""],["","00406048410","APAP\/CODEINE","TAB 300-30MG","30","Select","Select",""],["","00116200116","CHLORHEX","SOL 0.0012","473","Select","Select",""],["","00173086910","ANORO","AER 62.5-25","60","Select","Select",""],["","00173060202","FLOVENT","AER 100MCG","60","Select","Select",""],["","49035030882","PAIN","TAB 500MG","30","Select","Select",""],["","70010075401","METHOCARBAM","TAB 500MG","20","Select","Select",""],["","49035048462","ACETAMINOPHN","TAB 500MG","30","Select","Select",""],["","68645056854","ATORVASTATIN","TAB 40MG","30","Select","Select",""],["","68645051654","AMLODIPINE","TAB 10MG","30","Select","Select",""],["","81131074933","IRON","TAB 325MG","60","Select","Select",""],["","45802008801","ALBUTEROL","AER HFA","8","Select","Select",""],["","59310057922","PROAIR","AER ","8","Select","Select",""],["","57237012701","WARFARIN","TAB 10MG","90","Select","Select",""],["","00310737020","BUDES\/FORMOT","AER 160-4.5","10","Select","Select",""],["","00186037020","SYMBICORT","AER 160-4.5","10","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","68180012202","CEPHALEXIN","CAP 500MG","30","Select","Select",""],["","42806031250","DOXYCYCL","TAB 100MG","14","Select","Select",""],["","00085113204","PROVENTIL","AER HFA","7","Select","Select",""],["","00173068220","VENTOLIN","AER ","18","Select","Select",""],["","00487020103","IPRATROPIUM\/","SOL ALBUTER","270","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":""}]}]}